Urolithiasis (urolithiasis) - uroutiasss. Urolithiasis in cats

Urolithiasis is a metabolic disease caused by various endogenous and/or exogenous factors. Often it is hereditary and is determined by the presence of a stone or sand in the urinary system.

Causes of urolithiasis

The main reason for the formation of kidney stones is a metabolic disorder, especially a change in the water-salt and chemical composition of the blood. However, urolithiasis will not develop without the presence of predisposing factors:

hereditary predisposition;
chronic diseases of the gastrointestinal tract (gastritis, colitis, peptic ulcer, etc.) and organs of the genitourinary system (pyelonephritis, prostatitis, prostate adenoma, cystitis, etc.);
violations of the function of the parathyroid glands and castration.
osteomyelitis, osteoporosis, other bone diseases or injuries;
prolonged dehydration of the body due to poisoning or an infectious disease;
lack of vitamins in the body, especially group D;
constant abuse of products that increase the acidity of urine (acute, sour, salty);
drinking hard water with a high salt content;
physical factor. Animals living in hot climates are more likely to develop urolithiasis;
permanent lack of ultraviolet rays.

Symptoms of kidney stones

As a rule, kidney stone disease does not go unnoticed. However, in some cases, the course of the disease may be hidden and is detected during the examination of the body if other diseases are suspected.

Pain and renal colic.
Violent pain in the lumbar region. Subsiding and resuming, colic can last for several days. It usually stops if the stone moves or passes from the ureter into the bladder.
Pain when urinating, frequent urination.
Such pain is evidence that stones are present in the bladder or ureter. During urination, the stream of urine may be interrupted. This is the so-called 'lock-in' syndrome.
Blood in the urine.
Blood in the urine may appear after severe pain or after exercise.
Turbidity of the urine.
An increase in body temperature to 38-40 degrees, which is typical for the addition of pyelonephritis.
in cats, sand can clog the urethra in the narrowest part, while the bladder is not released from urine, which can lead to its overstretching or rupture - a lethal outcome in this case is inevitable. If the pet has not gone to the toilet during the day, this is an occasion to urgently call a doctor at home to empty the bladder.

An animal can carry stones or sand in the kidneys all its life and not show signs of anxiety. The symptoms of urolithiasis depend on the size and type of the stone, its location in the urinary tract, and the nature of the disorders it causes in the organs of the urinary system.

Diagnosis of urolithiasis
a general urine test reveals a slight admixture of blood in the urine, microbial infection, the nature of salt impurities;
a general blood test reveals inflammatory processes;
blood chemistry;
Ultrasound of the kidneys - one of the main methods for detecting stones - allows you to assess the degree of anatomical changes caused by the presence or movement of a stone or sand. The only drawback: it is much more difficult to diagnose ureteral stones with ultrasound, and sometimes impossible due to its deep occurrence in the retroperitoneal space.
When calling a veterinarian at home, you can carry out all diagnostic manipulations without leaving the veterinary clinic.

Disease treatment.

Treatment is carried out in several stages. First of all, in the treatment of kidney stones, it is necessary to relieve an attack of renal colic. The next stages of treatment are removal of stone or sand, treatment of infection and prevention of recurrence of stones.

Currently, the treatment of urolithiasis includes conservative and surgical methods of treatment.

Conservative treatment - treatment with drugs, diet and drinking regimen. It can be quite effective if the kidney stones are small (up to 3 mm - sand in the kidneys). Modern medicine uses drugs that dissolve sand in the kidneys or kidney stones. But remember that the use of these drugs is possible only under the supervision of a veterinarian. In the case of the onset of the inflammatory process, antibiotic therapy is also carried out.

The dissolution of stones and sand depends on the acidity of the urine.
Preparations for dissolution (litholysis) of urinary stones and alkalization of urine

Urate and mixed stones undergo medicinal litholysis. Considering that urate stones occur against the background of a decrease in the pH of urine, for their dissolution it is necessary to create a constantly elevated urine pH (pH = 6.2-6.8), which is achieved by taking citrate mixtures: Blemaren, Uralit.

Herbal preparations

Canephron N is a medicinal product containing extracts of centaury, wild rose, lovage, rosemary and 19 vol.% alcohol. Kanefron has a complex effect: diuretic, anti-inflammatory, antispasmodic, antioxidant and nephroprotective, reduces capillary permeability, potentiates the effects of antibiotics. The therapeutic properties of Kanefron are due to its constituent essential oils (lovage, rosemary), phenolcarboxylic acids (rosemary, lovage, centaury), phthalides (lovage), bitterness (centaury), ascorbic, pectic, citric and malic acids, vitamins. As is known, the main signs of inflammation are associated with the so-called inflammatory mediators (bradykinin, prostaglandins, histamine, serotonin, etc.). The anti-inflammatory properties of Kanefron are mainly due to the antagonism of rosmarinic acid against inflammatory mediators. The mechanism of action is associated with blocking the nonspecific activation of complement and lipoxygenase, followed by inhibition of leukotriene synthesis. A wide range of antimicrobial action of the drug is due to phenolcarboxylic acids, essential oils, etc. The antimicrobial effect of phenolcarboxylic acids is mediated by the effect on the bacterial protein. Lipophilic flavonoids and essential oils are capable of destroying bacterial cell membranes. The diuretic effect of the drug is determined mainly by the combined action of essential oils and phenolcarboxylic acids. Essential oils dilate the vessels of the kidneys, which increases their blood supply. Phenolcarboxylic acids, when released into the lumen of the renal tubules, create a high osmotic pressure, which also reduces the reabsorption of water and sodium ions. Thus, an increase in water excretion occurs without disturbing the ionic balance (potassium-sparing effect). The antispasmodic effect is due to the flavonoid component of the drug. A similar effect is shown by phthalides (lovage), rosemary oil. Phenolcarboxylic acids have weak antispasmodic properties. The high efficiency of the flavonoid component in reducing proteinuria (influence on membrane permeability) was found. Due to their antioxidant properties, flavonoids help protect the kidneys from free radical damage. According to clinical data, Kanefron increases the excretion of uric acid and helps maintain the pH of urine in the range of 6.2-6.8, which is important in the treatment and prevention of urate and calcium oxalate urolithiasis. Flavonoids and rosmarinic acid can bind calcium and magnesium into chelate complexes, and the presence of a diuretic component allows you to quickly remove them from the body.

