Urolithiasis in dogs and cats. Urolithiasis

Under the term urolithiasis disease or urolithiasis, doctors mean the formation of urinary stones (or sand) in the kidneys, bladder or their retention in the lumen of the ureters and urethra. Urinary stones occur in all domestic animals, but are more common in cats and dogs. The chemical composition of such stones is very diverse, for example, they may include uric acid, urates, oxalates, carbonates, phosphates, cystine, xanthine, etc. Along with this, the number of stones formed in the urinary organs ranges from one to one hundred or more. Their size also varies widely (from a millet grain to the size of a large walnut).

Etiology

What causes the formation of such stones? Unfortunately, there cannot be a clear answer to this question. However, today it has been established that possible predisposing factors for the appearance of insoluble compounds in urine are: genetic predisposition, animal diet, lifestyle (immobility, obesity), infectious agents, systemic diseases. In addition, domestic cats, descended from desert ancestors, easily maintain fluid balance in the body. This reflects their ability to produce highly concentrated urine. This exceptional ability may be a major factor in their development of urolithiasis. It should be noted that in cats the diameter of the urethral lumen is more than three times smaller than in cats. This causes more frequent clinical manifestations of urolithiasis.

Uroliths can form in urine under the following conditions:

1. The chemical components of urolith are present in the urine in concentrations exceeding the possibility of their dissolution, which contributes to the loss of crystals that collect in microstones.

2. A certain pH of urine, often alkaline.

3. The formation of crystals must occur quickly enough so that they cannot be washed out by the separated urine from the urinary tract.

4. The presence of a nucleus (matrix) for the formation of crystals, which can be cell remains, foreign bodies, bacteria and, possibly, viruses.

5. Bacterial flora may predispose to some forms of urolithiasis, because. It is during the life processes of organisms that insoluble mineral compounds are actively synthesized.

Clinical symptoms

The external manifestation of the disease depends on the shape, size and location of the stones. The disease may not manifest itself externally if the stones do not clog the lumens of the urethral canal and do not have sharp edges that would cause mechanical damage to the mucous membrane. Sometimes, when carrying out visual diagnostic methods, large stones were found in animals, more than two centimeters in diameter. The formation time of such a stone is at least one and a half years. However, during this period no complaints or signs of illness were observed. Suspicions of urolithiasis appear only when there is difficulty urinating, in which the animal strains, often takes an appropriate position, and urine is released in a very weak stream, often with blood, at times interrupted or completely stopped. Urine often contains fine sand.

Diagnostics

When making a diagnosis, the veterinarian takes into account clinical signs, the results of a survey of animal owners, laboratory tests of urine, and necessarily conducts X-ray and ultrasound examinations, because similar symptoms can occur: when the lumen of the urethra is compressed by a tumor, inflammatory edema, and blood in the urine and pain can occur with acute cystitis, hemolysis, etc.

Treatment

Treatment urolithiasis boils down to the following principles:

1. Relieving the acute condition and restoring the outflow of urine. To do this, it is necessary to remove stone or sand from the urethra with a catheter and rinse the lumen of the urethra with an antiseptic solution (done under general anesthesia). In advanced cases, doctors are forced to resort to urethrostomy surgery (creation of an artificial outlet channel to the area of obstruction). Even more complex is abdominal surgery - cystotomy, the purpose of which is the complete removal of large uroliths (the diameter of which is larger than the lumen of the urethra) from the bladder.

2. After restoring the outflow of urine, infusion therapy (drip) is necessary during the first few days in order to restore water-electrolyte balance and relieve intoxication. Anti-inflammatory and antibacterial therapy is also carried out (up to two weeks).

3. After stabilization of the condition, lifelong prevention is mandatory: diet therapy - medicinal food, if necessary, antibiotic therapy, herbal medicine (diuretics, etc.), as well as regular medical examination: urine analysis and ultrasound of the kidneys and bladder.

In each case, treatment is selected individually, taking into account gender, age, type of animal, degree of damage, presence of concomitant diseases, and must necessarily be based on detailed diagnostics.

The most correct approach to the problem of urinary stones is the prevention of this pathology. For this purpose, the conditions for feeding and watering the animal are improved. Avoid prolonged use of monotonous foods rich in salts (fish, milk, various seafood, mineral supplements, etc.), as well as hard drinking water. The diet is enriched with vitamins, and when feeding a pet dry food, food marked “for castrated animals” or “for the prevention of urolithiasis” is used.

We recommend that owners be more attentive to the health of their pets and respond quickly when unwanted symptoms appear, thereby preventing the development of a serious pathology that requires serious intervention.

Urolithiasis disease- a disease of dogs in which the formation and deposition of urinary stones or sand in the kidneys, bladder and blockage of the ureters occurs.

Cause. The cause of the occurrence and development of urolithiasis in dogs is disturbances in the processes of digestion, acid-base balance and metabolism, especially mineral metabolism. The development of urolithiasis in a dog can be caused by one or another bacterial infection of the genitourinary system, the presence of a nucleus that can become the basis for the formation of a large urolith (mainly bacteria or viruses).

What factors influence the development of urolithiasis in a dog?

The development of urolithiasis is influenced by an incorrectly formulated diet, when the dog’s diet is dominated by food with a high content of minerals or the diet has an excess protein content, a lack of vitamins A and D, imported food, supplements, etc.

Age of the dog – the disease is most often recorded in middle-aged dogs.

Gender – in males, due to the longer urethra, the disease is registered more often.

There is a pronounced breed predisposition to the formation of stones. Small breeds of dogs suffer from urolithiasis much more often than large breed dogs. Among dogs, pugs, Pekingese, dachshunds, terriers, bulldogs, Dalmatians, and hounds are more often affected.

The dog does not have a normal walk, a sedentary lifestyle - lack of physical activity, rare walks, lack of water.

Pathogenesis. A change in the acid-base balance in the dog’s body leads to disruption of redox processes and mineral metabolism (there is an increase in the excretion of calcium, phosphorus, magnesium, sodium, potassium, chlorine and sulfur by the kidneys). As a result of the above disorders, inflammatory-dystrophic processes develop in the kidneys, bladder, and liver. Changes in pH and specific gravity of urine lead to disruption of colloidal-crystalline equilibrium in the urine, precipitation of mucoprotein salts and ultimately the formation of urinary stones. The basis for stone formation is mucus, exudate, desquamated renal epithelial cells, and fibrin. Under such conditions, precipitation of salt crystals, protein-like substances, occurs. Blockage and damage to the mucous membrane of the genitourinary tract by the formed urinary stones is accompanied in the dog by stagnation of urine, penetration of various secondary infections along the ascending line, as a result of which the sick animal develops catarrhal-purulent inflammation of the bladder (urocystitis), renal pelvis and kidneys (pyelonephritis). If timely medical care is not provided, a sick dog dies from uremia and urine poisoning. Sand is found in the bladder, cystitis and uremia develop, and a pungent odor emanates from the urine itself.

