Diseases of the Urinary Bladder

Chapter 79 Diseases of the Urinary Bladder



Jennifer A. Gieg, Dennis J. Chew, Mary A. McLoughlin


The bladder has a limited manner in which it can respond to a variety of diseases and insults. This accounts for the similarity in clinical signs of lower urinary tract disease despite the diverse spectrum of underlying bladder disorders. Signs of inflammation (urgency, pollakiuria, dysuria, and hematuria) are common with most diseases of the bladder. Some of the disease processes listed in Table 79-1 can be associated with obstruction to the outflow of urine. In these instances, systemic signs of uremia (anorexia, lethargy, vomiting, and dehydration), as well as decreased or absent urination, may be recognized. Inability to evacuate urine can be a manifestation of obstruction, decreased ability to contract the detrusor, or inability to coordinate detrusor contraction with urethral relaxation.



Table 79-1 CAUSES OF BLADDER DISEASE



Cystitis



Bacterial—Most common in dogs

Polypoid

Fungal—Rare

Parasitic—Rare

Chemical—Cyclophosphamide, ifosfamide

Idiopathic feline lower urinary tract disease

Suture reaction

Emphysematous


Neoplasia



Transitional cell carcinoma

Rhabdomyosarcoma (botryoid sarcoma)

Lymphoma

Adenocarcinoma

Single polyps


Congenital



Persistent urachus

Urachal diverticulum

Pelvic bladder positioning

Abnormal trigone


Trauma



Bladder contusion

Ruptured bladder


PRINCIPLES OF DIAGNOSTIC EVALUATION



Blood Tests


Complete blood count (CBC) and serum biochemical analysis are essential in patients with clinical signs referable to bladder disease that are also systemically ill (anorexia, vomiting, lethargy, weight loss, polyuria and polydipsia, anuria).



Urinalysis and Culture


Although voided urine samples may be adequate for evaluation of urine concentrating ability or presence of hematuria, obtain urine by cystocentesis for evaluation of most bladder diseases. If cystocentesis is not possible or is undesirable (e.g., suspected neoplasia), obtain samples by urethral catheterization.


• Use the dipstick part of the urinalysis to identify blood, glucose, protein, and ketones in the urine. Also perform microscopic analysis of the urine sediment. Evaluation of the urine sediment may reveal inflammatory cells (red and white blood cells), bacteria, epithelial cells, and casts or crystals that may be important indicators of the disease process.

• Perform quantitative urine culture on freshly collected urine to determine what role, if any, uropathogens are playing in a particular bladder disease.



Key Point


While a negative culture on voided urine can reliably rule out infection, a positive culture may represent contamination rather than true urinary tract infection (UTI). For this reason, quantitative cultures are much more easily interpreted when urine is collected by cystocentesis.



Diagnostic Imaging



• Lower urinary tract imaging can be used both to include and to exclude the various bladder disorders. Some combination of plain abdominal radiography, contrast urography, abdominal ultrasonography, and urinary endoscopy are required to establish a definitive bladder disease process (see Chapter 4).

• CT with and without contrast is useful in selected cases to more definitively define bladder disease. Imaging of the upper urinary tract (kidneys and ureters) in addition to the bladder is important for any disease process that could affect the upper urinary tract, such as bladder infection leading to pyelonephritis, or proliferative bladder disease that has caused obstruction of the ureteral openings or urethral outflow (see Chapter 4).


Measurement of Residual Urine Volume


Measurement of post-voiding urine volume from the bladder (residual volume testing) is occasionally helpful in the evaluation of dogs with recurrent UTI or patients suspected of partial urinary obstruction or voiding disorders. Methods to estimate residual urine volume using ultrasonography have been attempted, but we recommend passing a urinary catheter following voiding and measuring the actual urine volume.


• Normal residual volume is estimated to be 0.2 to 0.4 ml/kg in dogs.

• Normal female dogs may have up to 5 to 10 ml and normal male dogs may have up to 10 to 20 ml of residual urine.

• Cats may have up to 2 or 3 ml of residual volume that is considered normal.


Cystoscopy


Cystoscopy can be a useful diagnostic tool for a variety of conditions such as urolithiasis, mass lesions such as polyps and neoplasms, cystic diverticula, and ectopic ureters.