Cyston is a complex herbal preparation, which consists of 9 components, such as extracts of bicarp stalk, madder cordifolia, reed saxifrage, membranous sytcha, rough straw flower, osma bracts, ashy vernia, mummy powders and lime silicate. The complex of biologically active substances that make up Cyston has a litholytic, diuretic, antispasmodic, antimicrobial, membrane-stabilizing and anti-inflammatory effect.

Antispasmodic drugs

The drugs of this group are used as a therapy aimed at eliminating an attack of renal colic. Spasmoanalgesics improve the discharge of small calculi, reduce tissue swelling during prolonged standing of the calculus. Given that inflammatory changes are usually accompanied by pain and fever, it is advisable in some cases to combine antispasmodics with non-steroidal anti-inflammatory drugs.
Depending on the mechanism of action, antispasmodics are divided into 2 groups: neurotropic and myotropic. In the treatment of urolithiasis, both neurotropic and myotropic antispasmodics are used.

Neutropic antispasmodics include M-anticholinergics. M-choliblockers are divided into tertiary (atropine, scopolamine). Neurotropic antispasmodics are rarely used in patients with KSD due to severe side effects and low antispasmodic activity.

To stimulate the independent discharge of stones in the lower third of the ureter, tamsulosin, alfuzosin, etc. are used.

Drugs aimed at correcting biochemical changes in the blood and urine

To correct purine metabolism, a drug that reduces the formation of uric acid, allopurinol, is used. Allopurinol inhibits the enzyme xanthine oxidase. In the body, this enzyme is involved in the conversion of hypoxanthine to xanthine and xanthine to uric acid. The use of a xanthine oxidase inhibitor, such as allopurinol, can reduce the formation of uric acid. In addition, allopurinol lowers the content of uric acid in the blood serum, thereby preventing its deposition in the kidneys and tissues. Against the background of allopurinol, the excretion of uric acid decreases, and the more soluble compounds in the urine, precursors of uric acid, such as hypoxanthine and xanthine, increase. Indications for the use of the drug are: hyperuricemia in gout; urate urolithiasis; other types of urolithiasis in case of detection of hyperuricemia; diseases accompanied by increased breakdown of nucleoproteins. In the group of patients with recurrent calcium oxalate urolithiasis with hyperuricosuria, allopurinol is also used. It is believed that the positive effect is due to uric acid, which provides the formation of a nucleus for the formation of a calcium oxalate crystal. Allopurinol is taken orally after meals at a dose of 300 mg / day. This drug must be prescribed immediately after the detection of certain biochemical changes. The effectiveness of treatment is assessed by a decrease in serum concentration and / or daily concentration of renal excretion of uric acid, as well as the absence of relapses.

Thiazide diuretics (hypothiazid, indapamide) inhibit the reabsorption of sodium and chloride ions in the proximal tubules of the kidneys. In the distal convoluted tubule, there is also an active reabsorption mechanism for calcium ions, regulated by parathyroid hormone. Thiazides increase calcium reabsorption in the distal convoluted tubules, but the mechanism is not fully understood. It is believed that it is associated with a decrease in the concentration of sodium in the cell due to the blockade of sodium entry under the influence of thiazides. Decreased levels of intracellular sodium can increase sodium-calcium metabolism in the basolateral membrane, and this promotes calcium reabsorption. Used for idiopathic hypercalciuria. It is necessary to remember about the possibility of hypokalemia, hyperuricemia. The criterion for the effectiveness of treatment is the reduction or normalization of daily calcium excretion.

Magnesium and vitamin B6 preparations. Treatment with magnesium preparations is the most optimal treatment for hyperoxaluria in patients with high pH levels and significant citrate excretion. The use of magnesium oxide is due to the fact that magnesium ions bind up to 40% of oxalic acid in the urine. Evaluation of the effectiveness of treatment is based on the reduction or normalization of the daily renal excretion of oxalates.

Vitamin B6 after absorption is activated into pyridoxal phosphate with the participation of riboflavin enzymes by phosphorylation. Vitamin B6 is the main component of the enzymes for transamination and deamination of amino acids. With hypovitaminosis, protein metabolism suffers and hyperaminaciduria and oxaluria are observed, caused by a violation of the metabolism of glyoxalic acid and a negative nitrogen balance. Vitamin B6 is used for hyperoxaluria and oxalate crystalluria.

Diet for urolithiasis.

Diet plays an extremely important role in the treatment of urolithiasis (urolithiasis). Its selection should be made by a veterinarian, depending on the composition of the stones and what causes urolithiasis in a particular case. The diet limits or excludes from the patient's diet foods that provoke the growth and formation of new deposits.

From the point of view of diet therapy, all kidney stones should be divided into two groups: alkaline (phosphates and carbonates) and acidic (urates and oxalates).

With phosphate stones, urine is alkaline, so it needs to be acidified. Given this, it is recommended to limit vegetables and fruits in the diet, exclude dairy products that alkalinize urine, and increase the consumption of meat, fish and vegetable oil, which acidify urine. With this type of stones, a drinking regimen is recommended in a slightly smaller volume than, for example, with oxalate and urate stones.

With carbonate stones, when urine becomes alkaline, calcium-rich foods (milk, cheese, yogurt, cottage cheese) are limited in the diet. Preference is given to oatmeal, boiled meat and fish, eggs, butter (in general, the "meat" table), as they increase the acidity of urine.

With urate stones, it is recommended to limit the use of foods that contribute to the formation of uric acid in the body (liver, kidneys, meat broths). It is also recommended to limit the diet of meat and fish, as well as vegetable fats, which acidify urine. Official drugs that alkalinize urine include blemaren, uralit, etc.

With oxalate stones, it is recommended to limit the consumption of foods rich in oxalic acid and calcium: potatoes, lettuce, milk, cottage cheese and cheese. Often such sick animals are advised to take magnesium carbonate daily. This is due to the fact that magnesium binds oxalic acid salts in the intestines.

