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Bladder stone surgery.

Species: Dog
Breed: Shepherd mix
Age: 8-11 years
I just returned from the vet where my dog still is. It was discovered through xrays/ultrasound that my dog Cooper has kidney stones. The vet thought he would be able to remove them but one is too far up in the pelvis to operate on. Therefore, my options are extremely limited according to the vet. Since my dog cannot empty his bladder on his own, the vet has to do it for him. As a result, it appears that my dog will need to be put down since he cannot live that way. The vet has never seen a worse case of stones in his 20 year career. He tried infusing the stones with jolts of water but that did not work. Do you have any suggestions for the treatment and/or removal of these stones? Thanks.


Online vet, Dr. Marie

Dr. Marie replied:

Oh no...I am so sorry to hear that Cooper is having this problem.

I think you mean to say he has bladder stones, rather than kidney stones. In male dogs, if there are a large number of small bladder stones they can often get into the urethra and block the dog's ability to urinate.

In 12 years of practice, I can remember having 2 cases that were severe like this. For one of them, I eventually did manage to flush the stones out, but it took two surgeries. In the second one, the stone lodged just behind the bone in the penis called the os penis. I tried for an hour to flush it out and could not. Eventually I did a surgery called a urethrostomy to make an opening in his penis so that he could urinate in front of the stone.

You could ask your vet if a urethrostomy is a possibility for Cooper. In Cooper's case, he may need something called a perineal urethrostomy which makes a hole in the urethra so that the urine would come out in a similar place that a female dog's urine would.

If your vet is not comfortable with doing a urethrostomy (as it is not a routine surgery) they may be able to refer you to a specialist.

It may not be a bad idea to ask your vet for a referral to a board certified surgeon to see if they think they can help Cooper.

I really pray he is ok!

Dr. Marie.



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Disclaimer: Although Dr. Marie is a qualified veterinarian, the information found on this site is not meant to replace the advice of your own veterinarian. AskAVetQuestion.com and Dr. Marie do not accept any responsibility for any loss, damage, injury, death, or disease which may arise from reliance on information contained on this site. Do not use information found on this site for diagnosing or treating your pet. Anything you read here is for information only.

Customer reply:

Thank you so much for you helpful response and also for correcting me re the type of stones. I live in Canada in a smaller city so I am not too sure re the experience of the vets but would be more than willing to ask my vet about a urethrostomy. Do you know the cost involved in that type of operation and how prevalent it is? I know my vet stated that he had only seen one other case like my dog's and he said the owners chose to have their dog put down because of the costs involved. I guess I am asking if this operation is doable would my dog still have time left to live a healthy life? However, do you know if "shock waves" might work instead (lithotripsy)?


Online vet, Dr. Marie

Dr. Marie replied:

You're very welcome. Where in Canada are you? I practice in Ottawa.

It's hard to say exactly what the cost would be. It would likely be 1.5 to 2 times the amount that you paid for today's surgery. A really rough guide would be perhaps around $2000. But this can really vary.

Lithotripsy is not commonly done in animals. There are a few veterinary universities in the states that do it, but the cost would be very high. I don't believe there is anywhere in Canada that does it.

Your vet should be able to tell you whether Cooper would have a chance with a urethrostomy. If you can tell me what city you're in, I can tell you if there is a board certified surgeon near you.



Customer reply:

I am in Cold Lake Alberta about 3 hours east of Edmonton.


Online vet, Dr. Marie

Dr. Marie replied:

It looks like Cold Lake is about five and a half hours from the veterinary university in Saskatoon.

If a urethrostomy is an option then going to the vet college in Saskatoon would be your best choice.

Your vet really should be able to tell you whether he has a chance with a board certified surgeon. He can also consult with someone at the university and get an idea on the cost of surgery.

One other thought - did the vet mention which kind of stones these are? If they are struvite stones, we may be able to dissovle them with special food and urinary acidifiers, but it would take some time. But, if they are calcium oxalate this will not work.



Customer reply:

Thanks again for the info. The vet did not tell me what kinds of stones they were. How can you tell the difference?


Online vet, Dr. Marie

Dr. Marie replied:

There are several things that can help us tell the difference. Struvite stones are usually smooth while calcium oxalate are spiky. If we look at a urine sample, the pH would be high with struvite stones and low with calcium oxalate.





