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Canine struvite urolithiasis

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6 Ammonium also contributes to crystallogenesis because metabolic factors. pyuria. with females people and in a study of related cocker spaniels. Its pathophysiology has not been fully elucidated. DVM. which can lead to stone formation. crystal solubility. Struvite crystal- Urine pH can alter struvite crystal solubility. for example. Vetlearn. DACVIM (Small Animal Internal Medicine) John McCue. bacteruria. They are the most common uroliths in dogs. <6.com | 2013 | Compendium: Continuing Education for Veterinarians™ E1 ©Copyright 2013 Vetstreet Inc.0) urine favor struvite crystal formation.3 Additionally. alkaline. Struvite stones have also been called urease. composed of magnesium ammonium phosphate. 3 CE Credits Canine Struvite Urolithiasis Douglas Palma. DACVIM (Small Animal Internal Medicine) Kelly Gisselman. solubility. refrigerated or not run within 60 minutes. DVM. contributing Struvite stone constituents exist within normal urine. Neurology) Animal Medical Center New York.7 ions results in precipitation and formation of particles. in which most cases of struvite urolithiasis are associated with infection.1 In this theory. urine should optimally be collected via cystocentesis concentrations. Pathophysiology As the hydrogen ions are buffered. increase urea production. Gener- • Proteus spp ated ammonia (NH3) is free to buffer hydrogen ions (H+) generated • Escherichia coli from production of carbonate and conversion of phosphorus to • Ureaplasma spp phosphate ions. have existed for thousands of years in human medicine and are a leading cause of calculi in companion animals.5 Box 1.2 Protein catabolism can alter urine pH and rapid plating. The precipitation. the urinary pH rises. phosphatic. Particles grow Common findings on urinalysis include hematuria.3) urine resulting in dissolution of struvite crystals. The urine pH is frequently neutral to calculi form if the microenvironment favors this process. Distal renal aminoglycans. local urinary microenvironment.9 Given the association Dietary factors may alter crystal solubility and urinary constituent with infection. Common Intermittent production mation is unlikely without concurrent production of the enzyme • Staphylococcus • Pseudomonas spp urease. with acidic (pH luria does not definitively result in struvite calculi. infection-induced. may promote struvite crystal growth. These factors may include a lower anion-cation following appropriate clipping and disinfection of the skin and balance of the diet and/or reduced concentrations of magnesium. urease production or sterile struvite calculi has been reported. DACVIM (Small Animal Internal Medicine) Cathy Langston.1 Local urinary factors. or sulfur. including damage to uroendothelial glycos. it is a component of struvite uroliths (MgNH4 PO4 6H2O). Ammo- crystallization theory of stone formation likely plays a role in nium also can induce local glycosaminoglycan damage that may struvite urolithiasis. a foreign body can act as a nidus for precipitation and aggregation of crystals. whereas iatrogenic struvite crystalluria is possible if urine samples are neutral and alkaline (pH >7. This document is for internal purposes only. Ultimately. Urease pseudintermedius • Klebsiella spp acts to convert urea into ammonia in the presence of water. into small crystals and aggregate into larger crystals. placed into appropriate transport media or a sterile container for phosphorus. and decrease phosphorus Struvite urolithiasis in dogs without concurrent uropathogenic and magnesium excretion. DVM. resulting in the formation of ammonium (NH4+).4 Rare risk factors can promote struvite urolithiasis. tubular acidosis has been associated with sterile urolithiasis in sex may affect the likelihood of struvite urolithiasis. but stone to struvite crystallogenesis through reduction in struvite crystal formation depends on diet. . and proteinuria. which is produced by certain bacterial species (BOX 1). DACVIM (Small Animal Internal Medicine. Reprinting or posting on an external website without written permission from Vetlearn is a violation of copyright laws. Management of struvite urolithiasis requires a multimodal approach that addresses the presence of the urolith(s) and associated infection while identifying risk factors that predispose to the development of infection.8 Additionally. struvite urolithiasis for. New York Abstract: Struvite calculi. and triple phosphate stones. and concurrent therapy.10 having higher predisposition for infections. and struvite crystalluria may be present. Veterinary Urease-producing Uropathogens Despite the factors mentioned above. supersaturation of urine with facilitate crystal and bacterial uroendothelial attachment. DVM.