For all types of urolithiasis, the following general recommendations should also be followed:

Increase the volume of fluid intake or regularly take diuretic infusions or decoctions of various herbs;
avoid eating too much food (do not overfeed animals). Weight loss by reducing the intake of high-calorie foods reduces the risk of disease;
increase physical activity (for dogs) or play for cats. However, excessive physical exertion should also be avoided;
avoid emotional stress;
do not overcool much, always keep the lower back warm;
if even slight signs of illness appear, apply heat to the lumbar region and immediately call a veterinarian at home.

If renal colic has taken you by surprise, then taking a warm bath or a heating pad on the lumbar region can help. It is necessary to take a drug with an antispasmodic effect and call a doctor.

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

Lower urinary tract disease in cats is a major problem in modern small animal veterinary medicine. The most serious disease of the urinary tract is recognized as urolithiasis and its 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 in the early 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 urologic disorders develop urolithiasis, cats have a higher proportionate mortality from urolithiasis than humans and dogs. Therefore, this problem goes beyond the scope of 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 urolithiasis is devoted to a lot of research in both humane and veterinary medicine. A large number of proposed various methods of treatment, 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 treating 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 a violation 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

Causes of urolithiasis can be:

Improper feeding (excess of proteins and lack of carbohydrates, excessive feeding of fish containing large amounts 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 causes lead to metabolic disorders, in which there is an excessive excretion of various metabolic products in the urine. So, for example, too early castration of a cat, accompanied by the removal of the testicles, 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 tripel phosphates. Neutered cats develop phosphate stones very quickly. Long-haired Himalayan and Burmese cats are most predisposed to oxalate urolithiasis, which occurs in about 25% of urolithiasis cases in cats, in addition to Persians. Overall, 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 out in the urine, which leads to spasms and urinary retention, followed by urinary tract infection and the development of acute renal failure. Males are most susceptible to KSD because their urethra is longer and narrower than that of females.

3. Pathogenesis and symptoms of the disease

With KSD, various sparingly soluble salts accumulate in the kidneys and urinary tract, which ensures a change in the acidity (pH) of 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 (there are spines on the surface of these stones that injure the vascular walls, contributing to inflammation), and phosphates are made of calcium and magnesium phosphates. Phosphate and struvite stones form mainly in alkaline urine and grow very rapidly. 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 the normalization of urine pH 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 the sand in the urine.

Uroliths are formed by the aggregation of mineral crystals. Urethral plugs, on the other hand, are made up of a protein matrix that 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 lining 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 leads to stagnation of urine and the development of a 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 the urine shifts to the acid side for urates, oxalates and to the alkaline side for phosphates (normal 6.5 - 7), the density of the urine increases. The animal refuses to eat, is depressed, 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 posture (hunches over) during urination, lingers in it for a long time, the pulse rate, respiration rate, and temperature increase. The animal experiences pain when it is touched on the stomach, goes to the toilet more often (or vice versa can urinate anywhere), the amount of urine decreases, the urine may be cloudy or bloody (hematuria), urination is difficult (or vice versa very frequent and painful) or may be absent altogether.

4. Diagnosis

Anamnesis. During the survey, it is usually possible to find out the main events in the development of the disease preceding the patient's admission to the veterinary specialist: when did the first signs of the disease appear, whether such disorders had occurred before, whether there is an 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, 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, the conditions for keeping a sick animal. After collecting an anamnesis, they proceed to a general clinical study.

Inspection. Many urologically ill cats and cats, even in a new environment, at a doctor's appointment, take a forced body position for urination, sometimes excreting a small amount of cloudy or bloody urine. Tousled, matted hair, sunken eyes, dryish mucous membranes, and shortness of breath indicate a long-term disease. With acute urinary retention in patients, severe neurological disorders can be detected: nystagmus, muscle twitching, forced head position - flexion of the occipito-atlantic joint, "look from under the brows." Quite rarely, overflow of the bladder is visually determined: a pendulous asymmetrical abdomen. When examining the perineum, it is possible to detect dried fragments of urethral plugs, salt crystals, blood clots, 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 the urological syndrome develops, the patient's body temperature steadily decreases and after 24-48 hours it 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, thickened. In the case of acute urinary retention, the soreness 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 removal of obstruction and emptying of the bladder. 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 characteristic crepitus of stones. If the kidneys are available for examination (in obese animals, the kidneys are not easily accessible for palpation), their location, shape, pain, and size are determined. This provides valuable information for excluding kidney pathology unrelated to feline urolithiasis. By palpation, in general clinical conditions, it is possible to determine the degree of dehydration and hemomicrocirculation disorders in urological patients.

Examination of the urethra. Palpation of the urethra in cats is of considerable 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 obstructions to the outflow of urine. Having exposed the head of the penis, they study the state of the mucous membrane of the preputial sac, head and urethra, often find hyperemic mucous membrane of the urethral opening, urethral plugs of various composition. In some patients, the urethral plug is extremely strongly “soldered” with the mucous membrane. In severely dehydrated cats, dry necrosis of part of the glans penis may occur. Light massage of the urethra is performed in order to obtain urethral contents. Sometimes with the help of massage it is possible to eliminate the obstruction of the urethra. Examination of the urethra: palpation, probing and catheterization - make it possible to establish the absence or presence of urethral obstruction and parietal calculi. It should be noted that the more proximal the obstruction is, the less organic matrix it contains, the more difficult and traumatic the obstruction elimination procedure will be.

Special research methods:

Ultrasound examination (ultrasound) - gives information about the thickness of the walls of the bladder; about the presence of sediment, calculi, 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 full contact of the sensor with the patient's skin, hair from the area under study should be shaved off. 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. Bladder and urethra stones in cats tend to be small and soft tissue in density. However, it is not advisable to completely abandon radiography, since in addition to an overview image, it is possible to perform a contrast radiograph, including double contrast, urethrocystography and emergency urography, which allow not only to make a diagnosis of urolithiasis, but also to carry out differential diagnosis.

Laboratory research methods:

Biochemical examination of urine using diagnostic strips is a simple and fairly effective method of rapid diagnostics, with which the following urine parameters can be determined within 1-1.5 minutes: pH, specific gravity, protein content, ketone content, content of bile pigments , microhematuria, microhemoglobinuria. The method has a significant drawback - with severe gross hematuria, the readings are significantly distorted and do not represent a diagnostic value.