Customer reply:

Oh that is good to know. I will ask my vet tomorrow. Perhaps I can contact you after I spoken with him and let you know what he suggested. I am extremely appreciative of you taking the time to help me. I just moved to Cold Lake from NB and this is not my normal vet which makes it more difficult to handle. Would it be safe to say that an urethrostomy is a possiblity re keeping my dog from being put down? I realize you might not be able to make that call though since you don't know all the details of my dog's condition but in your professional opinion, I would like your "bottom line". Thanks and I promise that's my last question until tomorrow!


Online vet, Dr. Marie

Dr. Marie replied:

You can definitely respond to this question tomorrow. I may not be able to answer right away as I am seeing patients tomorrow, but hopefully I can help if you have questions.

It is really hard to say whether a urethrostomy is going to be helpful or not. It sounds like it may be an option. But, I am a little concerned that if your vet didn't mention it to you it may be that it may not work in Cooper's situation. It all depends on where the stones are and how "lodged" they are.

I am heading to bed now, but I will wait for your reply tomorrow.

Dr. Marie.



Customer reply:

The vet did another xray and ultrasound today and was able to see what he thought was a stone lodged in the urethra. He went in with the plan of trying to push the stone down
where it was easier to get at then try and take it out via the bladder. However, he discovered that the stone was not a stone but in fact a tumour. He suggested inserting a catheter so I can bring Cooper home and over the next 3-4 days give him antibiotics so he won't get an infection and also give him some sterioids to see if the tumour will shrink enough to allow Cooper to unrinate on his own. I will then take him back in next week to see if the tumour shrunk at all and if it did then the vet can remove the catheter and allow Cooper to urinate normally. The vet said Cooper could have days or weeks depending on what happens with the tumour. I don't know how long a catheter can be left in but can you please give me your thoughts on what is currently happening with my dog? Thanks,


Online vet, Dr. Marie

Dr. Marie replied:

Oh, I am so sorry to hear this news. I had a similar case to this several years ago. We thought the dog had a bladder stone as we could see something that looked like a stone on the xray. When we went into the bladder to remove it, there was no stone there, but there was a swelling in the bladder wall. It turns out that what we thought was a stone was a calcified tumor.

What you do from here will be a hard decision. If your vet is very certain that this is a tumor then it is not likely to go away. In cases like this, I often will suggest euthanasia because we know that he does not have a chance of fully recovering.

You can ask your vet about a medication called piroxicam. This is a non steroidal anti-inflammatory medication that has been shown to work well to shrink tumors in the bladder or urinary tract. However, you can't use piroxicam along with steroids, so if your vet feels steroids are the best medicine right now then stick with what he is saying. When there is severe swelling that is preventing urination then the steroids may be necessary for the first little while.

I don't like having a catheter left in long term. I do believe that it is uncomfortable for the dog. It is also fairly common for these to develop infections.

I think it is reasonable to keep him at home with a catheter for a day or two to see how he does and to give you some time to come to a decision. But, if this is a tumor then unfortunately he will not have a lot of time left.

I'm very sorry for the bad news.



Customer reply:

I appreciate you info so very much. I do have a few question to ask you though. One, if the tumour is not cancerous does this change the prognosis? The vet is going to send the slides away to see if the tumour i.e. cells are indeed cancerous. He also suggested doing a biopsy on the "tumour". Thoughts? Second, if the tumour does indeed shrink do you have any idea how long it might take? The vet suggested leaving the catheter in for 3 -4 days. Do you feel that is too long? Finally, why isn't is possible to simply surgical remove the tumour? Please forgive me for perhaps appearing thick but my mind is racing when what to do.


Online vet, Dr. Marie

Dr. Marie replied:

It sounds to me that your vet is doing all of the right things.

Don't ever be worried about asking too many questions! That's why I have this site...to help when things are confusing with our pet's medical care.

Most tumors in the bladder or urinary tract are something called a transitional cell carcinoma. Unfortunately there are almost all cancerous. But, the right thing to do is to biopsy (as your vet has done) to determine what it is that we are dealing with.

Unfortunately it is not a simple matter to remove a tumor from the urethra as it is likely imbedded into the wall of the urethra.

I think 3-4 days of catheterization is just fine. I do think that it is worthwhile to give this treatment a try. I am afraid though that things are not sounding good and we do need to prepare ourselves for euthanasia.