these can only be used for approximation and establishing trends. LDDS) • Physical examination (vaginal examination. Laflamme DP. Ling et al15. ACTH stimulation.230(3):364-369. hematuria. and • Labrador retriever17 • Welsh corgi1 cocker spaniels between 6 and 10 years of age. Influence of diet on urinary pH. Sampling should be performed before feeding. urine and serum biochemical variables. Lulich JP. Osborne CA.3 Roughly 29% to 33% of renal calculi and Pseudomonas spp. Given the inaccuracy of urine test strips. They found that male Labrador retrievers over 10 years of age.17 cause for this trend is unknown. c Johnson KY. Canine Struvite Urolithiasis Table 1. complete blood count.16 • Dachshund1. J Nutr 1998. possible with some diets.3.17 • Poodle1 younger animals (<5 years) having an increased relative risk. Measures to Prevent Struvite Urolithiasis Goal Methods to Accomplish Goal and Comments Identification of conditions • Baseline diagnostics (serum biochemistry.com | 2013 | Compendium: Continuing Education for Veterinarians™ E2 . UCCR = urine cortisol to creatinine ratio. at the same time of day to limit potential postprandial rise in urine pH. assessment of vulvar anatomy) Management of recurrent • Early identification of lower urinary tract signs and appropriate intervention with antibiotics urinary tract infections • Management of conditions associated with recurrence • Urinary tract infection prophylaxis (i. Smith BE. • Bichon frise9.2(1):61-69. Klebsiella spp. Microbiology Anatomic Location The most common urease-producing bacteria associated with In dogs. regardless of sex.17 suggest that not only breed but also age and sex contribute to • German shepherd17 • Springer spaniel17 struvite urolithiasis predisposition. a Stevenson A.13.17 • Pekingese17 The mean age of veterinary patients is 3 to 7 years. with a wide range from 1 month to 19 years. • Lhasa apso9 • Yorkshire terrier9 were at increased risk. and Escherichia coli (TABLE 1).128(12):2761S-2762S. pollakiuria) • Urine pH monitoring could be considered to detect increases from baseline that may signify infection.11 Bacteria that occasionally produce urease include the upper urinary tract. A system to monitor urinary tract health in dogs. Bartges JW. Breeds Predisposed to Struvite Urolithiasis Signalment Females have been overrepresented in multiple studies of struvite • Basset hound17 • Miniature poodle17 urolithiasis in both human and veterinary medicine.9.15. Evaluation of the reproducibility and accuracy of pH-determining devices used to measure urine pH in dogs.11. Markwell PJ. J Am Vet Med Assoc 2007. struvite urolithiasis is most common (95%) in the lower struvite urolithiasis in dogs are Staphylococcus pseudintermedius and urinary tract.a–c Routine surveillance (by • Routine urinalyses and urine cultures veterinarian) • Periodic abdominal radiography Increased water consumption • Offer canned food • Free access to water at all times Dietary management • Reserved for sterile struvite calculi • Consider diets that favor acidification of urinary pH ACTH = adrenocorticotropic hormone.17 infections in female patients.e.. and blood-ionized calcium concentrations in healthy dogs. Vet Ther 2001 Winter. male pugs regardless of age.15 The • Crossbreed12 • Scottish terrier1.12 • Shih tzu9. b Gleaton HK. chronic low-dose antibiotics) if indicated Home monitoring (by owner) • Observe for clinical signs consistent with lower urinary tract disease (stranguria.17 Vetlearn. LDDS = low-dose dexamethasone suppression.12 This may be explained by the increased prevalence of urinary tract • Beagle1 • Miniature schnauzer1. Breed predispositions have been described (BOX 2).1 Box 2. with approximately 5% of stones reported within Proteus spp. urine culture) associated with recurrent urinary • Abdominal ultrasonography tract infections • Cystoscopy • Vaginourethrography • Hyperadrenocorticism testing (UCCR. urinalysis.14 Evidence points toward • Cocker spaniel12.

