Internal Medicine

Procedures for Urinary Disorders

Holmium

YAG laser lithotripsy now available at UC Davis - VMTHWe are now offering laser lithotripsy for cystic and urethral calculi in male and female dogs and female cats. This procedure involves using a holmium:YAG laser (introduced through the cystoscope) to non-invasively 'break up' stones and remove them from the bladder without surgery. Holmium:YAG lithotripsy can fragment stones by means of a photothermal process and the laser energy is absorbed in <0.5mm of fluid, making it safe for urologic procedures. Once the stones are fragmented, a basket can be inserted through the cystoscope and the largest fragment is grasped to ensure that it will pass easily through the urethra. The larger pieces should be included for stone analysis to properly identify all the layers of the stone. This is important in order to subsequently initiate proper management strategies for stone prevention. All other fragments can be removed by voiding urohydropropulsion. Dogs and cats with extreme stone burdens can be more difficult, but each case can be evaluated individually and recommendations made. This is an ideal tool for urethral obstructions in male dogs. 

Photo: Urinary Disoders Photo: Urinary Disoders Photo: Urinary Disoders

Prior to referral, a urinalysis and urine culture should be performed if possible. If a urinary tract infection is suspected, appropriate antibiotics should be started at least 3-4 days prior to referral. The cost for the procedure itself is approximately $780.00-1000.00 depending on the stone burden. This price does not include anesthesia, or other diagnostics which may be warranted.

Other applications for this laser include the removal of bladder polyps and minor biopsies or masses from the bladder or urethral mucosa. We cannot perform this procedure for ureteral stones at this time. For ureteral obstructions with calculi we recommend surgery or placement of a ureteral stents. Please feel free to contact the internal medicine service if you have specific questions regarding this disease.

If you have any questions about laser lithotripsy or other lower urinary tract diagnostics and therapeutics, please do not hesitate to contact Dr. Westropp at: 530-752-1393.

Furthermore, if you have already removed stones from a patient and would like them analyzed or have questions regarding a stone analysis, visit the G. V. Ling Urinary Stone Analysis Laboratory website at: www.vetmed.ucdavis.edu/usal. You may also email the laboratory at: stonelab@ucdavis.edu or phone: 530-752-3228 with questions you have pertaining to urolithiasis. 

What is Cystoscopy? 

Cystoscopy is a diagnostic procedure that is used to evaluate the lower urinary and genital tract in male and female dogs and cats. The procedure uses a rigid scope for females and a flexible scope for males to obtain good visualization of the bladder, urethra and ureteral insertions. Both dogs and cats need to be under general anesthesia for this procedure. We have cystoscopes available for all sizes of small animals - from male cats to large female dogs. We have even scoped several other species such as goats and tortoises. 

Photo: Urinary Disoders Photo: Urinary Disoders Photo: Urinary Disoders Photo: Urinary Disoders

When is Cystoscopy Indicated?

Cystoscopy can be used to help identify ectopic ureters in dogs, a common reason many young dogs present with urinary incontinence. We can also use cystoscopy to less invasively obtain biopsies of the lower urinary tract if mass lesions such as polyps or tumors are suspected. Oftentimes, we use this technique to evaluate dogs and cats that present with recurrent urinary tract infections; if no underlying cause is found, biopsy forceps can be inserted through the scope and small samples of the bladder wall can be obtained and submitted for histopathology and culture analysis. Finally, the cystoscope can be used as a treatment option for stones (see laser lithotripsy section), ectopic ureters, as well as submucosal urethral collagen injections for treatment ofurinary incontinence.

If you have any questions about the use of cystoscopy in small animal medicine, please contact Dr. Jodi Westropp or our service coordinator, Mari Anne Green at 530-752-1393

Gerald V. Ling Urinary Stone Analysis Laboratory

The Gerald V. Ling Urinary Stone Analysis Laboratory evaluates urinary tract stones for clinicians. The site also contains information about research on lower urinary tract disorders in small animals, including projects that seek input from practitioners and clients.