Symptoms of the disease. Symptoms of the disease depend on the location of the urinary stones and the gender of the dog. The main sign of urolithiasis in dogs is the dog's inability to defecate normally or extremely difficult urination. The dog produces urine slowly, sometimes drop by drop; upon careful examination, the dog owner discovers blood in the urine.

Veterinary specialists distinguish several degrees of development of urolithiasis, each of which is characterized by certain clinical signs.

Subclinical form of urolithiasis. With this form, the dog may not show any clinical signs of the disease. Urinary stones in dogs can be of different types. Some urinary stones in dogs can be detected using x-rays. In some dogs, this form of the disease is accompanied by some kind of inflammation of the genitourinary tract.

Mild form of urolithiasis. With this form, your dog may frequently ask to go to the toilet, at which time the urination time may be slightly increased. Animal owners usually note the presence of blood in the urine, the dog often licks its genitals, and after urinating, drops of blood remain on the bitch’s loop or on the tip of the male’s penis. Sometimes dog owners find drops of blood from urine on the ground.

Severe form of urolithiasis. With this form, the dog produces small drops of urine during urination, the dog develops tenesmus, the dog whines, trembles, looks tense and scared, pees in a strange position, blood is clearly visible in the dog’s urine (). Sick male dogs sit down when urinating, rather than lifting their paws. Girls sit down very often; when urinating, urine either does not flow out at all or there is very little of it. When conducting a clinical examination of such a dog, by palpating the abdominal area, the veterinarian determines that the bladder is very full and distended. The dog has no appetite, the dog is outwardly lethargic and apathetic. At the end of the disease with this form of the disease, the dog may not urinate at all, the dog becomes weak, and there may be an increase in body temperature. The dog often vomits (), dehydration and convulsions occur.

Diagnosis The diagnosis of urolithiasis is diagnosed by a veterinary specialist of the clinic in a complex manner based on the symptoms of the disease, urine analysis (epithelial cells, mainly of the kidneys and bladder with granular degeneration, crystals of calcium oxalate, calcium carbonate and triple phosphate), the results of an x-ray examination (stones are visible on an x-ray), and also ultrasound results (we find the location of urinary stones, their size and quantity). In order to exclude a bacterial infection of the genitourinary tract, it is necessary to take a smear for microflora and conduct a bacteriological examination of urine in a veterinary laboratory. As with all diseases, a general and biochemical blood test will be performed at the veterinary clinic.

Differential diagnosis. It is necessary to exclude, urethritis,.

Treatment urolithiasis in dogs should first of all be aimed at eliminating stagnation of urine and restoring patency of the urinary tract. Urinary stone blockage in a dog can occur as a result of smooth muscle spasm from urinary stones or sand. In these cases, the veterinary specialists of the clinic use antispasmodic drugs - atropine subcutaneously 0.5 ml 2 times a day, no-shpu intramuscularly 0.5 ml 3 times a day, papaverine hydrochloride subcutaneously 0.5 ml 3 times a day, antispasmodic , spasmalgon, spazgan, and other drugs. In parallel with antispasmodic drugs, sedatives (Rovatinex, Rovatin, Bromcamphor, magnesium sulfate solution, sodium bromide, etc.) and analgesics (Analgin, aspirin, Aspisol, Voltaren, Sedalgin, etc.) are prescribed. An attack of urinary colic can be stopped using a lumbar novocaine blockade. In order to destroy and remove urinary stones and sand, urodan (1 teaspoon inside in ½ glass of water 3 times a day), urolite, knotweed herb in the form of an infusion (10:200) 2 tablespoons 3 times a day is widely used in practice. the day before feeding, madder extract orally 0.25 -0.75 g 2-3 times a day in ½ glass of warm water. Treatment of urolithiasis in dogs depends on the location of the urinary stone in the dog’s genitourinary system and on its composition. If the disease in a dog is diagnosed in the initial stages of renal colic, then the sick dog is given rest and warmth in the kidney area. You can give your dog medicinal mineral water “Essentuki” or “Borjomi”. In the case where there is a blockage of the urethra with a urinary stone, veterinary specialists resort to removing it. The urinary stone is pushed back into the bladder cavity by a catheter, and if this cannot be done, then surgical removal is necessary. In order to eliminate the consequences of blockage of the urinary ducts, the veterinarian prescribes medications to relieve spasms, pain, stop bleeding, and prevent inflammation. In some cases, veterinary specialists, in order to restore normal urination, have to make a urethrostomy (an opening in the urethra above the urinary stone), through which the male dog will subsequently urinate.

In the event that we are faced with the presence of large urinary stones in the bladder, as well as stones that cannot be dissolved when using conservative treatment methods, the veterinary specialists of the clinic resort to a surgical operation - cystototomy (an incision is made in the bladder, the urinary stones located there are removed, and a suture on the bladder). After surgery on the bladder, the sick dog is given conservative treatment aimed at preventing inflammation of the bladder (cystitis); the dog is prescribed a strict diet to prevent the formation of new urinary stones.

Most stones in the genitourinary system in dogs can be crushed using a special diet.

Phosphate stones are dissolved by shifting the pH of the dog’s urine to the acidic side (a special diet that limits the intake of protein, phosphorus and magnesium from food), while simultaneously taking measures aimed at suppressing the microflora of the bladder, which contributes to their appearance (Escherichia coli, Proteus, staphylococci ).

Urate and cystine stones dissolve when the urine pH shifts to the alkaline side, and at the same time, owners should limit the amount of protein in the diet.

There are specially designed diets that help limit the formation of urinary stones, as well as quickly restore the acid-base balance and, thanks to the diuretic effect, are able to remove the remains of stones and sand from the urinary tract.

Depending on the number and size of urinary stones, the process of their destruction takes from 5 to 16 weeks.

It is very important that during this period the dog consumes only food prescribed by a veterinarian and prescribed medications.

Prevention of urolithiasis. In order to prevent the disease, animal owners should strive to use fresh, filtered (distilled) water for drinking their dog. Water for drinking a dog must be changed at least 2 times a day.

The dog's feeding diet must be balanced; it is advisable to give your pet a natural diet prepared by a veterinarian. It is necessary to exclude fish, sausage, sweets, salty foods, excess meat products and cereals from the feeding diet.