1998 before reaching a plateau. from model. pyramidal shape. Hill’s Pet Nutrition. Inc. Ireland. indicated for animals with Vetlearn.23 Medical therapy includes elimination of urease- producing organisms.. and 39% of submissions ance. FIGURE 1). (B) Smooth contour.15 The reduction in struvite vite calculi in an ex vivo for infection. Charles. Canine Struvite Urolithiasis Imaging Conventional radiography has been shown to have a 2% false- negative rate in the diagnosis of struvite urolithiasis. but struvite mean struvite calculi are with bacterial urease production in uroliths remain the most common canine uroliths in multiple present. dietary modification. pyramid-shaped stones (100%). with a smaller percentage having cystic calculi.25 Reducing urine pH increases the solubility of struvite crystals.24 Abdominal ultrasonography provides equal sensitivity. (Each scale mildly reduced albumin and phosphorus may be noted in the marker = 1 mm) first month of therapy. 44% of submissions in Canada. 52% of submissions in a measure of owner compli. infections is crucial to prevention of effective dissolution diets may reduce the numbers of struvite lolytic diets may be contra..23 Another diet (Royal in the Czech Republic. stones submitted for analysis. Inc.13.3. with a more abrupt decline between1981 and Canin USA. this finding should dogs. Dietary protein restriction decreases the amount of urea available for urinary bacterial conversion to ammonium and. Of all urolith submissions. • Routine monitoring for urinary tract known. with a reduced serum urea ni- Figure 1.23 Contrast studies using double-contrast cystography have been reported to improve sensitivity to 100%. decreases urease production. ovoid stones (80%).1 aid in determination of own.21 Canin Veterinary Diet ca. (A) Smooth-contour. necessary for success.com | 2013 | Compendium: Continuing Education for Veterinarians™ E3 .25 A bio- 42% of ureteral calculi are composed of struvite exclusively. and smooth stones with blunt edges (75%.12.and phosphorus- restricted. possibly. Royal dissolution therapy is usually the past 30 years.25 Elevations in alkaline phosphatase activity are sometimes recognized. struvite calculi.26 97% of submissions to 68%. with one study finding a effective in dissolving stru. FIGURE 2 summarizes the diagnosis and management of struvite urolithiasis. studies. some large (>1 cm) uroliths.18–20 In chemical change compatible comparison. St. humans frequently have struvite nephrolithiasis or with dietary influences can ureterolithiasis. Typical struvite urolith appearance.15 The reason for this decline is un. struvite accounts for 50% of resolve and can be used as • Effective medical dissolution therapy submitted uroliths in the United States. and facilitates diuresis through sodium naturesis.17 The decline in incidence of struvite MO) has been shown to be • Preventive efforts for struvite calculi urolithiasis is most notable in male dogs. KS) is magnesium. While stru- Incidence vite crystalluria does not • Struvite calculi are usually associated Geographic region has a notable effect on incidence. Struvite mineral content can be predicted from survey radiographs with the following predictive values: urolith size >10 mm (90%). Topeka. exists for struvite calculi. reduces urine pH and protein catabolism. • Antibiotic administration during The incidence of struvite calculi has declined gradually over nine urinary SO 13. but the author speculates that calculolytic therapy with ride concentration of calcu. urolithiasis in females over this time was less pronounced. round or trogen concentration being most reliably observed. The high sodium chlo. even for calculi <1 mm. urease inhibition. Key Points er compliance. Occasionally. 22 Treatment While spontaneous dissolution has been reported.3 Biochemical changes may be B noticed with dietary adjustment. and urinary acidification.23. Struvite stones are radiopaque on survey radiographs but appear radiolucent with double-contrast studies using 80 mg/mL iodinated contrast medium administered via A urinary catheter.16. definitive therapy should be sought. A calculolytic diet (Hill’s s/d. but the cause is unknown.22 The sensitivity is excellent for calculi that are >3 mm in diameter. should address underlying causes decrease in submissions from 79% to 16%.