Biopsy


The gross and endoscopic appearance of several proliferative or inflammatory diseases of the bladder can be similar. Biopsy of abnormal bladder tissue is essential to differentiate among neoplastic, polypoid, and granulomatous changes. Samples can be obtained via cystoscopy or surgically by laparotomy (see Chapter 80).



CONGENITAL DISEASES



Patent Urachus



Etiology


The urachus is the fetal conduit that allows urine to pass from the developing urinary bladder to the placenta. It usually atrophies completely and is nonfunctional at birth. The atrophied urachus is typically seen as a fibrous connective tissue remnant at the bladder apex. If the urachus does not close normally, urine leakage may occur from the bladder to the cutaneous opening of the urachus. At its most extreme, bladder exstrophy exists in which the bladder opens directly to the outside in the area of the umbilicus.



Clinical Signs


Urine leakage is seen in the area of the umbilicus. This can range from visible dripping of urine to damp fur or skin in the area of the urachus. These signs are typically present since birth. As a result, this condition is generally diagnosed in young animals.



Diagnosis



• Physical examination: Urine may be observed to collect or leak on the ventral abdominal wall around the umbilicus. Dermatitis or urine scald may be present in the urine-soaked area.

• Urinalysis and urine culture: There is an increased risk of UTI because of the leakage of urine. The urinalysis is typically normal unless a UTI is present.

• CBC and serum biochemical analysis: These tests are usually unremarkable.

• Radiography and ultrasonography: Plain radiography is usually normal. Abdominal ultrasound may be suggestive in some cases. Contrast cystography is the preferred imaging method to reveal the patent urachus (see Chapter 4). Options include a contrast cystourethrogram, or if an orifice is identified, contrast may be introduced at the umbilical opening. In either case, it is essential that an adequate volume of the contrast agent is used to distend the bladder and patent urachus.


Treatment


Surgical resection of the patent urachus (partial cystectomy) is the only definitive treatment option (see Chapter 80).



Urachal Diverticulum (Vesicourachal Diverticulum)



Etiology



• An urachal diverticulum is a small outpouching of tissue at the bladder apex resulting from incomplete closure of the fetal urachus.

• The lesion may be undetectable in a healthy bladder, but it can become more obvious in association with bladder disease, such as urolithiasis or infection.

• A recent study indicates that urachal diverticula are common in normal dogs.

• In cats, urachal diverticula can be acquired following severe urethral obstruction and, in some cases, is a component of non-obstructive sterile idiopathic cystitis.


Clinical Signs



• No clinical signs are observed in dogs with urachal diverticula if no other bladder disease is present.

• The diagnosis may be an incidental finding on radiographs or abdominal ultrasound performed in association with other bladder disease.

• Some diverticula provide a source of urine retention that can serve as a nidus for infection. The recess makes it difficult to eradicate bacterial UTI. Over time, microscopic abscesses commonly develop around the diverticulum. Many patients have a history of lower urinary tract disease that is refractory to treatment.

• In cats, the role of urachal diverticula in creating sterile inflammation and clinical signs is controversial.


Diagnosis



• Physical examination: The diverticulum itself causes no clinical signs, but clinical signs related to secondary infection or urolithiasis may be noted.

• Urinalysis and urine culture: In the absence of infection, the urinalysis may be normal. Because of urine retention, crystalluria and UTI may be seen more frequently than in normal animals.

• CBC and serum chemistry profile: These tests are unremarkable.

• Diagnostic imaging: Diverticula are rarely observed on survey radiographs and ultrasound; usually, they are diagnosed with contrast cystography (see Chapter 4). Look for a small pouch or outpocketing of the bladder apex.



Key Point


If a small diverticulum is suspected, gradual distention of the urinary bladder with contrast may better elucidate the extent of the abnormality. Note that maximal bladder filling may distort the architecture of the bladder, making the diverticulum more difficult to identify.



• Confirmation of equivocal diverticula at surgery can sometimes be made by simple inspection, or it may require forceps to probe the region from the interior of the bladder following cystotomy (see Chapter 80).


Treatment



• If lower urinary tract disease has not occurred, the diverticulum may be an incidental finding and treatment is not necessary.

• For a documented urachal diverticulum with recurrent disease such as infection, perform surgical resection (partial cystectomy) (see Chapter 80).

• Despite the tenuous association with inflammation in cats, reduction or resolution of clinical signs of lower urinary tract inflammation has been seen in some cats following diverticulectomy. This would only be recommended in cats that have failed attempts at medical management of their disease.


