Veterinary Medicine - October 2008 - (Page 561)

suspected to be composed of calcium oxalate and warrants removal. Ureteroliths will sometimes pass into the bladder or move retrograde into the kidney pelvis.50 In some cases, ureterolith passage into the bladder can be facilitated by administering smooth muscle relaxants such as prazosin (Minipress—P zer; 0.25 to 0.5 mg/cat orally twice a day; 1 mg/15 kg orally once or twice a day in dogs), uid therapy, and diuretics. Amitriptyline can also be used in dogs for ureteral smooth muscle relaxation (1 to 2 mg/kg orally once a day). If the ureterolith has not passed from the ureter in three to ve days with medical management, surgical intervention or lithotripsy may need to be considered. Consider removing an affected kidney and ureter if their function is severely impaired because of a nephrolith and the other kidney is functioning adequately as demonstrated by the results of laboratory tests and an excretory urogram or nuclear scintigraphy. Removing a urolith by surgically incising the renal pelvis or ureter is also an option but may cause permanent damage to these organs. The introduction of a percutaneous approach to surgical incision of the kidney for the purpose of urolith extraction, lithotripsy, or ureteral stent placement holds promise for decreasing associated damage to the affected area.16,17 In general, nephrotomy and ureterotomy should only be undertaken if the urolith is severely compromising renal function; is associated with severe pain, hematuria, or infection; or is steadily enlarging and causing obvious damage to kidney tissue. Otherwise, the best option is often monitoring the patient’s status by periodically evaluating the results of serum chemistry pro les, urinalyses, and abdominal imaging; observing for progressive clinical signs; providing pain management as needed; and implementing a preventive plan appropriate for the suspected urolith type. The evaluation interval will vary with the patient’s condition. Relatively asymptomatic patients may only require evaluation every two to three months, while patients exhibiting more clinical signs may warrant daily to weekly evaluation. REFERENCES 1. Osborne CA, Lulich JP, Ulrich LK, et al. Feline crystalluria. Detection and interpretation. Vet Clin North Am Small Anim Pract 1996;26(2):369-391. 2. Feeney DA, Weichselbaum RC, Jessen CR, et al. Imaging canine urocystoliths. Detection and prediction of mineral content. Vet Clin North Am Small Anim Pract 1999;29(1):59-72. 3. Weichselbaum RC, Feeney DA, Jessen CR, et al. Urocystolith detection: comparison of survey, contrast radiographic and ultrasonographic techniques in an in vitro bladder phantom. Vet Radiol Ultrasound 1999;40(4):386-400. 4. Lulich JP, Osborne CA, Sanderson SL, et al. Voiding urohydropropulsion. Lessons from 5 years of experience. Vet Clin North Am Small Anim Pract 1999;29(1):283-291. 5. Lulich JP, Osborne CA, Carlson M, et al. Nonsurgical removal of urocystoliths in dogs and cats by voiding urohydropropulsion. J Am Vet Med Assoc 1993;203(5):660-663. 6. Lulich J, Osborne CA. Beyond the stone age: minimally invasive techniques, in Proceedings. 25th Am Coll Vet Intern Med Forum, 2007. 7. Lulich JP, Osborne CA, Polzin DJ, et al. Incomplete removal of canine and feline urocystoliths by cystotomy (abstr). J Vet Intern Med 1993;7:124A. 8. Grant DC, Werre SR, Gevedon ML. Holmium: YAG laser lithotripsy for urolithiasis in dogs. J Vet Intern Med 2008;22(3):534-539. 9. Adams LG, Berent AC, Moore GE, et al. Use of laser lithotripsy for fragmentation of uroliths in dogs: 73 cases (2005-2006). J Am Vet Med Assoc 2008;232(11):1680-1687. 10. Osborne CA, Lulich JP, Polzin DJ, et al. Medical dissolution and prevention of canine struvite urolithiasis. Twenty years of experience. Vet Clin North Am Small Anim Pract 1999;29(1):73-111. 