Canine Struvite Urolithiasis Figure 2. Vetlearn. Diagnosis and management of struvite urolithiasis in dogs.com | 2013 | Compendium: Continuing Education for Veterinarians™ E4 .

and concerns about the induction of pancreatitis in at-risk patients have also been expressed. Tokyo. A recent abstract demonstrated efficacy at 100 mg/kg PO q12h when given with appropriate antibiotics even when diet was not Mechanical Removal changed. and poor dietary compliance. isolation of urease producing organism and struvite crystalluria).30–32 Vetlearn.3 Clinical signs do not predict calculi dissolution. using therapy. Dissolution therapy results in a sustained release of viable bacterial pathogens as the outer mineral layers dissolve. Figure 3. (C) After 2 months of dissolution therapy. Abdominal ultrasonography may provide a way of detecting small calculi without the inva- siveness or risk of iatrogenic infections associated with contrast cystography. and serial objective monitoring (radiography or ultrasonography) is important to success.23 The increased lipid content associated with protein restriction creates concerns regarding hypercholesterolemia.2. Japan ). mixed or non-struvite stone composition. Serial radiographic assessments are recommended at 4-week intervals to detect changes in calculi number.23 It is important that the same radiographic technique be used at each evaluation and that it is optimized for enhanced abdominal contrast.3 The authors recommend serial radiography until the C calculi are no longer visible and focused ultrasonography before discontinuing dissolution therapy. The reduced protein content may be inappropriate for young and old animals. and size.3 Appropriate antibiotic therapy must be used in conjunction with calculolytic diets. Hoechst assisted Ellik evacuator techniques. Larger calculi have a reduced surface area relative to small calculi and therefore take longer to dissolve (FIGURE 3). (B) After 1 month of dissolution When dissolution dietary compliance cannot be achieved.com | 2013 | Compendium: Continuing Education for Veterinarians™ E5 . medical dissolution of suspected struvite nephroli. techniques in select patient populations. location.28 Removal of small calculi can be performed with various nonsurgical In 2000. Canine Struvite Urolithiasis hypertension and cardiac disease because it may cause volume expansion and exacerbation of these diseases.29 retrieval. urinary acidification with D-L methionine could be considered. Non- struvite calculi and mixed calculi with >20% non-struvite com- position are not dissolved by diet therapy.3. lithotripsy. Clinical signs vary but often improve during B the first 10 days of therapy in accordance with infection control.3 The average duration of dissolution therapy in dogs is 3 to 3. Struvite stones that form in the presence of infection contain layers of bacterial colonies. Calculus composition cannot be predicted reliably despite the radiographic characteristics described above or the associated urinary changes (alkaline urine. and percutaneous cystolithotomy.6 months. catheter-assisted retrieval. (A) Before dissolution therapy. with a range from 2 to 5 months. It is important to perform urinalysis and culture every 4 weeks during therapy to evaluate for changing resistance patterns. These techniques include thiasis without dietary manipulation was described in two dogs voiding urohydropropulsion.25 Evidence of a persistently alkaline urine or active urine sediment may suggest ongoing infection. cystoscopic- receiving an intravenous amino acid infusion (Amiyu.26 Common causes of treatment failure include inability to control urinary tract infection.27 The duration of therapy is individualized to the patient. Radiographs of a patient during struvite urolith dissolution with diet and antibiotic therapy. Medical therapy should be continued 1 month beyond radiographic clearance because calculi <3 mm cannot be accurately detected by radiography. cystoscopic-assisted basket Marion Roussel Ltd. Successful A stone dissolution with antibiotic therapy and a noncalculolytic diet has been described.