· Studies of urine sediment are carried out by microscopy under low and medium magnification. To obtain a sediment, fresh urine is centrifuged at 1000-1500 rpm for 5-7 minutes. The undesired liquid is drained, the precipitate 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, cylinders. Significant gross hematuria is an obstacle to obtaining a "readable" urine sediment. In such cases, for an approximate determination of the type of crystals, it is reasonable to conduct microscopy of urethral plugs and calculi. The results of microscopy of urine sediment and urethral contents are almost always the same.

5. Treatment and prevention

Treatment is aimed at eliminating the pain syndrome, increasing the solubility of salts, loosening stones, and preventing further formation of urinary stones. It is possible to alleviate the condition of the animal with the help of antispasmodics (baralgin, spazgan), treatment of detected infections with antibiotics (cefa-cure, enrofloxacin, albipen LA), sulfonamides (urosulfan, sulf-120), the drug "Cat Ervin" (with 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 katazol are recommended, to eliminate urethral plugs - catheterization and washing the urethra with Ervin the Cat (16 ml per dose), hot baths (40ºC) when the cat is immersed to half of the body, anti-inflammatory therapy - dexafort .

Cats should not use medications containing glycerin and essential oils - urolesan, cystenal, pinobine, phytolysin, as this can be fatal. Avisan, cystone can be used, however, the dosage of these drugs is designed for a person, so it is necessary to take into account not only the weight of the cat, but also its sensitivity to the plants that make up the drugs.

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).

Although catheterization is often used to dislodge or break up uroliths in cats and some dog breeds, this treatment is the most dangerous for the following reasons:

* it injures tissues, leading to fibrosis and scarring, followed by narrowing of the urethra;

* introduces infection into the urinary tract.

2) Retrograde washing of the urethra.

Retrograde flushing of the urethra followed by dissolution (struvites, urates, and cystines) or cystotomy (calcium oxalates, other uroliths containing calcium and silicon dioxide) is the only treatment for urethral urolithiasis.

Method of retrograde washing out of urethral calculi. 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 squeeze the urethra opposite the pubis, below the urolith (this requires an assistant).

* A sterile catheter is inserted into the distal part of the urethra.

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

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

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

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

* You can repeat the procedure several times.

After retrograde lavage, recurrences of obstruction are very rare. In cats, this method is usually not used; in males, this low-impact method is often recommended for use.

3) Urethrostomy.

Urethrostomy is used in males when manipulation or retrograde lavage has failed. A urethrostomy creates a permanent opening in the urethra. This method is used for recurrent obstruction of the penile urethra in cats and sometimes in males. Although this is the only treatment for animals with permanent urethral obstruction, it must be used with caution because some reports indicate that 17% of feline urethrostomies result in postoperative urinary tract infections. In 10% of cats, urethrostomy and dietary changes also lead to postoperative infection, while none of the diet-treated cats has a urinary tract infection.

4) Dissolution.

Struvite, urate and cystine stones can be dissolved. This is the only non-life threatening method of removing stones in animals with urolithiasis. Dissolution is used for kidney or bladder stones. If a urinary tract infection is present, antibiotics are given as part of the treatment based on the results of the urine culture and sensitivity test. The details of the treatment 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 acidification of the urine, causing the struvite to dissolve. In addition, the high sodium content in these diets stimulates diuresis (urination), which helps flush the bladder and remove accumulated salts as soon as possible. With urolithiasis not complicated by bacterial infections, treatment with special diets brings positive results as early as 4-5 days after the start of treatment. It should be noted that the earliest possible visit to the veterinarian and early diagnosis of urolithiasis contributes to the speedy recovery of the animal and minimizes possible relapses of the disease. Of great importance is the owner's compliance with the feeding regimen of the animal.

Quality control of treatment is carried out by laboratory tests of urine and x-ray diagnostics of the presence of stones in the bladder. In the absence of stones in the urine and on the pictures, the treatment is recognized as effective, and the task of the owner in the future is to conduct a mandatory urine test at least once every six months. The optimal term for the control delivery of analyzes is 3 months.

The laboratory evaluates the pH of urine, as well as the presence and analysis of urine sediment, determining the type and number 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 crystal is completely insoluble, and the treatment of this type of urolithiasis is carried out exclusively by surgical removal of stones from the bladder. Sometimes 3-4 operations per year are required if the intensity of oxalate formation is very high.

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

calcium phosphates.

Phosphate-calcium crystalluria manifests itself in various forms: both in amorphous (calcium phosphates) and in the form of calcium hydrophosphates (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 pH sensitive 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 oxalocalcium urolithiasis), but not alkalinization of the urine, is recommended.

6) Pulsed magnetic field.

Also in practice, a method is used to treat KSD 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 neglected cases.

7) Homeopathic treatment.

Of great importance is the control of the condition of the mucous membrane of the bladder and urethra in cats with KSD.

For this, long-term therapy is prescribed with the use of Berberis-homaccord and Mucosa compositum. Medicines can be given with drinking water 2-3 times a week.

In 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 with the help of preparations cantharis compositum and berberis-homaccord.

8) Phytotherapy.

Assign in the chronic course of the disease. Decoctions and infusions of urological preparations have an antiseptic and anti-inflammatory effect, 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: a decoction of bearberry leaves (bear ears), an infusion of half-pala (herva woolly), parsley rhizomes, highlander, watercress, etc.

9) Diet therapy.

Currently, foods are more effective at preventing struvite uroliths, thus inevitably increasing the percentage of oxalate uroliths.

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

An increase in the incidence of oxalate urolithiasis in cats contributed to the development of the new Hill's Prescription Diet Feline x / d diet, which was created specifically to prevent the formation of calcium oxalate crystals and uroliths and prevent recurrence 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 intestines.The increased content of potassium citrate, which is able to form soluble salts with calcium, contributes to the partial destruction of oxalates, and soluble fibers contribute to the binding of calcium in the intestines.

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

While there are general principles for preventing both types of KSD, recommendations for specific nutrients vary considerably. 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 appears as the primary cause of urolithiasis in cats, more often as a secondary or concomitant 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 amount of urine produced and dissolve the crystal-forming substance. Urine volume is usually greater in cats fed a canned diet. Also, if the feed is highly digestible, this reduces the amount of dry matter in faecal matter, which requires less water. Thus, faecal water loss is reduced, allowing water to be excreted in the urine.