11. Forrester SD. Management of feline lower urinary tract disease, in Proceedings. Hill’s Global Symp Feline Care 2006;51-60. 12. Lekcharoensuk C, Osborne CA, Lulich JP, et al. Association between dietary factors and calcium oxalate and magnesium ammonium phosphate urolithiasis in cats. J Am Vet Med Assoc 2001; 219(9):1228 -1237. 13. Chew DJ, Buf ngton CA. Feline urolithiasis, in Proceedings. VCA Antech Semin: Update on Nephro/Urol 2006;1-5. 14. Chew DJ, Buf ngton CA. Diets and drugs for canine urolithiasis, in Proceedings. VCA Antech Semin: Update on Nephrol/Urol 2006. 15. Lulich JP, Osborne CA, Thumchai R, et al. Management of canine calcium oxalate urolith recurrence. Compend Contin Educ Pract Vet 1998;20(2):178-189. 16. Berent A. Interventional endoscopy of the urinary system in Proceedings. 25th Am Coll Vet Intern Med Forum 2007. 17. Berent A. Interventional radiology and endourology of the urinary system, in Proceedings. Am Coll Vet Surg 2006. 18. Bovee KC, McGuire T. Qualitative and quantitative analysis of uroliths in dogs: de nitive determination of chemical type. J Am Vet Med Assoc 1984;185(9):983-987. 19. Osborne CA, Lulich JP, Kruger JM, et al. Medical dissolution of feline struvite urocystoliths. J Am Vet Med Assoc 1990;196(7):1053-1063. 20. Houston DM, Rinkardt NE, Hilton J. Evaluation of the ef cacy of a commercial diet in the dissolution of feline struvite bladder uroliths. Vet Ther 2004;5(3):187-201. 21. Osborne CA, Lulich JP. Perspectives: analysis of 275,000 uroliths. DVM Newsmagazine July 1, 2006. Available at: http://veterinarynews.dvm360.com/dvm/article/articleDetail. jsp?id=360567&sk=&date=&pageID=1. 22. Osborne CA, Lulich JP. Changing trends in composition of feline uroliths and urethral plugs. DVM Newsmagazine April 1, 2006. Available at http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=408450&sk=&date=&pageID=2. 23. Cannon AB, Westropp JL, Ruby AL, et al. 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Vet Clin North Am Small Anim Pract 2006;36(6):1361-1376. 35. McClain HM, Barsanti JA, Bartges JW. Hypercalcemia and calcium oxalate urolithiasis in cats: a report of ve cases. J Am Anim Hosp Assoc 1999;35(4):297-301. 36. Lulich JP, Osborne CA, Lekcharoensuk C, et al. Effects of hydrochlorothiazide and diet in dogs with calcium oxalate urolithiasis J Am Vet Med Assoc 2001;218(10):1583-1586. 37. Pearle MS, Roehrborn CG, Pak CY. Meta-analysis of randomized trials for medical prevention of calcium oxalate nephrolithiasis. J Endourol 1999;13(9):679-685. 38. Bartges JW, Sanderson S, Osborne CA, et al. Urolithiasis in English bulldogs, in Proceedings. 16th Am Coll Vet Intern Med Forum 1998. 39. Bartges JW, Osborne CA, Lulich JP, et al. Canine urate urolithiasis: etiopathogenesis, diagnosis, and management. Vet Clin North Am Small Anim Pract 1999;29(1):161-191. 40. Houston DM, Moore AE, Favrin MG, et al. 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Kirk’s current vete http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=46550 http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=46550 http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=360567&sk=&date=&pageID=1 http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=360567&sk=&date=&pageID=1 http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=408450&sk=&date=&pageID=2 http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=408450&sk=&date=&pageID=2 http://www.vin.com/Members/SearchDB/rounds/1c070325.htm http://www.vin.com/Members/SearchDB/rounds/1c070325.htm

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Veterinary Medicine - October 2008

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