33 nalidixic acid. vulvovaginitis) urethra. — Prostatic wash or third fraction collection (intact males) Procedures include urethrotomy.e. effect. polyps. and laparoscopic- — Cystoscopy (i. and procedure time. failure of dissolution therapy.19 exert antimicrobial activity in the urine but little to no systemic Laser lithotripsy techniques have been described for nephro. — Contrast radiography pyelolithotomy/nephrotomy.e.. If recurrence of infection is noted and no identifiable risk treatment of canine struvite nephrolithiasis or ureterolithiasis factors can be identified. etc. or — Neurologic examination (i. such as • Chemotherapy anatomic abnormalities (urachal diverticuli.32 Given the cost of lithotripsy equipment. Stone composition Recurrent Urinary Tract Infection does not influence the efficacy of fragmentation. limited Evaluate for causes of treatment failure accessibility. neoplasia. and nephrectomy for upper urinary Evaluate for systemic risk factors tract calculi.36–38 If no identifiable risk factors can be identified and Lithotripsy involves fragmenting stones mechanically using either corrected. ureteral. definitive diagnosis • Diagnostics of stone type (via quantitative stone analysis). ectopic ureters) guided cystotomy for lower urinary tract calculi and ureterotomy. urine retention) unacceptable clinical signs associated with urolithiasis.34 Evaluate for external and nonstructural risk factors • Diagnostics Surgical Therapy — Vulvar conformational evaluation (e. lithotripsy provide the clinician with minimally invasive options An elevated urine pH may allow early suspicion of infection in the management of cystic. Only 33% of nephroliths and uretero. Infections should be treated aggressively before stones patient morbidity. recessed vulva) Indications for surgical therapy include obstructive calculi of the — Perivulvar cytology (i. prophylaxis with urinary antiseptics or have not been performed. they include drugs like nitrofurantoin. cystotomy. Minimally invasive tech- niques such as percutaneous cystolithomy have allowed visualized • Poor drug absorption access to the bladder for retrieval of calculi and simultaneous access • Poor owner compliance for mucosal biopsy/culture.g. many clinicians prefer cystotomy • Poor drug selection or scope-assisted retrieval techniques. Predisposing factors for urinary tract infections include hyper- adrenocorticism. and bladder and urethral calculi in dogs. vaginal recession.e. Prophylactic antibiotic therapy includes the use of Vetlearn. and liths. granulomas).33 Procedure times are shorter in female patients (median time: 42 min) compared Evaluate for infection recurrence (relapsing and reinfection) with male patients (median time: 143 min) and for urethral calculi • Perform urine culture following discontinuation of antibiotics at (median time: 70 min) compared with cystic calculi (median 5 to 7 days and 1 month time: 105 min). However. Cystoscopic retrieval and nisms is suspected.) recover renal function with resolution of obstructive calculi. strictures. diabetes mellitus. methenamine. • Evaluation for and elimination of all risk factors if there is persistent Testing for systemic diseases and risk factors associated with both recurrence of infection overt and occult urinary tract infections should be performed. ureteroliths.com | 2013 | Compendium: Continuing Education for Veterinarians™ E6 . neoplasia. or as a means of definitive treatment.32. reducing (TABLE 1).g. • Bacterial sequestration (see internal risk factors) which can occur with traditional cystotomy. renal pelvis. Direct visualization of the bladder lumen can help reduce the likelihood of leaving calculi behind. antibiotics can be considered. Patients with recurrent urinary tract infections should be evaluated to identify and correct underlying risk factors..23. and potential to — Abdominal ultrasound (e. ability to collect samples for biopsy.35 Surgical intervention provides Evaluate for internal risk factors benefits such as reduced time to effective therapy. Large studies evaluating lithotripsy in the form. The residual calculi Evaluate for cause of urine retention rate with cystotomy has been reported to be as high as 20%. a surgical Clinical Pearl: Management of or cystoscope-guided approach must be used. Canine Struvite Urolithiasis Because direct contact with the calculus is necessary. Urinary antiseptics are drugs that liths are composed of struvite in dogs.. recurrence of struvite calculi in dogs can be Eliminate complicating drugs (when possible) reduced by careful surveillance for bacterial urinary tract infec- • Immunosuppressive drugs tions.. and immunosuppressive Minimally Invasive Techniques therapy.. reduced risk of urinary — Digital rectal and vaginal examination obstruction.3. Indication for urinary tract infection prophylaxis perivaginal dermatitis. and renal calculi. idiopathic dysfunction of local urologic defense mecha- extracorporeal shock waves or a laser. or ureters.31 • Diagnostics — Serum biochemistry Prevention — Urinalysis Increased water consumption is the mainstay of therapy in both — Complete blood count people and animals to reduce supersaturation of urine with struvite — Hyperadrenocorticism screening testing (when appropriate) constituents.