Customer reply:

Thank you again for the very helpful info. If the tumour does indeed shrink thus allowing Cooper to urinate on his own, do you think he'd have some quality of life for a while and how long might it take for the tumour to grow again yet blocking his ability to urinate? I realize that you are not God and cannot forsee the future so I guess I am asking you what you might tell you own patient. I do realize that time is not on his side but as any pet owner who loves their animal, I am trying to find any positive I can. Finally, how long would you suggest I give the steroids or the new med you suggested before having to deal with the thought of having him put down?


Online vet, Dr. Marie

Dr. Marie replied:

From what you have described, I can see a few possible outcomes to Cooper's situation:

1. If the catheter comes out in 3-4 days and he is still not able to urinate on his own despite medications then this is not good, and I personally would not want to put him through any more discomfort.

2. If the catheter comes out and he is able to urinate better then, with medication we may get anywhere from a week to 3 months of him doing ok and then the tumor will eventually start to affect him again.

3. It's possible that this is not a tumor. (But it sounds like your vet is quite confident in this.) If the biopsy comes back as this not being a tumor, and possibly being stones after all then we could consider the surgery in Saskatoon. But, from what you have described this sounds less likely.

I hope that helps.

Just so you know, I'll be heading offline shortly...bedtime here.



Customer reply:

Thanks so much. I will keep you informed re what happens in the next 3-4 days. I so wish I lived in Ottawa so you could treat my dog! I will contact you when I know more.


Online vet, Dr. Marie

Dr. Marie replied:

OK Jill...I pray that Cooper feels better and that you have wisdom and clarity in your decision making.

Dr. Marie.



Customer reply:

Hi Dr. Marie,

I had no intention of contacting you again until after Cooper had been rechecked on Monday but I do have something to ask you re the medication you suggested (piroxicam). According to the vet the tumour is supposedly in Cooper's prostate. I know you mentioned that piroxicam works well at shrinking tumors in the bladder and urinary tract. Would it work in tumors in the prostate? As well, my vet prescribed two meds to give Cooper over the next five days: Cephalexin and Pred ( I am assuming it is prednisone). Could you let me know your thoughts on them?
I promise to not take all your time tonight...just wanted some feedback on the meds. Thanks,


Online vet, Dr. Marie

Dr. Marie replied:

Hi Jill. Piroxicam can have some effect against prostate cancer, depending on which type of cancer it is. There are sometimes other drugs that we use along with piroxicam which can work as well.

It sounds like your vet wants to try to shrink the tumor with prednisone and then most likely wants to see what the biopsy results say first before deciding whether to go with piroxicam and other drugs.





Customer reply:

Thanks...will let you know the outcome re the tumor shrinking the first of the week.


Customer reply:

Hi Dr. Marie,

Just wanted to give you an update on my dog since you have been so helpful regarding him over the past week. The catheter was removed on Monday and to our relief, Cooper was able to urinate on his own. The vet decided to keep him on antibiotics and pain meds for the next 14 days. He also has been on steroids for the past week but will stop taking them on steroids Friday and begin taking piroxicam Monday for 30 days. After that time, we will do another xray and ultrasound to see if mass has shrunk. Obviously during the next 30 days, we will continue to keep a close eye on him to make certain he continues to be able to pass urine on his own. The vet never did a biopsy but instead send slides into the lab and the results came back today as ìnconclusive. My question to you is re the piroxicam. Is it a pretty safe drug and how long can Cooper be on it. I know that have no way of knowing for certain if Cooper has cancer but based on what the vet thinks, the mass (blockage)is attached to something because if they were stones, then the catheter would have been able to move them correct thus making him stongly feel it is indeed a tumor of some sort. Any suggestions you might be able to make would be greatly appreciated. Thanks,


Online vet, Dr. Marie

Dr. Marie replied:

This really sounds like excellent news Jill! I am so pleased to hear that Cooper is able to urinate. The plan sounds like a good one.

I have several dogs in my practice that are on Piroxicam long term (i.e. several years) and have done fine. It is an NSAID and that means that it can cause issues if a dog has existing kidney problems. Some dogs can get some stomach upset on it as well, but most do ok.

It sounds like your vet is doing all of the same things I would.

I hope Cooper continues to improve!



Customer reply:

Thank you so much. Your response was exactly what I was hoping to hear! It has been an emotional rollercoaster the past week and I am so thrilled to think that Cooper's condition could in fact be managed and/or treated. If you'd like, I can contact you again in a month to update you on how things are going. Please know that you have been so helpful to me re trying to figure out what I should do. You are a great vet and I won't soon forget all you did to address my concerns.