· Avoiding excessive consumption of those minerals that are constituents of urolith, thereby reducing their concentration in the 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). A dietary reduction in only one of these may mean that the other is free for absorption and will then be excreted in the urine (where it can bind to oxalate or calcium, which are released from body tissues to form calcium oxalate). It is recommended that calcium and oxalate restriction occur long-term and together. There should not be a large reduction in calcium intake, and its absorption may be reduced by binding to soluble fibers.

Prevention.

Prevention is primarily to control the acidity of the urine. Depending on the age of the animal, the types of stones differ, and quite significantly. So, in young cats (up to 5 years old), phosphates are most often detected. Acidification of urine prevents their occurrence. In older cats (6-9 years), the chance of phosphate stones (struvites) is reduced, but the risk of oxalate stones is increased, 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 (over 10 years old), the formation of oxalate crystals should be most feared: urine with a neutral acidity index when potassium citrate is added limits the risk of their formation. Allopurinol (a xanthine oxidase inhibitor) is used to prevent and dissolve urate stones. Cranberry juice has been shown to lower urine pH and prevent the formation of uroliths. An excellent prophylactic is the phytopreparation "Cat Erwin". To restore the body after surgery, the microelement preparation Gamovit-plus is indicated.

Conclusion

urolithiasis urethral cat chronic

Currently, urolithiasis is very common, the incidence is ubiquitous. Both domestic and wild animals are at risk of developing KSD, therefore, the conditions of keeping and feeding 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 its recurrence is high. Therefore, the ICD is an extensive field for the study and development of new modern methods of treatment.

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

Literature

1. E.M. Kozlov Urolithiasis of cats. N .: MAG TM, 2002. - 52s.

2. Ed. A.F. Kuznetsova Handbook of veterinary medicine - St. Petersburg: Publishing house "Lan", 2004. - 912p.

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 / a: ed. "Phoenix", 2002. - 448s.

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

Hosted on Allbest.ru

...

History reference

For the first time, they started talking about urolithiasis in the 70s of the twentieth century. In 1973 a group of researchers proposed a viral cause of the origin of urolithiasis. The role was assigned to calicivirus and herpesvirus infection of cats. This assumption has not been confirmed in numerous other studies. In the 1970s, it began to be assumed that the use of dry foods or their mixing could lead to urolithiasis. Scientists have proven that this is not the case, although the important role of magnesium salts in the occurrence of urolithiasis has been established.

It has now been established that insufficient water intake in the body of a cat and an increased pH value of urine contribute to the formation of uroliths and the occurrence of urolithiasis.

It has evolved so that cats have a weakened sense of thirst. Cats are descended from the African wild cat, and they have retained the body's ability to concentrate urine, which, accordingly, can contribute to the formation of stones - struvites (the main uroliths in urolithiasis).

Urine and its role in the cat's body

Urine plays a fundamental role in the life of cats. Its main role is to remove residual waste products of the body and toxins that accumulate in the bloodstream. Urea is excreted in the urine (hence its name) and other products, such as uric acid, creatinine, sodium, oxalates. In addition, urine plays a role in maintaining homeostasis by regulating the excretion of water and minerals from the body. Urine formed in the kidneys as a result of filtering blood through the nephrons, flows down the two ureters and accumulates in the bladder. When the animal feels the urge to urinate, the urine is expelled through the urethra.

Unlike humans, cats have a bone in their penis. With urolithiasis, the bone of the penis serves as an obstacle to the removal of stones, and most often it is in this place that the blockage of the urethra occurs.

The reasons

By and large, scientists have not yet reliably determined what can be the cause of urolithiasis in cats. It is assumed that in most cases the formation of urinary stones is caused by a violation of water-salt metabolism as a result of improper, monotonous feeding and vitamin deficiencies. There is also an opinion that the constant feeding of commercial dry food is one of the leading factors that leads to the formation of stones. And, often when examining animals, the owners admit that they basically, and often constantly feed their pets with just such feeds. And, the latter are usually supersaturated with phosphates (bone meal), the main substances contributing to the onset of the disease.

In addition to the monotonous and improper feeding of concentrated feeds, there are other reasons that can directly or indirectly affect the formation of stones in the kidneys and urinary tract:

microorganisms - staphylococci, streptococci, proteus and others;
prolonged stagnation of urine - as a result, alkalization occurs, precipitation of salts and the formation of stones;
medicines, namely their uncontrolled and too frequent use;
polyhypovitominosis - insufficient intake of vitamins in the body;
individual characteristics of the cat's body;
climatic conditions (according to the same scientists, in Russia, for example, the disease is most often found in the North Caucasus, the Urals, the Don, the Volga. This is due to the characteristics of the soil, vegetation and water composition);
violation of the functions of the endocrine organs - the thyroid gland, gonads, etc.;
small diameter of the urethra, especially for neutered cats;
inflammatory processes in the renal pelvis, urinary tract, bladder.

Symptoms

The manifestation of the disease directly depends on where the urinary stones are located, as well as on their size, the nature of the surface and mobility. The main signs of urolithiasis in cats include:

pain during urination, which is manifested by the anxiety of the animal when visiting the toilet, a tense posture, as well as plaintive sounds;
frequent urination;
hematuria, that is, the appearance of blood in the urine, while the urine turns red;
colic, which can be constant or manifest in sharp attacks (you can understand colic by the cat's anxiety, throwing around the room and meowing).

I would also like to draw attention to the fact that in case of blockage of the urinary tract with urinary stones, the disease may be accompanied by stagnation of urine. Sometimes an animal can die from uremia (poisoning of the body by products of stagnant urine). The number of stones can vary from one to several hundred. Stones injure the mucous membrane, as a result of which inflammation develops, which can cause diseases of the bladder, kidneys, and purulent urethritis. In the event that the disease process is complicated by pyelitis or pyelonephritis, that is, inflammation of the kidneys, then signs characteristic of these diseases may appear:

temperature rise;
weakness, oppression, which can be replaced by anxiety;
the appearance of pus in the urine, while it becomes cloudy and has an unpleasant odor.

If at least one of the signs listed above has been noticed in a cat, then it is advisable to contact a veterinary specialist. It is not possible to make a diagnosis on your own at home. In the veterinary clinic, it is necessary to accurately describe the signs that were observed, as well as to talk in detail about feeding. You will also need to take a urine test of the cat to the laboratory. In some cases, they may offer to do an ultrasound or x-ray.