Walk your dog three times a day; during a walk you should not overload your pet (long walks are better).

Visit a veterinary clinic twice a year with a mandatory urine test.

Send your good work in the knowledge base is simple. Use the form below

Students, graduate students, young scientists who use the knowledge base in their studies and work will be very grateful to you.

Posted on http://www.allbest.ru

Introduction

Diseases of the lower urinary tract in cats are a serious problem in modern veterinary medicine for small animals. The most severe disease of the urinary tract is urolithiasis and associated complications, for example, feline urological syndrome. Urolithiasis is widespread, difficult to treat, persistently recurs, and is accompanied by high mortality. In cats, urolithiasis was first described at the beginning of the 20th century. Since then, it has been found that urological diseases occur in cats almost 3 times more often than in dogs, and 4 times more often than in humans. Although not all patients with urological disorders develop urolithiasis, the proportional mortality rate from urolithiasis is higher in cats than in humans and dogs. Therefore, this problem goes beyond veterinary medicine and becomes socially significant. Unfortunately, it is still not possible to give unambiguous answers to questions about the causes of the development of the disease and its pathogenesis. Although a lot of research has been devoted to urolithiasis in both humane and veterinary medicine. The large number of proposed various treatment methods, developed by scientists and practicing veterinarians, indicates not only the relevance of this problem, but also the dissatisfaction of many specialists with the results of treatment of urolithiasis in cats.

1. Definition of disease

Urolithiasis (UCD) is a chronic disease of all types of domestic and wild animals, as well as humans, characterized by disruption of acid-base balance, mineral, protein, carbohydrate, vitamin, hormonal metabolism and the formation of single or multiple urinary calculi (stones) in the kidney. parenchyma, pelvis or bladder.

2. Etiology

The causes of urolithiasis can be:

· improper feeding (excess proteins and lack of carbohydrates, excessive feeding of fish containing large quantities of phosphates and magnesium salts);

· lack of vitamins A and D;

· sedentary lifestyle;

· imbalance of acid-base balance of blood and lymph;

· breed predisposition;

· overweight;

· early castration;

· lack of free access to drinking water (or poor water quality);

· urinary tract infections (especially streptococcal and staphylococcal).

Most of these reasons lead to metabolic disorders, in which there is excessive excretion of various metabolic products in the urine. For example, too early castration of a cat, accompanied by removal of the testes, can lead not only to hormonal imbalance, but also to narrowing of the already narrow urethra (urethra).

Cat breeds such as Persians have a genetic predisposition to urolithiasis, most of all to the formation of tripelphosphates. Neutered cats develop phosphate stones very quickly. In addition to Persians, long-haired Himalayan and Burmese cats are most predisposed to oxalate urolithiasis, which occurs in cats in approximately 25% of cases of urolithiasis. In general, KSD is detected in approximately 7% of cats admitted to veterinary clinics.

The urethra in cats is already quite narrow, and with a high content of fish and dairy products in the diet, crystals of phosphorus and calcium salts fall into the urine, which leads to spasms and urinary retention, with the subsequent occurrence of urinary tract infections and the development of acute renal failure. Males are most susceptible to UCD because their urethra is longer and narrower than that of females.

3. Pathogenesis and symptoms of the disease

With urolithiasis, various sparingly soluble salts accumulate in the kidneys and urinary tract, which causes a change in the acidity (pH) of the urine. These can be calcium phosphates, calcium carbonates, calcium oxalates, urates, as well as struvites (complex salts of ammonium, magnesium, phosphorus and calcium). Urates consist mainly of uric acid salts (on the surface of these stones there are spines that injure the vascular walls, promoting inflammation), and phosphates are made of calcium and magnesium phosphates. Phosphate and struvite stones form primarily in alkaline urine and grow very quickly. The hardest stones are oxalates, they are formed from salts of oxalic acid and are found, like urates, mainly in acidic urine. That is why normalizing the pH of urine leads to a slowdown in the formation of crystals and to the dissolution of existing ones. Carbonates are formed from salts of carbonic acid; they are soft, crumble easily and make up the bulk of sand in urine.

Uroliths are formed by the aggregation of mineral crystals. But urethral plugs consist of a protein matrix, which usually contains many mineral crystals. Both uroliths and urethral plugs can lead to inflammation and obstruction of the lower urinary tract.

Many uroliths in cats form in the bladder and can damage the mucous layer of the bladder. Depending on their size, uroliths can partially or completely block the bladder neck. And the urethra of cats can be blocked by both uroliths and urethral plugs.

Both blockage of the urethra and damage to its mucous membrane lead to stagnation of urine and the development of secondary ascending urinary tract infection. As a result, catarrhal-purulent inflammation of the bladder (urocystitis) and renal pelvis (pyelonephritis) develops.

Symptoms The disease develops slowly - without obvious clinical signs, but the results of a urine test can give a fairly reliable prognosis. The pH of urine shifts to the acidic side for urates, oxalates and to the alkaline side for phosphates (the norm is 6.5 - 7), the density of urine increases. The animal refuses to eat, is depressed, and often licks the perineum. When the urinary tract is blocked, urinary colic is observed, the animal is restless, makes restless sounds when urinating, takes an unnatural position during urination (hunched over), stays in it for a long time, the pulse rate, breathing rate, and temperature increase. The animal experiences pain when its stomach is touched, goes to the toilet more often (or, on the contrary, can urinate anywhere), the amount of urine decreases, the urine may be cloudy or mixed with blood (hematuria), urination is difficult (or, conversely, very frequent and painful) or may be completely absent.

4. Diagnosis

Anamnesis. During the interview, it is usually possible to find out the main events in the development of the disease that preceded the patient’s admission to a veterinarian: when the first signs of the disease appeared, whether similar disorders occurred before, whether there is appetite, whether the patient takes water, the presence of vomiting and its intensity, what is the frequency of urination and the amount of urine excreted, the presence of blood in the urine, and the duration of urinary retention. In addition, it is appropriate to find out the structure of the diet, the method and amount of water taken, and the conditions under which the sick animal is kept. After collecting anamnesis, a general clinical examination begins.

Inspection. Many urologically ill cats, even in a new environment, at a doctor’s appointment, take a forced body position to urinate, sometimes excreting a small amount of cloudy or blood-tainted urine. A long-term disease is indicated by tousled, matted hair, sunken eyes, dry mucous membranes, and shortness of breath. In case of acute urinary retention, patients may exhibit severe neurological disorders: nystagmus, muscle twitching, forced position of the head - flexion of the occipito-atlas joint, "look from under the brows." Quite rarely, bladder overflow is visually determined: a saggy asymmetrical abdomen. When examining the perineum, you can find dried fragments of urethral plugs, salt crystals, blood clots, and in cats “forced” paraphimosis.