Other Bladder Anomalies



• Complete agenesis of the urinary bladder is extremely rare. Bladder hypoplasia or excessively small bladder size has been reported most frequently in patients with persistent urinary incontinence. This is more likely to represent a failure to distend the bladder as a result of urethral incompetence rather than a true inability to distend the bladder.

• Malformations of the bladder wall, trigone, and vesico-urethral junction resulting in a poor distinction between the bladder neck and the proximal urethra are frequently identified in patients with ectopic ureters (see Chapter 77).

• Urinary bladder duplication and colo-urocystic fistula have also been rarely observed.

• These congenital conditions often become symptomatic in younger animals. It is necessary to rule out ureteral or urethral abnormalities that do not allow the bladder to store urine normally.

• Pelvic bladder refers to caudal positioning of the bladder within the pelvic canal. The bladder often appears elongated with a shortened urethra and an indistinct vesico-urethral junction. Pelvic positioning of the bladder can exert effects in some dogs so that urethral function is compromised, resulting in urinary incontinence. Pelvic bladder can be found as an incidental finding in dogs without urinary tract signs.


Clinical Signs



• Any abnormality leading to poor urethral tone or abnormal placement of ureters may lead to incontinence.

• Recurrent or persistent UTI and associated lower urinary tract signs may be additional findings.



Key Point


Pelvic bladders may be identified in normal dogs and, thus, should not always be considered a pathologic abnormality.



Diagnosis



• Physical examination: Abdominal palpation may reveal a small bladder or a bladder that is difficult to palpate because of its positioning.

• Urinalysis and urine culture: These are normal unless UTI is present.

• CBC and serum biochemical analysis: These tests are unremarkable.

• Radiography and ultrasonography: Radiography or ultrasonography may confirm a small bladder, an abnormal bladder shape or wall thickness, or a widened and indistinct junction between the bladder neck and the proximal urethra. Radiography is needed to diagnose a pelvic bladder (see Chapter 4).

• Cystoscopy: Cystoscopy can confirm an abnormal urethra-to-bladder transition.


Treatment


Treatment of the primary disease is not always possible. Control of UTI may be beneficial. Patients with bladder hypoplasia and ectopic ureters may show improvement in bladder capacity as continence is restored following surgical management of ectopic ureters (see Chapter 78).



Ureteral Ectopia or Trigone Abnormalities


See Chapter 77 for discussion of this topic.



INFLAMMATORY BLADDER DISEASE



Urolithiasis (Bladder Calculi)



Etiology



• Uroliths (calculi in the urinary tract) are concretions of minerals with a small portion of matrix proteins that form in the urinary tract. The urinary bladder is the most common site of urolith formation.

• Uroliths form when urine is oversaturated with minerals in susceptible individuals. Supersaturation occurs when the concentration of calculogenic minerals is increased.

• Factors such as urine pH and promoters or inhibitors of crystal formation may affect the solubility of the calculogenic minerals.

• Some types of uroliths form because of metabolic disease such as urate-containing calculi in dalmatians and calcium-containing uroliths in animals with hypercalcemia.

• Additional risk factors for urolith formation include breed, gender, age, and diet (Table 79-2). Once initiation of urolith formation has occurred, the nidus must be retained within the urinary tract, and conditions must favor continued precipitation of minerals to promote growth of the urolith.

Table 79-2 UROLITH BREED PREDISPOSITIONS























































































Predominant Mineral Type Canine Uroliths Feline Uroliths
Struvite Miniature schnauzer Ragdoll
Shih Tzu Foreign, domestic, and Oriental shorthair
Bichon frisé Chartreux
Lhasa apso Himalayan
Miniature poodle
Cocker spaniel (sterile)
Calcium oxalate Miniature schnauzer Persian
Shih Tzu Himalayan
Bichon frisé British, foreign, and Oriental shorthair
Lhasa apso Havana Brown
Yorkshire terrier Scottish Fold
Miniature poodle Ragdoll
Calcium phosphate Miniature schnauzer No breed predisposition
Bichon frisé
Shih Tzu
Yorkshire terrier
Urate Dalmatian No breed predisposition
English bulldog
Any breed predisposed to portosystemic shunt
Cystine Newfoundland Siamese
Mastiff Domestic shorthair
English bulldog
Dachshund
Tibetan spaniel
Basset hound
Silica German shepherd No breed predisposition
Old English sheepdog
Xanthine Cavalier King Charles spaniel
Dachshund


Struvite Uroliths



• Struvite (triple phosphate) uroliths are most likely to form in alkaline urine. Struvite is the most common urolith in dogs. Although struvite once was the most common urolith in cats, currently calcium oxalate is the most common.