In the laboratory, the presence in the urine of crystals of uric acid salts, the epithelium of the renal pelvis, and urinary cylinders is usually determined. Based on laboratory data, the results of ultrasound (X-ray) and make the final diagnosis of urolithiasis in a cat. However, urinary tract disease does not always indicate the presence of stones, they can have different causes and differ for dogs and cats.
Diseases of the lower urinary tract, in essence, can be explained by the following factors:

Cystitis (inflammation of the bladder) of infectious origin: when a large number of bacteria are found in the urine. In cats, infectious cystitis is quite rare.
Idiopathic cystitis: common in cats, among which it accounts for more than 60 percent of urinary tract diseases. Many factors are involved in the development of this disease, such as stress, living conditions (presence of several cats in the house, keeping exclusively indoors, etc.). Surprisingly, nutrition plays a key role in the prevention and treatment of this disease.
Urinary stones (stones), which in animals usually form in the bladder, and not at all in the kidneys, as in humans. The main role in the prevention of recurrence of this disease is played by the diet.
Tumors.

To make an accurate diagnosis, it is necessary to pass a clinical urinalysis and only after its results, draw appropriate conclusions.

What is a urinary stone

Actually urinary stones are formed from the crystals present in the bladder. These same crystals, even if they do not form stones, can nevertheless cause clinical signs of urinary tract disease or even obstruct the flow of urine, which is life-threatening for the animal.

Crystals are formed when the urine is saturated with minerals as a result of metabolic or feeding disorders, which can create favorable conditions for the formation of urinary calculi. Most people are under the delusion that dry food promotes the formation of urinary stones. After all, with the right selection of high-quality food, it helps to protect the urinary tract.

Types of stones

Struvite stones: the most common are formed from phosphate, ammonium and magnesium ions. Often formed in dogs with any urinary tract infections, which complicates the course of the disease. In this case, both problems must be treated at the same time.

Calcium oxalate stones: are also common in both dogs and cats.

Ammonium urate stones: are much less common, often associated with liver disease.

Cystine stones: the most rare of all listed.

Stones can be of various sizes, single or multiple, one or more types at the same time. To prescribe the correct treatment, it is very important to determine the type of stones. Therefore, if your pet has a stone removed surgically, take it for analysis, according to the results of which the veterinarian will be able to choose the appropriate treatment for the animal. Treatment will likely include antibiotics to fight a possible bladder infection, anti-inflammatory drugs to reduce inflammation in the urinary tract, or drugs to change the pH of the urine. With idiopathic cystitis, pheromones can go in to help the animal cope with stress.

Struvite stones can be dissolved by following special diets. Usually such a diet contains a higher percentage of sodium, but its amount is safe for the health of the animal, which stimulates thirst and fluid intake, and therefore leads to the formation of less concentrated urine. In addition, the composition of such food reduces the concentration of minerals in the urine and acidifies it. Cystine and ammonium urate stones can also be dissolved, but this requires a completely different diet that alkalizes the urine. Calcium oxalate stones are insoluble. So, they will have to be removed surgically under anesthesia.

Urinary stones in cats can be up to one centimeter in diameter. They are not formed under the influence of food, but food can reveal their presence.

predisposition to disease

Breeds most commonly affected by oxalate formation include:

Burmese;
Persian;
Russian blue;
Maine Coon;
Siamese.

The concentration of urea in the animal's urine directly depends on the content of proteins (protein) in the animal's diet. Excessive protein content in cat food (beef - 16.7%, chicken - 19%, fish - 18.5%, cottage cheese - 16.7%), with impaired purine metabolism (the end product of purine metabolism is uric acid), leads to development of uric acid urolithiasis in cats. Reducing the protein content has a positive effect, as it helps to reduce the amount of substrate favorable for the growth of pathogenic bacteria. Lactic acid diet and vegetarian diet contribute to the development of alkaline urolithiasis

The risk of developing urolithiasis in cats is higher:

with constant home maintenance;
after castration, sterilization;
with excess body weight;
with improper feeding;
in cats (cats suffer from urolithiasis much more often than cats);
in adult animals (struvite stones are more often formed in cats under 4 years old, the peak of oxalate stones formation occurs in the period of 10-15 years).

Prevention and treatment

Prevention comes down to improving the conditions for feeding and watering the cat. Be sure to take care of a varied diet. Try to avoid giving monotonous feed and drinking hard water. Introduce vitamins into your pet's diet. Don't forget to take regular walks. You can also sometimes take urine for analysis to the laboratory, where it will be possible to examine the sediment to detect the disease in the early stages.

For the treatment of urolithiasis in cats, symptomatic treatment is used, it is advisable to use painkillers, as well as antispasmodics.

In rare cases, probing the urethra or even surgical removal of urinary stones may be necessary.

The following treatment regimen is usually used:

antibiotic therapy is recommended to relieve inflammation;
It may not be superfluous to give the cat medicinal herbs: a decoction of bearberry leaves, parsley root;
the use of drugs that disinfect the urinary system (furadonin, urosulfan, metronidazole);
for destruction, removal of stones, sand - uradon, cystone are prescribed inside;
removal of spasm, elimination of pain, colic - for this, no-shpu, analgin, baralgin or any other antispasmodic drugs are administered intramuscularly;
displacement of the stone - usually a solution of novocaine is injected into the urethra and after a while they try to move the stone into the bladder (this manipulation is carried out if the cat has a blockage of the urethra with urinary stones);
washing the bladder with anti-inflammatory drugs (sodium chloride solution with an antibiotic).

diet therapy

struvite stones, can be dissolved with special diets from Royal Canin. and Hills. This diet contains more sodium (in a safe amount for the cat), which stimulates thirst and therefore water intake, resulting in more dilute urine. Also, this food reduces the concentration of minerals (magnesium and phosphorus) in the urine and acidifies it.

With struvite stones, it is necessary to exclude:

foods high in calcium compounds;
milk;
cottage cheese;
egg (yolk);
curdled milk.

boiled beef;
veal;
egg (protein);
carrot;
oatmeal (in a small amount);
liver, cabbage, fish (eel, pike).