Thermometry. The general body temperature of patients with urolithiasis is almost always within the physiological norm of 38-39.5ºC. However, if a urological syndrome develops, the patient’s body temperature steadily decreases and after 24-48 hours can reach critical levels of 34-35ºC.

Palpation. During palpation examination of a urological patient, it is necessary to determine the condition of the bladder. In most patients, the walls of the organ are moderately or severely painful and thickened. In the case of acute urinary retention, the pain increases, and the filling of the bladder rarely exceeds 350 ml, and the bladder fills a larger volume of the abdominal cavity. Palpation should be performed before and after the obstruction is relieved and the bladder is emptied. In cats and cats it is extremely rare to palpate the presence of uroliths in the bladder, but with luck it is possible to identify foreign inclusions and the characteristic crepitus of stones. If the kidneys are accessible for examination (in obese animals the kidneys are less accessible for palpation), their location, shape, pain, and size are determined. This provides valuable information for excluding renal pathology not associated with feline urolithiasis. By palpation, in general clinical conditions, it is possible to determine the degree of dehydration and disturbances of hemomicrocirculation in urological patients.

Urethral examination. Palpation of the urethra in cats is of significant clinical interest. It is carried out through the skin of the penis from the level of the ischial arch to the head of the penis, often revealing urethral uroliths or the location of other obstacles to the outflow of urine. Having exposed the head of the penis, they study the condition of the mucous membrane of the preputial sac, glans and urethra, often finding hyperemic mucous membrane of the urethral opening, urethral plugs of various compositions. In some patients, the urethral plug is extremely firmly “soldered” to the mucous membrane. In cats with severe dehydration, dry necrosis of part of the glans penis may occur. A light urethral massage is performed to obtain urethral contents. Sometimes massage can relieve urethral obstruction. Examination of the urethra: palpation, probing and catheterization make it possible to determine the absence or presence of urethral obstruction and parietal stones. It should be noted that the more proximally the obstruction is located, the less organic matrix it contains, the more difficult and traumatic the procedure for eliminating the obstruction will be.

Special research methods:

· Ultrasound examination (ultrasound) - provides information about the thickness of the walls of the bladder; about the presence of sediment, stones, neoplasms; about the condition of the kidneys. For ultrasound of the urinary tract of cats, high-frequency sensors of 5-7.5 MHz are used, which provide the most reliable image of the internal organs. To ensure complete contact of the sensor with the patient's skin, hair should be shaved from the area being examined. The bladder is scanned in the transverse and longitudinal planes, changing the position of the patient's body, that is, a polypositional study is used.

· X-ray examination is of secondary importance in the diagnosis of urolithiasis in cats. Stones in the bladder and urethra in cats are usually small and consistent in density with soft tissue. However, it is not advisable to completely abandon radiography, since in addition to a survey image, it is possible to perform a contrast radiograph, including double contrast, urethrocystography and emergency urography, which allows not only to diagnose “urolithiasis”, but also to carry out differential diagnosis.

Laboratory research methods:

· Biochemical examination of urine using diagnostic strips is a simple and quite effective method of express diagnostics, with which within 1-1.5 minutes you can determine the following urine indicators: pH, specific gravity, amount of protein, ketone content, bile pigment content , microhematuria, microhemoglabinuria. The method has a significant drawback - in case of severe gross hematuria, the readings are significantly distorted and do not provide diagnostic value.

· Examination of urine sediment is carried out by microscopy under low and medium magnification. To obtain sediment, freshly obtained urine is centrifuged at 1000-1500 rpm for 5-7 minutes. The excess liquid is drained, the sediment is placed on a glass slide and covered with a coverslip. Microscopy determines the type of crystals, the number of erythrocytes and leukocytes in the field of view, the epithelium of various parts of the urinary system, and cylinders. Significant gross hematuria is an obstacle to obtaining a “readable” urine sediment. In such cases, to approximately determine the type of crystals, it is reasonable to conduct microscopy of urethral plugs and stones. The results of microscopy of urine sediment and urethral contents almost always coincide.

5. Treatment and prevention

Treatment is aimed at eliminating pain, increasing salt solubility, loosening stones, and preventing further formation of urinary stones. You can alleviate the animal's condition with the help of antispasmodics (baralgin, spazgan), treatment of identified infections with antibiotics (cefa-kure, enrofloxacin, albipen LA), sulfonamides (urosulfan, sulf-120), the drug "Cat Erwin" (for obstruction of the urinary tract, it can be administered directly into the bladder, after pumping out the contents of the latter), as well as with the help of a special diet that prevents oversaturation with calcium and phosphorus salts. To stimulate the smooth muscles of the bladder, gamavit or catazol are recommended, to eliminate urethral plugs - catheterization and lavage of the urethra with the drug "Cat Erwin" (16 ml per dose), hot baths (40ºC) when immersing the cat up to half the body, anti-inflammatory therapy - dexafort .

Cats should not use medications containing glycerin and essential oils - urolesan, cystenal, pinobin, phytolysin, as this can be fatal. You can use Avisan, Cyston, but the dosage of these drugs is designed for humans, so it is necessary to take into account not only the weight of the cat, but also its sensitivity to the plants included in the medicine.

1) Manual massage:

Manual massage (often used for cats with sand plugs) or catheterization with a small polyurethane catheter (for example, a special Jackson catheter for cats or a medical subclavian catheter with a diameter of 0.6 - 0.8 mm).

Despite the fact that catheterization is often used to displace or break up uroliths in cats and some breeds of dogs, this method of treatment is the most dangerous for the following reasons:

* it injures tissue, which leads to fibrosis and scarring with subsequent narrowing of the urethra;

* introduces infection into the urinary tract.

2) Retrograde urethral lavage.

Retrograde urethral lavage followed by dissolution (struvite, urate and cystine) or cystotomy (calcium oxalates, other calcium- and silica-containing uroliths) is the only treatment for urethral urolithiasis.

Method of retrograde washing out of urethral stones. The animal is given general anesthesia or strong sedatives. Then the following steps are performed:

* Empty the bladder by cystocentesis (puncture of the bladder through the abdominal wall).

* Through the rectum, fingers compress the urethra opposite the pubis, below the urolith (an assistant is needed for this).

* A sterile catheter is inserted into the distal urethra.