• In dogs, UTI with urease-producing bacteria predisposes the animal to struvite stone formation in the vast majority of cases. Urease-producing bacteria cause alkaline urine, increased levels of ammonium ion in the urine, and increased trivalent phosphate ions.

• A urine culture positive for a urease-producing organism (usually Staphylococcus or Proteus species, occasionally Streptococcus, Klebsiella, or Ureaplasma species) is necessary for infection-induced struvite uroliths to develop.

• Canine breeds predisposed to struvite formation include miniature schnauzers, Shih Tzus, bichon frisés, Lhasa apsos, and miniature poodles. Cocker spaniels have been reported to develop sterile struvite urolithiasis. Feline breeds at increased risk include the Ragdoll, foreign shorthair, domestic shorthair, Oriental shorthair, Chartreux, and Himalayan. The Rex, Burmese, Abyssinian, Russian Blue, Siamese, and Birman cats are reported to be at decreased risk.



Key Point


Unlike dogs, 95% of struvite uroliths in cats are sterile and considered metabolic in origin.



Calcium Oxalate Uroliths



• Calcium oxalate crystalluria is more likely to occur in acidic urine. This is due to systemic acid-base effects and not the effects of urine pH favoring precipitation.

• Factors that contribute to calcium oxalate urolithiasis include hypercalcemia, administration of calciuretic substances (e.g., saline diuresis, furosemide, and glucocorticoids), and hyperadrenocorticism.

• Calcium oxalate uroliths are recognized more commonly in male dogs with the following breeds being predisposed: miniature schnauzers, Shih Tzus, bichon frisés, Lhasa apsos, Yorkshire terriers, and miniature poodles. Persian, Himalayan, Ragdoll, British shorthair, foreign shorthair, exotic shorthair, Havana Brown, and Scottish Fold cats are predisposed. Birman, Abyssinian, and Siamese cats are at decreased risk.


Ammonium Urate Uroliths



• Ammonium urate uroliths form when increased amounts of uric acid build up in the urine. This can occur if there is increased intake of purines, the precursors of uric acid. It is also more likely to occur in acidic urine.

• These calculi can also occur with impaired ability to convert uric acid to allantoin, the more soluble end product of purine metabolism.

• Breed predisposition to ammonium urate uroliths has been reported most often in the dalmatian. This appears to be due to both impaired conversion of uric acid to allantoin and increased uric acid resorption by the kidneys. English bulldogs are also predisposed to these calculi.

• Formation of ammonium urate uroliths can also be associated with hepatic disease, most notably with portosystemic shunts (PSSs) or microvascular dysplasia. The breeds predisposed to PSS formation include Maltese dogs, Yorkshire terriers, miniature schnauzers, and papillons (see Chapter 71).


Calcium Phosphate Uroliths



• Pure calcium phosphate (hydroxyapatite) uroliths occur infrequently in dogs and cats. Calcium phosphate is more commonly found as a component of other stones (such as struvite uroliths).

• Canine breeds predisposed to these calculi include miniature schnauzers, bichon frisés, Shih Tzus, and Yorkshire terriers.

• Alkaline urine causes increased precipitation of hydroxyapatite in the urine. Hyperparathyroidism is the most common clinical disorder associated with calcium phosphate urolithiasis.


Cystine Uroliths



• Cystine uroliths are found in both dogs and cats, although they are much less common than the types of urolith discussed previously.

• Acidic urine decreases the solubility of cystine crystals, increasing the likelihood of stone formation.

• Breeds that are predisposed to cystine urolithiasis include the mastiff, Newfoundland, English bulldog, dachshund, Tibetan spaniel, and basset hound. Siamese cats also appear to be predisposed. Male dogs and cats are more likely to develop cystine uroliths than females.


Xanthine Uroliths



• Primary xanthine urolithiasis is uncommon in both dogs and cats.

• Xanthine uroliths occur most commonly secondary to allopurinol administration in the treatment of urate calculi. This is particularly true in patients still consuming a high purine diet.

• Cavalier King Charles spaniels and dachshunds are at increased risk for primary xanthine urolithiasis. Overall occurrence of xanthine uroliths is most frequent in breeds, such as dalmatians, that are likely to be placed on allopurinol.