Bailie NC. 37. 33. et al. and citrate on Proteus mirabilis-induced struvite crystallization in vitro. fails to achieve optimal pH (<6. Unusual case of foreign body-induced struvite urolithiasis Philadelphia. Choi YK. Irish Vet J 2001. Canine urolithiasis: a look at over dogs with pruritic disorders receiving long-term glucocorticoid treatment.222(6):759-761. Canine lower urinary tract disease.45:225-230. and detection and management Vet Clin North Am Small Anim Pract 1999. 1999. Osborne CA. Br Jour 28. sex. Steffey MA. et al. 34.59:624-629. Rinkardt NE. Ruby AL. Hoff B. acid in clinically normal beagles. In vitro effects of pulsed holmium laser 7. evening or.106:S191-S193. <6. which could be important in preventing recurrent 23(5):407-421. J Am Anim Hosp Assoc 1992. sex and mineral composition. Osborne CA. Weichselbaum RC. Ex vivo canine struvite stone dissolution. Franti CE. Mahaffey MB. sex. Compend Contin Educ Vet 2013. medical dissolution of spontaneously occurring infection-induced struvite urocystoliths 3. 4.13(6):557-560. Evaluation of calculolytic diet in female dogs with induced struvite urolithiasis. Clapham L.158(3):327-335. Canine uroliths: analysis of uroliths from calculi. Houston DM. 39. Detection of occult urinary tract 10. Urolithiasis in dogs III: prevalence of urinary infection in 42 dogs with hyperadrenocorticism or diabetes mellitus or both.127:369-373. 3rd ed. et al. 38. Weichselbaum RC. vomiting. J Am Vet containing urinary calculi from dogs. age. Lasers Surg Med 2003. and mineral composition. 27. et al. Berent A. 18.29:231-250.9:630-642. Dibartola SP. Osborne CA. Ross SJ. Can Vet J 1999. hyperbilirubinemia. Compend Contin Ed Vet 2001. Torres SMF. Franti CE. et al. although no clinical studies dogs in Ireland. and crystal formation in urine samples from dogs and cats. Chew DJ. Lulich JP. Higbee RG. Johnson BA. Calabro S. Vet Clin North Am Small Anim Pract 1999. calculi composed of calcium oxalate or struvite in specimens analyzed from 1981 Acetohydroxaminic acid (AHA). Ruzicka M. Canalis C. Osborne CA. Sosnar M. Am J Vet Res 1998. Controlled studies of urinary interrelations of breed. Snyder DM. 31. Lulich JP. Osborne CA. Houston DM. Downey J. hemolytic anemia. Internal Medicine.144:1267-1271. Bartges JW. 2003:1619-1672.39:161-181. J Am Vet Med 16000 urolith submissions to the Canadian veterinary urolith centre from February 1998 Assoc 2005. Mishina M. Canine Struvite Urolithiasis any other antibiotic class. Syme HM. Vetlearn. Am 1997. specific gravity. Effects of storage time and temperature on 35. 40.177-184. crystalluria. Jones BR. et al. Lulich JP. Bulkova T. J Vet Med Sci 2000. 6th ed. Am J Vet Res 1986. 32. 8.47:2604-2611. Krawiec DR. 24. PA: WB Saunders. tract in dogs: 128 cases (1994-2006) J Am Vet Med Assoc 2010. Griffith DP.40(4):386-400.35(1):E1-E7. Fletcher TF. Wynn VM. Harper TA.28 25. Grant DC. Polzin DJ.3 may be helpful because acidification may prevent struvite 29(1):59-72. Dunn M. Medical dissolution and prevention of canine 30.45:1508-1519.L-methionine and antimicrobial agents for Nutr 2011. In: Textbook of Small Animal Surgery. et al. and prevent development of infection. Teratogenic effect of acetohydroxaminic 14. Treatment options in struvite stones. Canine uroliths: frequently asked questions and diagnostic imaging following cystotomy for removal of uroliths from the lower urinary and their answers. Ling GV. Larkin H. et al. J Small Anim Pract 2005.40:125-126. Davidson EB.33:243-246. sterile struvite calculi. Vet Res 1998. Fujii K. including 19.45:1266-1275. Intern Med 2001. et al. Canine and feline nephrolithiasis: epidemiology. using amino acid preparation in dogs. Seaman R. J Urol 29. Am