In the application of dietary rations, it is necessary to take into account some nuances. The acidifying effect of feed on urine can be both excessive and insufficient. Therefore, in the process of treatment, repeated urinalysis is required. All medicinal feeds have contraindications, therefore, before giving them to your pets, you should contact your veterinarian. Cat food manufacturers do not recommend combining ready-made dry or canned food with natural (homemade) food. It is strictly forbidden to mix ready-made food with porridge or other products in a cat feeding bowl. Fresh, clean water (preferably filtered) should be available to the cat at all times.

Uric acid and cystine stones can also be dissolved. To dissolve them, a special diet from Royal Canin or Hills is used, which alkalizes the urine.

Unfortunately, calcium oxalate stones, are insoluble. Therefore, they will have to be removed surgically under general anesthesia.

At oxalate stones the diet should limit the intake of:

oxalic acid;
liver;
kidneys;
foods rich in calcium (milk, cheese, cottage cheese, etc.).

It is necessary that the following foods be present in the diet:

beet;
cauliflower;
peas, legumes;
boiled meat;
fish;
cereals;
vegetables.

In extreme cases, a cystomy is performed. This is a surgical opening of the bladder cavity to remove stones. Such measures are taken if the stones reach sizes that do not allow extraction using less radical methods.

During the treatment of urolithiasis, it is also necessary to correct and maintain the normal functioning of all body systems, namely: to intensively fight intoxication and replenish the loss of blood and fluid, control the function of the kidneys and heart, and prevent hypothermia of the animal. This whole complex of tasks is solved by competent infusion therapy (droppers) in combination with additional studies of urine, blood and cardiac function.

Definitions of the concept " urolithiasis disease"You can give a lot. Simply put, its essence is this - due to metabolic disorders in the body of dogs and cats, stones are formed in the urine and urinary tract, called uroliths or calculi.

Urine is a complex solution, which is a necessary medium for removing metabolic products from the body. Metabolism products (urea and creatinine), minerals (calcium, magnesium, phosphates), electrolytes (sodium and potassium), water are excreted in the urine, urine pH varies depending on the homeostatic maintenance of acid-base balance. Any deviation from the norm can lead to the development of urolithiasis in animals. Mechanical blockage of the urinary tract with calculi is the cause of urolithiasis. Stones can form in both the kidneys and the urinary tract, but the clinical symptoms of urolithiasis are associated with urinary tract disease.

Diagnosis. Urolithiasis is established when stones are found in fresh urine, in the bladder by means of ultrasound or X-ray examination and the detection of stones during the operation to remove them. The presence of stones in urine that has stood for more than an hour does not give grounds to conclude that urolithiasis, since uroliths can precipitate as a result of natural chemical reactions.

Uroliths vary greatly in composition - from homogeneous (cystin) to a complex mixture of minerals and even minerals and proteins. They also differ in appearance - from soft deposits of sandy material (mucoid plugs), which are mainly observed in cats and consist of a protein-like shell filled with mineral content, to hard smooth or uneven stones, consisting mainly of minerals and small matrices. We will not describe in detail the properties of each of the stones, this is not the purpose of this article. Fellow veterinarians involved in an in-depth study of this problem can refer to the relevant guidelines.

The formation of stones occurs for the following reasons:

1. If the concentration of the components of the urolith in the urine is higher than the possibility of their dissolution and excretion without the formation of a crystal.
2. Some types of crystals are sensitive to urine pH. So, struvites are formed only in alkaline urine (PH> 7.0). Calcium oxalates are generally not sensitive to urine pH.
3. The formation of large crystals that can cause obstruction (blockage) of the urinary tract should occur very quickly, because. with the slow formation of crystals, they are washed out of the bladder without having time to do harm.
4. The presence of a core (base) to start the formation of a large urolith. It can be the remains of cells, suture material, bacteria and, according to some reports, viruses.
5. Some bacterial infections can contribute to the development of urolithiasis. Thus, some bladder infections contribute to the development of struvite-type urolithiasis in dogs (especially in bitches and puppies of the first year of life).

Clinical symptoms of urolithiasis

The presence of uroliths in the urinary tract can cause clinical symptoms that the pet owner may or may not notice. This is especially true for cats, as they hide from the owners and their act of urination is not always seen by the owners. The main clinical symptom is the impossibility of the natural act of urination or urination is difficult.

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

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

There are several degrees of urolithiasis:

1. subclinical urolithiasis. Symptoms associated with the presence of uroliths in the urinary tract may be absent. Struvite, calcium oxalate, and other calcium-containing uroliths are radioopaque and show up on x-rays. Urinalysis may show elevated crystals and abnormal urine pH. These uroliths are usually struvite and sometimes calcium oxalate. Calcium oxalate stones often have a very uneven surface and can cause symptoms (mild to severe) of urinary tract inflammation, while smooth struvites or cystines often do not cause clinical symptoms at all. Nephroliths are rarely accompanied by clinical symptoms, with the exception of hematuria, until they move into the ureter, causing its obstruction (blockage) and hydronephrosis.

2. Mild symptoms of urolithiasis:

Some increase in urinary frequency
Mild hematuria - blood staining
Slight increase in urination time
Slight discomfort during urination
Increased genital licking

3. severe symptoms:

Pollakiuria - cats almost do not leave their toilet, dogs constantly seep and drops of urine
Urinary tenesmus (to be distinguished from constipation)
Severe hematuria - obvious blood in the urine
Severe urinary discomfort - vocalization and overt 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 life of the animal:

Anuria (lack of urination)
Weakness/collapse
Dehydration
On palpation, the bladder may not be found if it is burst or 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)
Radiopaque uroliths are seen on plain x-rays.
Contrast radiographs for radiolucent and small (less than 2 mm in diameter) uroliths
Isolation of uroliths during urination (they can be collected in a grid)

Radiography is necessary to determine the radioopacity, the site of deposition, the 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 (triple phosphate), but recently there have been more cases 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 pH level in the urine. Many veterinarians neglect laboratory diagnosis, relying on the prevalence of struvite in cats. I consider this approach to be wrong.

In dogs, urolithiasis can proceed with the formation of all known uroliths., therefore laboratory visual determination of the type of stones for dogs is very important for the appointment of treatment. The sediment of a 10 ml fresh urine sample should be microscoped immediately after collection at body temperature because time, cooling, or evaporation of the urine may precipitate crystals and give false positive or paradoxical results. Most of the common crystals in the urine have a typical appearance, and with a large number of them, one can judge the composition of the urolith, or at least its outer layer.