Silica Uroliths



• Silica uroliths occur rarely in dogs and cats.

• German shepherds and Old English sheepdogs have an increased incidence of silica urolithiasis. Males appear to be affected more frequently than females. There is no reported feline predisposition.


Clinical Signs



• Animals affected with urolithiasis of any type typically present with signs of lower urinary tract disease including dysuria, stranguria, pollakiuria, and hematuria.

• Bacterial UTI associated with uroliths may magnify clinical signs.

• A surprising number of animals with cystic calculi display no signs for protracted periods of time. Animals may have a history of passing uroliths or of previous urolith episodes.

• If uroliths are small enough to move out of the urinary bladder but too large to pass through the urethra, urethral obstruction can occur.

• In some animals, uroliths may not be associated with any clinical signs and diagnosis may be incidental.



Key Point


Diseases that predispose an animal to urolithiasis or recurrent UTI should raise the index of suspicion for uroliths.



Diagnosis



Physical Examination


The exam is often normal unless urethral obstruction is present. Uroliths may be palpated in approximately 20% of the cases. It is more difficult to palpate uroliths in dogs, particularly large breeds, than in cats.



• Animals that form ammonium urate uroliths in association with PSS may be stunted in growth or exhibit signs of hepatic encephalopathy (see Chapter 71).

• Dogs and cats with infection-induced struvite uroliths may exhibit more severe signs of lower urinary tract disease due to the bacterial UTI.


Urinalysis



• Examination of urine may reveal hematuria, pyuria, bacteriuria, and/or crystalluria.

• Urine pH may aid in predicting the possible mineral composition of the uroliths. If a UTI with ureaseproducing bacteria is present, the urine pH will be alkaline.



Key Point


Crystalluria may or may not be present with uroliths. If present, the type of crystalluria may be different from that of the urolith.



Culture and Sensitivity



• Urine cultures may be positive with any urolith because, once present, they serve as a nidus for infection and damage to the bladder mucosa, increasing the risk of bacterial UTI.



Key Point


Although struvite urolith formation is caused by a UTI in most dogs, the presence of a UTI does not prove that uroliths are composed of struvite.



• Consider culture of the bladder mucosa or a portion of the removed stone at the time of surgery if urine culture was negative.


Complete Blood Count and Serum Biochemical Analysis


CBC and serum biochemical analysis are usually normal.



• Hypercalcemia may be observed in approximately 4% of dogs and 35% of cats with calcium oxalate uroliths.

• A low blood urea nitrogen (BUN) concentration or hyperammonemia may be observed in animals with ammonium urate uroliths that form in association with liver diseases such as portosystemic shunting or microvascular dysplasia.


Diagnostic Imaging



• Survey radiography may reveal radiodense uroliths (e.g., struvite, calcium oxalate, and calcium phosphate) if they are of adequate size. Typically uroliths must be greater than 3 mm to be identified radiographically. Urate uroliths and some cystine uroliths may not be observed on plain radiographs because of their poor mineral density. Double-contrast cystography will reveal these uroliths (see Chapter 4).

• Ultrasonography may demonstrate uroliths. It can be difficult to distinguish very small uroliths from aggregates of sediment, for even experienced ultrasonographers. Only the proximal urethra may be evaluated by ultrasonography.

• Consider intravenous pyelography in animals with nephroliths or ureteroliths or in animals with recurrent bacterial UTI.



Key Point


It is essential that the entire urethra be included on radiographs of male cats and dogs with suspected urolithiasis. If necessary, obtain a separate film of the caudal abdomen to be sure that the entire urethra is evaluated.



Additional Laboratory Testing


A bile acids test or other indicator of liver function is indicated in animals with ammonium urate uroliths (other than in dalmatians or English bulldogs) to determine if hepatic disease is present (see Chapter 71).



Urolith Composition


Submit all uroliths that are retrieved for quantitative analysis, even in animals with crystalluria or history of formation of a particular type of urolith. Also, submit stones for analysis for each episode of urolithiasis to be sure that stone composition has not changed.



Treatment



• Uroliths can be treated either medically or surgically.

• Surgically remove uroliths that cause repeated urethral obstruction, that cause unacceptable clinical signs, or in which the owners do not wish to attempt medical dissolution.