J Vet Res 1998. Dietary modification designed to achieve urinary pH detection and prediction of mineral content. et al. et al. Pozin DJ.28:459-469.3). Urol Clin North of uroliths: lower urinary tract uroliths. Schulman R. Bartges JW. Houston DM.62(8):889-892. Defarges A. Osborne CA. anorexia. Franti CE.38(6):541-544. Eaglesome H. New alternatives for minimally invasive management 6.com | 2013 | Compendium: Continuing Education for Veterinarians™ E7 . antiseptics and/or prophylactic antibiotics in animals have not 17. Leninger JR. and mineral composition. Urocystolith detection: comparison Some authors would consider urinary acidifiers (D. et al. Bjorling DE. Osborne CA. Bianchi S. PA: WB Saunders. Hynds W. McLoughlin MA. Watanabe T. Ling GV.54(12):629-632. Use of laparoscopic-assisted struvite urolithiasis: twenty years of experience. Medical dissolution and prevention of canine petitive inhibitor of the enzyme urease. Effect of acetohydroxamic acid 13. teratogenicity. Retrospective evaluation of urinary tract 11. Frequency of incomplete urolith removal. Bartges JW: Canine struvite urolithiasis. but this has not been critically evaluated. can inhibit stone growth and feline uroliths: Diagnostic and therapeutic caveats. Leininger JR. 9. Lulich JP.24(1):149-162. Finco DR.52(1):19-25. Smith BH. Mehler SJ. Can Vet J 2004. Vet Radiol Ultrasound 1999. Imaging canine urocystoliths: in dogs. 1. Johnson DL. to April 2003. J Am Vet Med Assoc 2003. 1999:1850-1874. Osborne CA. Wang LP. J Vet Intern Med 2003. Johnson BA. In: Textbook of Veterinary energy on canine uroliths and porcine cadaveric urethra. Moyers T. but is rarely used in dogs. Philadelphia. a competitive and noncom. Were SR. Ultrastructure of selected struvite- pH. Albasan H. et al. Management of struvite uroliths in dogs. Current status of canine urolithiasis J Am Vet Med Assoc 1971.227(2):239-243. 26. Markwell PG. Diagnosis and surgical management of Dietary intervention may be considered for sterile struvite ureteral calculi in dogs: 16 cases (1990-2003). et al. Osborne CA. Koehler LA. “pulsed” for 1 week every month to 16. Dalton MN. Buettnera MT. Feeney DA. Osborne CA. Ridgway MD.40 20. Evaluation of D. J Vet 3(3):226-234. as is commonly done in cats. Canine urolithiasis. through 2001. 5. Vet Clin North Am Small Anim Pract 2008. heparin in dogs. Can Vet J 2004. Epidemiology of canine urolithiasis in the Czech on dissolution of canine struvite uroliths. Recurrent sterile struvite urocystolithiasis in infections in dogs with diabetes mellitus. McLean RJ. Troy GC. age. sulfate. less commonly. Wong HY.236(7):763-766. J Vet Int tract infection and interrelations of infection. Bartges JW. 21. Diaz SF. Omodo-Eluk AJ. Nickel JC. Am J Vet Res 1984. Republic from 1997 to 2002. Proc 2010 ACVIM Forum.57(9):1274-1287.15(3):301. et al. Changes in proportion of canine urinary been performed. Prophylactic antibiotics are typically 15. Urolithiasis in dogs II: breed prevalence. Nogueira SA. et al. contrast radiographic and ultrasonographic techniques in an in vitro bladder for prevention of struvite crystalluria when medical management phantom. et al. Favrin MG.29(1):73-111. 23.59:643-649. Abdullahi SU. Am J Vet Res 1984. 2. Jessen CR. Leininger FR. Am J Med 1999. Med Assoc 2003.222:176–179. have been performed evaluating the efficacy of preventive diets 22.L-methionine) of survey. Vet Rec 1990. Moore AEP. Rawlings CA. et al. Frequency of urinary tract infection among 12. et al. Compendium Contin Educ Vet 1981. Dissolution of infection-induced struvite bladder stones References by using a noncalculolytic diet and antibiotic therapy. age. J Am Anim Hosp Assoc 2002. complications. McGuire NC. Ling GV. Tudisco R. Bollero G.17:817-823. Vet Clin North Am Small Anim Pract cystoscopy for removal of urinary calculi in dogs.46. Adams LG. Influence of chondroitin sulfate. Feeney DA. Forrester SD. Domingo-Neumann RA. Ureters. 