* Secure the penile part of the urethra around the catheter.

* Sterile saline solution is injected into the catheter through a syringe.

* When the intraluminal pressure reaches the desired point, the assistant removes his fingers and releases the urethra.

* Under the pressure of the saline solution, the urolith returns back to the bladder.

*You can repeat the procedure several times.

After retrograde lavage, recurrence of obstruction is very rare. This method, as a rule, is not used in cats; in males, this low-traumatic method is often recommended for use.

3) Urethrostomy.

Urethrostomy is used in males when manipulation or retrograde lavage has not been successful. A urethrostomy creates a permanent opening in the urethra. This method is used for recurrent obstructions of the penile urethra in cats and sometimes in males. Although this is the only method of treating animals with permanent urethral obstruction, it must be used with caution, because according to some data, in 17% of cases, urethrostomy in cats leads to postoperative urinary tract infection. In 10% of cats, urethrostomy and dietary changes also result in postoperative infection, while none of the cats treated with diet develop a urinary tract infection.

4) Dissolution.

Struvite, urate and cystine stones can be dissolved. This is the only method for removing stones in animals with non-life-threatening urolithiasis. Dissolution is used for kidney or bladder stones. If a urinary tract infection is present, antibiotics are prescribed as part of treatment based on the results of urine culture and sensitivity testing. Treatment details are discussed below.

Struvites (magnesium ammonium phosphate, tripel phosphates). To dissolve struvite stones, it is enough to strictly adhere to special veterinary diets.

These foods contribute to the acidification of urine, causing the dissolution of struvite. In addition, the increased sodium content in these diets stimulates diuresis (urination), which helps flush the bladder and speed up the elimination of accumulated salts. For urolithiasis not complicated by bacterial infections, treatment with special diets brings positive results already 4-5 days after the start of treatment. It should be noted that contacting a veterinarian as early as possible and early diagnosis of urolithiasis promotes a speedy recovery of the animal and minimizes possible relapses of the disease. The owner's compliance with the animal's feeding regime is of great importance.

Quality control of treatment is carried out by laboratory tests of urine and x-ray diagnosis of the presence of stones in the bladder. If there are no stones in the urine and in the photographs, the treatment is considered effective and the owner’s task in the future is to carry out a mandatory urine test at least once every six months. The optimal period for control testing is 3 months.

Laboratory assessment of urine pH, as well as the presence and analysis of urine sediment, determination of the type and quantity of urinary crystals.

5) Treatment of insoluble uroliths.

Calcium oxalates.

Calcium oxalate uroliths are more common in certain breeds of dogs (Yorkshire terriers and miniature schnauzers), and in recent years they have become noticeably more common, especially in cats.

Unfortunately, this type of crystals is completely insoluble, and treatment of this type of urolithiasis is carried out exclusively surgically, removing stones from the bladder. Sometimes 3-4 operations per year are required if the intensity of oxalate formation is very high.

To prevent relapses, it is necessary to reduce the concentration of calcium and oxalates in the urine. Prevention is possible with special diets.

Calcium phosphates.

Calcium phosphate crystalluria manifests itself in various forms: both amorphous (calcium phosphates) and calcium hydrogen phosphates (brushite). These minerals are often present in mixed uroliths along with struvite, urate, or calcium oxalate. Most calcium phosphate crystals (with the exception of brushite) are sensitive to urine pH and form in alkaline urine.

A medical protocol for dissolving these uroliths has not yet been developed, so surgical removal and prevention of hypercalciuria (as in the case of calcium oxalate urolithiasis), but not urine alkalinization, are recommended.

6) Pulsed magnetic field.

Also in practice, a method is used to treat urolithiasis using a pulsed magnetic field, which not only promotes the dissolution of uroliths, but also has an anti-inflammatory and local analgesic effect. Relief occurs in all but the most advanced cases.

7) Homeopathic treatment.

Monitoring the condition of the mucous membrane of the bladder and urethra in cats with urolithiasis is of great importance.

For this purpose, long-term therapy is prescribed using the drugs Berberis-Homaccord and Mucosa Compositum. Medicines can be given with drinking water 2-3 times a week.

For acute inflammation and pain, traumeel is prescribed subcutaneously 2-3 times a day or in the form of drops every 15-30 minutes. Traumeel is also prescribed after surgery (cysto- or urethrotomy).

If urolithiasis develops against the background of chronic pyelonephritis, then the main treatment is best carried out using the drugs Cantharis Compositum and Berberis Homaccord.

8) Herbal medicine.

Prescribed for chronic disease. Decoctions and infusions of urological preparations have an antiseptic and anti-inflammatory effect and contain compounds that play the role of a protective colloid that prevents the agglomeration of microurolith crystals. The use of phytoelite preparations “Healthy Kidneys” and “Cat Erwin” is recommended. From herbs: decoction of bearberry leaves (bear's ears), infusion of half-fallow (woolly erva), parsley rhizomes, knotweed, watercress, etc.

9) Diet therapy.

Currently, feeds are more effective in preventing struvite uroliths, thus the percentage of oxalate uroliths has inevitably increased.

Over-acidification of some cat foods or use of acidifying diets in conjunction with urine acidifiers results in bone demineralization, releasing calcium to provide a buffer.

The increase in cases of oxalate urolithiasis in cats contributed to the development of a new diet, Hill's Prescription Diet Feline x/d, which was created specifically to prevent the formation of calcium oxalate crystals and uroliths and prevent relapses of calcium oxalate urolithiasis. Carefully selected and strictly controlled calcium levels slow down crystal formation. Reduced vitamin content D helps to avoid excessive absorption of calcium from the intestine.The increased content of potassium citrate, which can form soluble salts with calcium, contributes to the partial destruction of oxalates, and soluble fiber promotes the binding of calcium in the intestine.

Both struvite and oxalate are most common in overweight, indoor cats with low water intake—the former two factors impair urinary frequency and lead to urinary retention, and the latter factor increases the concentration of minerals in the urine. However, while struvite is more common in young animals (under 5 years), the risk of developing oxalate uroliths is greater in older cats (over 7 years).

Although there are general guidelines for preventing both types of KSD, recommendations for specific nutrients vary significantly. For optimal control of a specific type of urolith, the most appropriate level of each individual nutrient must be strictly controlled. Therefore, there is no diet that is suitable for controlling both types of stones.

The presence of a urinary tract infection with urease-producing bacteria will worsen the development of struvite uroliths. But infection rarely acts as the primary cause of urolithiasis in cats, more often as a secondary or accompanying microflora.