• Uroliths that are smaller than the smallest diameter of the urethra may be retrieved using voiding urohydropropulsion or catheter-assisted retrieval technique.

• For all stones being treated with medical dissolution, continue therapy for 1 month after radiographic resolution of the uroliths. If no improvement is seen in size after 4 to 6 weeks of therapy, consider surgical removal.



Key Point


Because many types of uroliths are recurrent, surgical removal or medical dissolution of uroliths is not the end point of therapy. Institute appropriate preventive measures and follow-up evaluations. Lack of adequate patient surveillance is often associated with recurrent stone formation.



Struvite Uroliths (Table 79-3)



• Infection induced: Medical dissolution of infection-induced struvite uroliths is possible using appropriate antimicrobial therapy based on culture and sensitivity and a diet designed for struvite dissolution. A diet for struvite dissolution should be protein and magnesium restricted and should induce an acid urine pH (e.g., Prescription Diet s/d; Hills). The average time for dissolution of canine uroliths is 12 weeks.

• Sterile: Dissolution of sterile struvite uroliths is accomplished in a manner similar to infection-induced struvite uroliths except that antimicrobial therapy is not necessary. Average dissolution time for dogs and cats is 4 to 6 weeks.


Table 79-3 PROTOCOL FOR DISSOLUTION OF STRUVITE UROLITHS IN ADULT DOGS AND CATS



1. Confirm the mineral composition of uroliths when a stone is available. If no stone is available, make the best estimate of its mineral content using results from a combination of urine pH, radiodensity, breed, sex, and diet history.

2. If uroliths are obstructive, recommend surgical removal to the owner (see Chapter 80).

3. In infection-associated stones, begin therapy for urinary tract infection with antibiotics based on cystocentesis, culture, and susceptibility. Maintain antimicrobial therapy during, and for 3 to 4 weeks following, urolith dissolution.

4. Dietary therapy includes use of a phosphorus- and magnesium-restricted diet that is highly acidifying. Dissolution of struvite stones has been achieved following the feeding of Prescription Diet s/d (Hills) (usually canned) in both dogs and cats and IVD Dissolution Diet in cats. Compliance with dietary recommendations is suggested by reduction in blood urea nitrogen concentration (usually <15 mg/dl). Other dietary formulations designed to undersaturate urine for struvite in prevention protocols are not useful in dissolution protocols.

5. Monitor efficacy of therapy:
a. Perform serial radiographs at monthly intervals to evaluate stone location(s), number, size, density, and shape.

b. If urinary tract infection was present, perform a quantitative urine culture 5 to 7 days after initiation of therapy to document sterile urine while on antibiotic therapy.

c. Repeat urine culture several days after completion of antibiotic therapy to document sterile urine.

d. Continue all therapy for 1 month after radiographic resolution of uroliths.

e. If uroliths increase in size or have not decreased in size within 4 to 6 weeks of appropriate medical management, consider the following:
(1) The wrong mineral component was identified

(2) The nucleus of the uroliths is of different mineral composition than other portions of the urolith.

(3) Relapsing urinary tract infection or reinfection is interfering with dissolution of the stones.

(4) The owner or the patient is not complying with medical recommendations.

6. In dogs and cats with persistent urinary tract infection or stones despite appropriate medical therapy, surgical removal of the stones is recommended.


Calcium Oxalate Uroliths (Table 79-4)



• There is no medical therapy available for dissolution of calcium oxalate uroliths; however, use medical therapy to prevent recurrence after urolith removal.

• Surgical removal, urohydropropulsion, and lithotripsy are the treatment options for uroliths that are causing clinical problems.


Table 79-4 PROTOCOL FOR PREVENTION OF CALCIUM OXALATE UROLITHS



1. Calcium oxalate stones cannot be dissolved medically. Recommend surgical removal, lithotripsy, or, for small enough stones, urohydropulsion.

2. Although urinary tract infection is not a cause of calcium oxalate urolithiasis, treat secondary urinary tract infection with antibiotics based on culture and sensitivity.

3. Perform complete blood count and biochemical profile on all patients with calcium oxalate urolithiasis to rule out hypercalcemia or any other diseases (e.g., hyperadrenocorticism) that could predispose to stone formation. Identify and treat the underlying cause of hypercalcemia. Persistent hypercalcemia greatly increases the risk of recurrence.

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Aug 27, 2016 | Posted by in SMALL ANIMAL | Comments Off on Diseases of the Urinary Bladder

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