Online vet, Dr. Marie

Dr. Marie replied:

Sounds great and thanks for your kind words!



Customer reply:

Hi Dr. Marie,

Cooper is continuing to hang in there but his appetite has decreased significantly in the past week or so. He has absolutely no interest in eating even though we have tried a variety of different foods but with very limited results. Do you know of any supplements that might increae his appetite? Thanks,

Jill


Online vet, Dr. Marie

Dr. Marie replied:

Hi Jill. I'm sorry to hear that Cooper is not eating. This is usually a sign that there is something medically wrong. It may be a good idea to have your vet take another look and possibly repeat a blood profile.

As far as supplements go, you can try some canned food instead of dry (if he is not already on canned.) Iams makes a gravy that you can buy to put on dog food which sometimes helps as well. This is the product here.

However, you need to consult with your vet before adding too many things to the food as Cooper is likely on a special food and supplements can change the effect of the food.

If I have a dog on urinary food and they won't eat the food I will often have the owners try the dog's regular food for a couple of days to see if this is simply because they don't like the food. If so, then there are other options as far as urinary foods go. But if not, then we have to go looking for medical reasons for him to not want to eat.



Customer reply:

Hi Dr. Marie,

Sorry for the last response. My modem went kaput Friday so I was waiting for Telus had to send me a new one. Thanks for your feedback. Cooper's bloodwork and urine came back as normal so other than of course the bladder cancer, I am wondering if the meds are making him not want to eat. As I mentioned before, he is on piroxicam but I am finding it is causing him discomfort i.e. gas, upset stomach and nausea. I am giving him another pill (omeprazole 20 mg)prior to giving him the piroxicam but I had been given him the liquid form of omeprazole (3 ml) prior to beginning the pill form. In your opinion, do you think the liquid is better or does it matter? He still will eat dog treats but dog food be it dry or wet he could care less about. I do realize that since he has bladder cancer it could also be the cancer affecting his appetite but thought I would ask you what you thought. Thanks,

Jill


Online vet, Dr. Marie

Dr. Marie replied:

Piroxicam can cause some stomach upset, but the omprazole should really be helping with this. There really shouldn't be a difference between the liquid or pill form. Unfortunately if he's continuing to not eat then I am concerned that there is either some pain or that it is due to his body fighting cancer.



Customer reply:

I have tramadol to give him but he hasn't shown any signs of pain for the past week so I have not given him any. He was eating up a storm the first week he was on Piroxicam but the last 8 days or so, his appetite has slowly decreased to the point now he has very little interest in food. As well, for the past three mornings, he has vomited and has been burping and farting quite a bit. The vet suggested switching his medication to Deramaxx so we plan on not giving him the Piroxicam for the next five days then begin giving him the new med. Perhaps you are right re the reason he is not eating is due to his body fighting cancer but based on his lack of appetite and other symptoms, I feel we have no alternative but to switch his meds. Have you heard of a med called Denamarin? Previcox? Do you know if they have had any impact on fihting cancer in dogs? Not sure really where to go from here but will continue to try and do what's best for Cooper. Thanks once again for your very helpful feedback :)


Online vet, Dr. Marie

Dr. Marie replied:

Denamarin is a drug in the family called SAM-e. It's a supplement that we know helps to support the liver, but it has other good effects as well. It's not specifically for cancer though.

Previcox is another type of non steroidal anti-inflammatory very similar to Deramaxx. Some people believe Previcox may be as good as Piroxicam at fighting cancer, but there are no studies to prove this. Previcox is gentler on the stomach however.

The best advice I can give here is to keep trusting the advice of your vet!



Customer reply:

I have an appointment tomorrow with the vet. Cooper has gone down hill fast and based on the past 24 hours of him not eating and vomiting five times, I think it is time to let him go. He has struggled long enough to stay strong and it is not fair to make him fight any longer as it breaks my heart to see him the way he is. I cannot fool myself any longer in believing he will recover. I had prayed that I would not have to make this decision so soon though. I want to thank you so very much for all your advice. It was very helpful and your compassion and concern is greatly appreciated.

Jill


Online vet, Dr. Marie

Dr. Marie replied:

Oh, I'm sorry to hear that Cooper is not doing well. I think you're right and it may be time to make the hard decision. I'm so sorry.

Dr. Marie.



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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.