The basic principles of nutrition to prevent urolithiasis are a number of rules:

· Maintain adequate water intake to ensure adequate urine output. Increasing your water intake will increase the volume of urine produced and dissolve the substance that promotes crystal formation. The volume of urine is usually greater in cats consuming a canned diet. Also, if the feed is well digestible, it reduces the amount of dry matter in the feces, which requires less water. Thus, water loss through feces is reduced, allowing water to be excreted in urine.

· Avoiding excessive consumption of those minerals that are constituents of urolith, thereby reducing their concentration in urine.

Calcium and oxalate in the intestinal lumen form an insoluble complex that is not absorbed (just as they form an insoluble complex in the bladder). Dietary reduction of just one of these may mean that the other is free to be absorbed and will then be excreted in the urine (where it can bind with oxalate or calcium, which is released from body tissues to form calcium oxalate). It is recommended that calcium and oxalate restriction occur over a long period of time and together. There should not be a large reduction in calcium intake, and its absorption may be reduced by binding to soluble fiber.

Prevention.

Prevention consists primarily of controlling the acidity of urine. Depending on the age of the animal, the types of stones vary, and quite significantly. Thus, in young cats (up to 5 years old) phosphates are most often detected. Acidification of urine prevents their occurrence. In mature cats (6-9 years), the likelihood of phosphate stones (struvite) decreases, but the risk of oxalate stones increases, especially if the urine is too acidic. In order to limit their formation, it is recommended to take measures to reduce the acidity of urine. But in older cats (more than 10 years old), you should be most wary of the formation of oxalate crystals: neutral urine with the addition of potassium citrate limits the danger of their formation. Allopurinol (xanthine oxidase inhibitor) is used to prevent and dissolve urate stones. Cranberry juice is indicated to reduce urine pH and prevent the formation of uroliths. An excellent preventive remedy is the herbal medicine “Cat Erwin”. To restore the body after surgery, the microelement preparation Gamovit-plus is indicated.

Conclusion

chronic urolithiasis in cat

Currently, urolithiasis is very common, the incidence is widespread. Both domestic and wild animals are at risk of developing urolithiasis; therefore, housing and feeding conditions do not play a major role in the occurrence of this disease.

At the moment, the disease is difficult to fully treat and the risk of relapse is high. Therefore, ICD is an extensive field for the study and development of new modern treatment methods.

It should be noted that feeding with specialized food can reduce the risk of developing urolithiasis, since such food has a balanced composition that is suitable for the body characteristics of a particular animal species.

Literature

1. E.M. Kozlov Urolithiasis in cats. N.: MAG TM, 2002. - 52 p.

2. Ed. A.F. Kuznetsova Handbook of Veterinary Medicine - St. Petersburg: Lan Publishing House, 2004. - 912 p.

3. S.V. Starchenkov Diseases of small animals: diagnosis, treatment, prevention. Series “Textbooks for universities. Special literature". - St. Petersburg: Publishing House "Lan", 1999. - 512 p.

4. S.S. Lipnitsky, V.F. Litvinov, V.V. Shimko, A.I. Gantimurov Handbook of diseases of domestic and exotic animals - 3rd ed., revised. and additional - Rostov n/d: ed. “Phoenix”, 2002. - 448 p.

5. A. Sanin, A. Lipin, E. Zinchenko Veterinary reference book of traditional and non-traditional methods of treating dogs. - 3rd ed., revised and supplemented. - M.: ZAO Tsentrpoligraf, 2007. - 595 p.

Posted on Allbest.ru

...

Clinical symptoms of urolithiasis

The presence of uroliths in the urinary tract can cause clinical symptoms that may or may not be noticed by the pet owner. This is especially true for cats, since they hide from their owners and their owners do not always see their act of urination. The main clinical symptom is the inability to urinate naturally or urination is difficult.

In this case, the animal often sits down (male cats, females) or raises its paw (males), tries to urinate, whines, cries, urine is released in drops, often with blood.

Palpation of the abdomen establishes the presence of a full bladder. This procedure can always be performed in cats; in dogs, it is sometimes extremely difficult to palpate the abdominal wall due to the tense powerful muscles of the abdominal wall.

There are several degrees of urolithiasis:

1. Subclinical urolithiasis. There may be no symptoms associated with the presence of uroliths in the urinary tract. Struvite, calcium oxalate and other calcium-containing uroliths are radioopaque and are visible on x-rays. A urine test may show elevated crystals and an abnormal urine pH. These uroliths are usually struvite and sometimes calcium oxalate. Calcium oxalate stones often have a very rough surface and can cause mild to severe symptoms of urinary tract inflammation, while smooth struvite or cystine stones often cause no clinical symptoms at all. Nephroliths rarely cause clinical symptoms other than hematuria until they move into the ureter, causing obstruction (blockage) and hydronephrosis.

2. Mild symptoms of urolithiasis:

Slight increase in urinary frequency
Mild hematuria - blood staining
Slight increase in urination time
Slight discomfort during urination
Increased licking of the genitals

3. Severe symptoms:

Pollakiuria - cats almost never leave their toilet, dogs constantly leak drops of urine
Urinary tenesmus (to be distinguished from constipation)
Severe hematuria - obvious blood in the urine
Severe discomfort when urinating - vocalization and obvious pain
On palpation, the bladder is greatly distended
Polydipsia/polyuria in case of secondary renal failure
General depression and anorexia

4. Symptoms that threaten the animal's life:

Anuria (lack of urination)
Weakness/collapse
Dehydration
On palpation, the bladder may not be found if it has burst or is anuric (otherwise it feels like a dense mass)
Uremic halitosis may be detected
Vomit
Convulsions

To prescribe adequate treatment, the veterinarian must be able to assess the degree of development of urolithiasis.

Diagnosis of urolithiasis

Urolithiasis is confirmed:

Clinical symptoms
Palpation of uroliths in the bladder in dogs (in cats they are difficult to palpate)
Plain x-rays show radioopaque uroliths
Contrast radiographs for radiolucent and small (less than 2 mm in diameter) uroliths
Discharge of uroliths during urination (they can be collected in a net)

Radiography is necessary to determine radioopacity, location of deposition, number and size of uroliths. Usually stones are present in several places at once, so examination of all urinary tracts is necessary.

Rice. 1. Calcium oxalate crystals in urine

In cats, urolithiasis usually resolves with the formation of struvite (tripelphosphate), but recently there have been increasing cases of detection of calcium oxalates in the urine of cats and, even worse, mixed type urolithiasis, when both struvite and oxalates are present in the urine at a neutral urine pH level. Many veterinarians neglect laboratory diagnosis, relying on the prevalence of struvite in cats. I think this approach is wrong.