Rice. 2. Struvites

Rice. 3. Struvite and erythrocytes in the urine

Treatment of urolithiasis

Choosing the right 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 a nephrectomy (removal of the kidney) is possible. With nephroliths, the development of postrenal renal failure is possible. Dissolution of struvite uroliths is possible by prescribing a special diet.

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

Bladder- treatment depends on the type of uroliths. Struvites, urates, and sometimes cystines can be dissolved, and calcium oxalates and other uroliths containing calcium and silicon dioxide are surgically removed by conventional cystotomy (opening the bladder and removing stones).

Urethra- depending on how 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).

Although catheterization is often used to dislodge or break up uroliths in cats and some dog breeds, this treatment is the most dangerous for the following reasons:

it injures tissues, leading to fibrosis and scarring, followed by narrowing of the urethra;
introduces infection into the urinary tract.

2) Retrograde urethral lavage followed by dissolution (struvites, urates and cystines) or cystotomy (calcium oxalates, other calcium and silica containing uroliths) is the only treatment for urethral urolithiasis.

Method of retrograde washing out of urethral calculi

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 squeeze the urethra opposite the pubis, below the urolith (this requires an assistant)
A sterile catheter is inserted into the distal urethra.
Secure the penile part of the urethra around the catheter
Sterile saline is injected into the catheter through a syringe.
When the intraluminal pressure reaches the desired point, the assistant removes the fingers and releases the urethra
Under the pressure of saline solution, the urolith is pushed back into the bladder
You can repeat the procedure several times

After retrograde lavage, recurrences of obstruction are very rare. In cats, this method is usually not used; in males, this low-impact method is often recommended for use.

3) urethrostomy used for males when manipulation or retrograde flushing has failed. A urethrostomy creates a permanent opening in the urethra. This method is used for recurrent obstruction of the penile urethra in cats and sometimes in males. Although this is the only treatment for animals with permanent urethral obstruction, it must be used with caution because some reports indicate that 17% of feline urethrostomies result in postoperative urinary tract infections. In 10% of cats, urethrostomy and dietary changes also lead to postoperative infection, while none of the diet-treated cats has a urinary tract infection.

Dissolution

Can dissolve struvite, urate and cystine stones. This is the only non-life threatening method of removing stones in animals with urolithiasis. Dissolution is used for kidney or bladder stones. If a urinary tract infection is present, antibiotics are given as part of the treatment based on the results of the urine culture and sensitivity test. The details of the treatment are discussed below.

Struvites (Magnesium Ammonium Phosphate, Tripel Phosphates). To dissolve struvite stones, it is enough to strictly adhere to special veterinary diets. On the Russian market, they are quite widely represented, any veterinary clinic in Moscow and large Russian cities can offer a veterinary diet for your pet. We successfully use Purina (UR) and Hills (s/d, c/d) feeds.

Quality control of treatment is carried out by laboratory tests of urine and x-ray diagnostics of the presence of stones in the bladder. In the absence of stones in the urine and on the pictures, the treatment is recognized as effective and the task of the owner in the future is a MANDATORY urine test at least once every six months. In our opinion, the optimal time for the control delivery of tests is 3 months.

The laboratory evaluates the pH of urine, as well as the presence and analysis of urine sediment, determining the type and number 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 crystal is completely insoluble, and the treatment of this type of urolithiasis is carried out exclusively by surgical removal of stones from the bladder. Sometimes 3-4 operations per year are required if the intensity of oxalate formation is very high.
To prevent relapse, 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
Phosphate-calcium crystalluria manifests itself in various forms: both in amorphous (calcium phosphates) and in the form of calcium hydrophosphates (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 pH sensitive 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 oxalocalcium urolithiasis), but not alkalinization of the urine, is 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 formation of these stones increases if the dog eats soil or soil-contaminated types of vegetables (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 that the dog does not eat soil or vegetation contaminated by it.

Urolithiasis disease(urolithiasis)

Urolithiasis disease(urolithiasis) – the disease is characterized by the formation of urinary stones and sand in the kidneys and urinary tract. Animals of all kinds are ill, but most often young sheep, cattle and minks.

The disease often spreads massively among bulls in specialized complexes for fattening cattle. Sick animals are difficult to treat and are subject to culling.

Etiology . The main cause of urolithiasis is a violation of vitamin and mineral metabolism in the body, especially a lack of retinol and a violation of the drinking regimen.

Desquamated epithelium with hypo- and avitaminosis A serves as the basis for the crystallization of salts in it and the formation of stones. These violations are usually observed with a concentrated type of feeding with the inclusion in the diet of a large amount of meat and bone or fish meal and various mineral premixes.

Symptoms . Clinical signs depend on the location of the stones and their size. With the formation of small stones and sand, painlessly emerging from the urethra, there are no pronounced symptoms. Vivid clinical signs of the disease appear when the stones close the area of the urinary tract. With partial blockage, there is periodic pain when urinating, urine is discharged intermittently, in a thin stream or drops. With complete blockage, severe colic is noted, the animals groan, grind their teeth.

In the urine with urolithiasis, leukocytes, erythrocytes, deflated epithelium, small stones, urinary sand are found.

With the development of inflammation, symptoms of pyelitis, urocystitis, urethritis occur, and the number of leukocytes in the urine increases.

Diagnosis and differential diagnosis . Diagnosis is based on characteristic clinical symptoms and laboratory tests of urine, if necessary, fluoroscopy and rectal examination.

Urolithiasis must be differentiated from nephritis, pyelitis and urocystitis.

Treatment . Small stones and sand can be removed with various diuretics and antispasmodics. In some cases, the removal of stones is facilitated by catheterization and washing of the bladder and urethra. Large stones are removed surgically. With the complication of urolithiasis by the inflammatory process, treatment is prescribed, as with pyelitis and urocystitis. In all cases, to prevent the recurrence of stones, it is necessary to organize a full feeding and provide plenty of water.

Prevention is based on compliance with the technology of feeding, watering and keeping animals, providing them with active exercise. In addition, inflammatory diseases of the bladder and urinary tract should be treated in a timely manner.