WAIT, if you haven’t read part 1 stop what you’re doing right now and go back to read it first. This post is written as a continuation of the part 1 and it probably will make zero sense maybe even less.

Scroll down once you’ve done that

 

 

So your pet has had some difficulties with urinating, peeing blood (not great) and something just seems off (maybe it’s the blood).  We took some urine and did a urinalysis and we saw, surprise surprise lots of red blood cells. There was also bacteria and a lot of it.  We are sending the urine off to the lab to check to see what antibiotics will be the most effective for this urinary tract infection. The next diagnostic step (I’m the worst right? more tests?) is the infamous radiograph. Radiographs or x-rays help us to see inside like superman or woman. We do this diagnostic step to check for uroliths, or urinary stones. Low and behold there are two big white spots we see on our xray of the bladder (yay, well not really, but good thing we checked right?????)

Urinary stones, the proverbial easter egg of bladder problems, are the cause of much pain and discomfort. These bad boys are typically caused either by a urinary tract infection, which our hypothetical patient has OR by patients metabolism and genetics. There are two main types of urinary stones calcium oxalate and magnesium ammonium phosphate (struvite). Having fun yet? So these two stones are a product of their surrounding environment, literally. Animals with uti’s typically develop struvite stones because of the bacteria metabolizing the goodies in the urine. Oxalate stones are usually due to the absence of a specific enzyme or due to an excess of the hormone cortisol. Struvite crystals are typically found in urine with a high (alkaline pH) while oxalate crystals are found in acidic urine (low pH). Struvite stones/crystals can be dissolved with diet while calcium oxalate stones need to be removed surgically. Still following? I’m not, so lets use this chart:

Struvite (magnesium ammonium phosphate)	Calcium oxalate
·        Found in high pH urine (alkaline) ·        Usually due to UTI ·        Can be dissolved ·        painful	·        Found in low pH urine (acidic) ·        Genetic/metabolic usually ·        Cannot be dissolved ·        Also painful

So we see what we believe are stones in what we know is the bladder. We are also confident that our patient has a urinary tract infection. So we will make a tentative diagnosis of struvite urolithiasis. Now we have two options: option 1) treat the urinary tract infection and place the animal on a dissolution diet (dissolve that bad boy-because struvites can dissolve) or option 2) remove it surgically. Now we can be honest, most people don’t want the surgical option and yes waiting and dissolving CAN be a viable option. However, I would like to point out a few things to consider:

If they are big stones, they may take a very very long time to dissolve and while we wait for them to melt away they are clink clacking around your pets bladder, not fun for fluffy. Eventually they will get to a size where they could be small enough to pass or maybe not quite small enough to go all the way through and lodge somewhere to cause a blockage (medical emergency). As these sharp and hard stones are bouncing in your pets bladder like a kid with scissors in a jumpy castle they can cause lots of irritation and damage. This can result in mucous/blood clots that can cause the same blockage a stone can. Another factor to consider if the species and the sex: male cats, tiny urethra= easy blockage.

So we take our pet to surgery to remove these stones, and flush out the beginnings of new stones (sand and grit). Once we have removed the problem we now plan on how to prevent more from forming. We place them on antibiotics to clear the urinary tract infection (recheck urine after to make sure it’s gone!) and put them on a special diet. Maybe most importantly we encourage increased water consumption.

Urinary diets serve to modify the urine pH preventing struvite, limit calcium to stop calcium oxalate crystals from forming and, to increase water consumption.

There is ALOT of info there, sorry! but check out these main points:

1. Diagnostics are key, if we stopped at UTI we would have missed the stones
2. Two types of stones, each with its own options on treatment
3. Consider surgery even if the stone is dissolvable
4. Finish off antibiotics, always, make sure that infection is gone
5. If a urinary diet is recommended it may be worthwhile to remain on it unless you love UTI’s and stones,…
6. dissolution is the solution to pollution= drinking lots of water makes sure the concentration is low making it hard for crystals to link up and form stones

**many different stones exist eg Dalmations are well known for developing urate crystals and sometimes require specialized diets and medications.