In dogs, KSD can occur with the formation of all known uroliths, therefore, laboratory visual determination of the type of stones for dogs is very important for prescribing treatment. A 10-mL sample of fresh urine sediment should be microscopically examined immediately after collection at body temperature because time, cooling, or evaporation of the urine may accelerate crystal precipitation and produce false positive or paradoxical results. Most common crystals have a typical appearance in urine, and if their number is large, one can judge the composition of the urolith, or at least its outer layer.

Rice. 2. Struvite

Rice. 3. Struvite and red blood cells in urine

Treatment of urolithiasis

The choice of the correct treatment depends on the location(s) of the uroliths:

Kidneys- nephroliths are very difficult to remove surgically, unless they are concentrated in one kidney. Then nephrectomy (kidney removal) is possible. With nephrolitas, the development of postrenal renal failure is possible. Dissolution of struvite uroliths is possible by prescribing a special diet.

Ureters- uroliths located in the ureters can be successfully removed surgically, but one should remember the possibility of developing postrenal renal failure.

Bladder- treatment depends on the type of uroliths. Struvite, urate, and sometimes cystine can be dissolved, and calcium oxalate and other calcium- and silica-containing uroliths can be removed surgically by conventional cystotomy (opening the bladder and removing stones).

Urethra- depending on how the uroliths lie, several types of treatment are used:

1) Manipulation - manual massage(often used for cats with sand plugs) or catheterization a small polyurethane catheter (for example, a special Jackson catheter for cats or a medical subclavian catheter with a diameter of 0.6 - 0.8 mm).

Despite the fact that catheterization is often used to displace or break up uroliths in cats and some breeds of dogs, this method of treatment is the most dangerous for the following reasons:

it injures the tissue, which leads to fibrosis and scarring with subsequent narrowing of the urethra;
causes infection in the urinary tract.

2) Retrograde urethral lavage followed by dissolution (struvite, urate and cystine) or cystotomy (calcium oxalates, other uroliths containing calcium and silicon dioxide) is the only method of treating urethral urolithiasis.

Method of retrograde washing out of urethral stones

The animal is given general anesthesia or strong sedatives. Then the following steps are performed:

Empty the bladder by cystocentesis (puncture of the bladder through the abdominal wall)
Through the rectum, fingers compress the urethra opposite the pubis, below the urolith (an assistant is needed for this)
A sterile catheter is inserted into the distal urethra
Secure the penile part of the urethra around the catheter
A sterile saline solution is injected into the catheter through a syringe.
When the intraluminal pressure reaches the desired point, the assistant removes his fingers and releases the urethra
Under the pressure of the saline solution, the urolith returns back to the bladder
You can repeat the procedure several times

After retrograde lavage, recurrence of obstruction is very rare. This method, as a rule, is not used in cats; in males, this low-traumatic method is often recommended for use.

3) Urethrostomy used for males when manipulation or retrograde lavage has not been successful. A urethrostomy creates a permanent opening in the urethra. This method is used for recurrent obstructions of the penile urethra in cats and sometimes in males. Although this is the only method of treating animals with permanent urethral obstruction, it must be used with caution, because according to some data, in 17% of cases, urethrostomy in cats leads to postoperative urinary tract infection. In 10% of cats, urethrostomy and dietary changes also result in postoperative infection, while none of the cats treated with diet develop a urinary tract infection.

Dissolution

Struvite, urate and cystine stones can be dissolved. This is the only method for removing stones in animals with non-life-threatening urolithiasis. Dissolution is used for kidney or bladder stones. If a urinary tract infection is present, antibiotics are prescribed as part of treatment based on the results of urine culture and sensitivity testing. Treatment details are discussed below.

Struvite (magnesium ammonium phosphate, tripel phosphates). To dissolve struvite stones, it is enough to strictly adhere to special veterinary diets. They are represented quite widely on the Russian market; any veterinary clinic in Moscow and large Russian cities can offer a veterinary diet for your pet. We successfully use food from Purina (UR) and Hills (s/d, c/d).

Quality control of treatment is carried out by laboratory tests of urine and x-ray diagnosis of the presence of stones in the bladder. If there are no stones in the urine and in the photographs, the treatment is considered effective and the owner’s task in the future is a MANDATORY urine test at least once every six months. In our opinion, the optimal period for control testing is 3 months.

Laboratory assessment of urine pH, as well as the presence and analysis of urine sediment, determination of the type and quantity of urinary crystals.

Treatment of insoluble uroliths

-Calcium oxalates
Calcium oxalate uroliths are more common in certain breeds of dogs (Yorkshire terriers and miniature schnauzers), and in recent years they have become noticeably more common, especially in cats.
Unfortunately, this type of crystals is completely insoluble, and treatment of this type of urolithiasis is carried out exclusively surgically, removing stones from the bladder. Sometimes 3-4 operations per year are required if the intensity of oxalate formation is very high.
To prevent relapses, it is necessary to reduce the concentration of calcium and oxalates in the urine. Prevention is possible with special diets (Hills x/d, Eucanuba Oxalat Urinary Formula, etc.). I repeat. PREVENTION. But not the dissolution of oxalate stones!

-Calcium phosphates
Calcium phosphate crystalluria manifests itself in various forms: both amorphous (calcium phosphates) and calcium hydrogen phosphates (brushite). These minerals are often present in mixed uroliths along with struvite, urate, or calcium oxalate. Most calcium phosphate crystals (with the exception of brushite) are sensitive to urine pH and form in alkaline urine.
A medical protocol for dissolving these uroliths has not yet been developed, so surgical removal and prevention of hypercalciuria (as in the case of calcium oxalate urolithiasis), but not urine alkalinization, are recommended.

-Silicon dioxide (silicates)
Silicate uroliths are rare in dogs. They are called "Jack stones." The etiopathogenesis of these uroliths is not completely clear, however, it is believed that the risk of the formation of these stones increases if the dog eats soil or types of vegetables contaminated with soil (rutabaga, beets). Personally, I have never encountered this type of urolithiasis.
For clinical symptoms, the only treatment is surgical removal of stones, and as a preventive measure, it is recommended to ensure that the dog does not eat soil or vegetation contaminated with it.

We talked about the main causes of the disease, as well as methods for diagnosing it. In the sequel we will mainly talk about the types of urinary stones and treatment of urolithiasis in cats and dogs.

Types of urinary stones

Type name urinary stone reflects its mineral composition. The most common stones are: struvite (magnesium ammonium phosphate), calcium oxalates, urates, cysteates and silicas.