36. Ling GV. three related cocker spaniels. N Z Vet J 2004. Jessen CR. Griffith DP. Ling GV. Am J Vet Res 1996. Urolithiasis in dogs I: prevalence of urinary given at one-half to one-third the standard dose once daily in the tract infection and interrelations of infection. in a dog.39 Adverse effects are common. Medical dissolution of struvite nephrolithiasis 1990. Thurmond MC. Barsanti JA.45:838-840.

d. diabetes mellitus c. c. a. b. dissolution therapy takes roughly ______ b. Mixed stone composition reduce urine pH and protein catabolism.com. 1. superoxide dismutase dissolution therapy is a reduction in _______ concentration. all patients with struvite urolithiasis. serum urea nitrogen d. Effective dissolution diets are typically c. 2 4. magnesium a. designed c. diabetes mellitus. b. urease a. Canine Struvite Urolithiasis This article qualifies for 3 contact hours of continuing education credit from the Auburn University College of Veterinary Medicine. hyperadrenocorticism d. b.com | 2013 | Compendium: Continuing Education for Veterinarians™ E8 ©Copyright 2013 Vetstreet Inc. Vetlearn. catalase indirectly associated with owner diet compliance during b. Pasteurella spp c. d. after effective dissolution therapy.6 increase urine pH but reduce protein catabolism. magnesium. 9. Staphylococcus pseudintermedius a. designed to a. identification and management of predisposing factors for urinary tract infection. magnesium. carbamoyl phosphate synthase b. Those who wish to apply this credit to 3 CE Credits fulfill state relicensure requirements should consult their respective state authorities regarding the applicability of this program. The most reliably observed biochemical change that is a.6 a. 4. c. magnesium-restricted and phosphorus-supplemented. On average. increasing water consumption. Which of the following is a not common cause of occult urinary tract infection? 10. but has been c. b.and phosphorus-restricted. urinary acidification with D. CE tests must be taken online at Vetlearn. phosphorus associated with d. 7. This document is for internal purposes only. of the urine that may result in struvite urolithiasis. d. The most important aspect of struvite urolithiasis struvite urolithiasis in dogs? prevention is a. Reprinting or posting on an external website without written permission from Vetlearn is a violation of copyright laws. Sterile struvite urolithiasis is uncommon. Klebsiella spp b. test results and CE certificates are available immediately. Inappropriate antibiotic selection 5. Hypothyroidism to reduce urine pH and protein catabolism. Which is the most common uropathogen associated with 6. hypothyroidism b. c.5. 3 to 3. Escherichia coli phosphorus to acidify urine. albumin 3. View publication stats . chronic renal failure. 2. 1 d. designed to d. Preventive diets should be considered in a. with dissolution therapy. renal tubular acidosis. c.and phosphorus-restricted.and phosphorus-supplemented. patients with persistent urine pH <6. portovascular anomalies. feeding a diet formulated with reduced magnesium and b. patients with recurrent sterile struvite urolithiasis. all patients.L-methionine. magnesium. 8. months for complete dissolution. immunosuppressive therapy a. c. ____________ is not a common cause of treatment failure designed to increase urine pH and protein catabolism. The production of _______ by bacterial organisms is responsible for production of ammonium and alkalization d. Owner noncompliance d.