Struvite

The most common type of mineral found in dogs is magnesium ammonium phosphate hexahydrate, also known as - struvite. This type of urinary stone accounts for about 50% of all urinary stones in dogs. Their prevalence in cats is about 30%. Miniature schnauzer, miniature poodle, bichon frize and cocker spaniel are the most susceptible dog breeds. Urinary tract infection is a major factor in the formation of struvite stones. With the enzymatic action of certain bacteria in the bladder dogs urea is produced, which increases it pH, making urine more alkaline and reducing crystal solubility struvite. increases the amount of organic residues in the urine, which undergo gradual crystallization.

Calcium oxalate kidney stones

Detection rate in dogs calcium oxalate stones makes up about 35% of the total number of all stones, while in cats this figure is higher and amounts to 50-70%. Urine stones, extracted from a cat's kidneys or ureters, were diagnosed as calcium oxalates in 70% of cases. The dog breeds most commonly affected by calcium oxalate include miniature and standard schnauzers, miniature poodles, bichon frizes, Lhasa Apso, Yorkshire terriers, and Shih Tzus. Of the cats, these are Burmese, Persian and Himalayan cats.

The elderly are also more susceptible to salt formation calcium oxalate. In animal kidneys they are more common than struvite stones. Reasons leading to the formation oxalate stones have not yet been thoroughly studied, but there is some correlation between an increase in the concentration of calcium in the urine after eating certain foods and the formation of these urinary stones. In cats that exhibit struvite accumulation, oxalate stones practically never occur and there is clearly a certain relationship in this. The results of epidemiological studies confirm the hypothesis that the developed special diets for urolithiasis to reduce struvite formation may inadvertently increase the likelihood of formation oxalate stones. Decreased urinary concentrations of natural crystal inhibitors and increased intake of mineral-rich foods may also play a role in stone formation. calcium oxalate. The appearance of oxalate stones varies and depends on what form of oxalate is involved in its formation. The figures show oxalate urinary stones, which are formed most often.

Urats

Education urate stones in dogs occurs due to two different mechanisms. One of them is associated with high excretion of ammonium crystals in cases of pathology of portosystemic shunts. Dalmatian dogs have defects in the hepatic transport membranes of uric acid, and this also contributes to the formation urates.

A retrospective study conducted to evaluate clinical signs and surgical outcomes in Dalmatians with urate stones showed that blood in the urine is found in 85% of dogs, but crystals are found in only 54%. Most dogs affected by this are males. Contrast x-ray and ultrasound are the most useful diagnostic tools urates.

Cystine stones

Excessive formation of cystine in urine is an inherited disorder of renal tubular transport and is considered the main cause cystine stones. At a high concentration of cystine in an acidic environment (low pH), stones may form. They most often form in male dachshunds aged 3 to 6 years.

Silicate stones

Formation mechanism silicate stones completely unknown, but may be associated with the consumption of silicates, silicic acids and magnesium silicate in food components. The formation of these stones is directly related to the consumption of large amounts of corn and soy gluten, in which the concentration of silicates is quite high. Great Danes, Old English Cattle Dogs, Golden Retrievers and Labradors are most susceptible to their formation. The average age of incidence is from 6 to 8 years.

Treatment of urolithiasis in cats and dogs

Calcium oxalates, urates, cystine And silicate stones cannot be treated conservatively, they are insoluble, and require surgical treatment of urolithiasis. Most of them have a high relapse rate. Struvite stones sometimes they can be dissolved with the help of special therapy and dietary nutrition specially designed for this purpose.

Prevention of urolithiasis in cats and dogs

Prevention of urolithiasis with struvite stones

Prevention education struvite stones depends on dietary restrictions on protein, calcium, phosphorus and magnesium, and an increase in the amount of salts that acidify the urine. Prompt treatment of urinary tract infection is also important and is a means of prevention.

Prevention of urolithiasis in calcium oxalate stones

Feeding protein- and sodium-restricted, alkalizing diets may reduce recurrence of the formation. oxalate stones. Potassium citrate can be used to neutralize and slightly alkalinize urine. Sometimes high doses of B6 are used for prevention in combination with diuretics.

Prevention of urolithiasis in cystine stones

Low protein and alkalizing diets are highly successful in preventing the formation of cystine stones. pH urine level should be above 7.5. Potassium citrate and D-penicillamine are sometimes used for additional alkalization.

Prevention of urolithiasis with urate stones

Education urates can be prevented using low-protein and alkalizing diets. Allopurinol is one of the drugs that helps prevent the formation of uric acid and is sometimes used to prevent urate. Allopurinol should not be given to cats. Urate stones can be prevented in 80% of dogs and 95% of cats.

Prevention of urolithiasis in silicate uroliths

Alkalinization of urine and low silicate diets are the only method to prevent their formation.

Treatment of urinary tract obstruction

Obstruction of the urethra by urinary stones is a very dangerous situation. A blockage in the urinary tract must either be cleared by removing the stone and emptying the bladder, or cystocentesis (puncture of a full bladder with a needle through the abdominal wall) must be performed if the stone cannot be removed.

Urine stones those lodged in the urethra can be dislodged and pushed back into the bladder using a technique called retrograde flushing.

The blockage can also be overcome using a technique called urinary flushing. (Fig. 1). After the stones blocking the canal are removed, the remaining stones in the bladder are removed surgically.

Figure 1 - Washing out urination

Surgical treatment of urolithiasis in cats and dogs

Procedure for surgical removal urinary stones depends on where exactly in the urinary tract they are located. The procedure for removing them from the bladder is called cystotomy. When stones are located in the urethra and urethra, - urethrotomy. Sometimes, with complete obstruction of the urethra, a urethrostomy is performed to create complete and constant outflow and prevent possible obstruction. A perineal urethrostomy is often performed in cats with an obstruction.

Laser lithotripsy- least invasive removal method urinary stones, which has been tested and used relatively recently. This procedure requires advanced laser and endoscopic equipment and high technique. In some cases, the procedure is performed through the urethra, but sometimes a small incision is made into the bladder and an endoscope with a laser fiber is inserted through this canal into the urinary canal and then into the upper part of the animal's urethra. Laser lithotripsy most applicable for urethral blockage with a small number of cystic stones.

Urine stones which are formed in the kidneys can be removed using nephrotomy. Most veterinary specialists perform quite professionally cystotomy, however, urethrostomy, urethrotomy, and nephrotomy require special surgical training and not every specialist can handle it. It should be performed by a surgeon with at least 5-7 years of experience in this field.