Bladder stone surgery.

Dr. Marie replied:

Oh no...I am so sorry to hear that Cooper is having this problem.

I think you mean to say he has bladder stones, rather than kidney stones. In male dogs, if there are a large number of small bladder stones they can often get into the urethra and block the dog's ability to urinate.

In 12 years of practice, I can remember having 2 cases that were severe like this. For one of them, I eventually did manage to flush the stones out, but it took two surgeries. In the second one, the stone lodged just behind the bone in the penis called the os penis. I tried for an hour to flush it out and could not. Eventually I did a surgery called a urethrostomy to make an opening in his penis so that he could urinate in front of the stone.

You could ask your vet if a urethrostomy is a possibility for Cooper. In Cooper's case, he may need something called a perineal urethrostomy which makes a hole in the urethra so that the urine would come out in a similar place that a female dog's urine would.

If your vet is not comfortable with doing a urethrostomy (as it is not a routine surgery) they may be able to refer you to a specialist.

It may not be a bad idea to ask your vet for a referral to a board certified surgeon to see if they think they can help Cooper.

I really pray he is ok!

Dr. Marie.


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Dr. Marie replied:

You're very welcome. Where in Canada are you? I practice in Ottawa.

It's hard to say exactly what the cost would be. It would likely be 1.5 to 2 times the amount that you paid for today's surgery. A really rough guide would be perhaps around $2000. But this can really vary.

Lithotripsy is not commonly done in animals. There are a few veterinary universities in the states that do it, but the cost would be very high. I don't believe there is anywhere in Canada that does it.

Your vet should be able to tell you whether Cooper would have a chance with a urethrostomy. If you can tell me what city you're in, I can tell you if there is a board certified surgeon near you.

Dr. Marie replied:

It looks like Cold Lake is about five and a half hours from the veterinary university in Saskatoon.

If a urethrostomy is an option then going to the vet college in Saskatoon would be your best choice.

Your vet really should be able to tell you whether he has a chance with a board certified surgeon. He can also consult with someone at the university and get an idea on the cost of surgery.

One other thought - did the vet mention which kind of stones these are? If they are struvite stones, we may be able to dissovle them with special food and urinary acidifiers, but it would take some time. But, if they are calcium oxalate this will not work.

Dr. Marie replied:

There are several things that can help us tell the difference. Struvite stones are usually smooth while calcium oxalate are spiky. If we look at a urine sample, the pH would be high with struvite stones and low with calcium oxalate.

Dr. Marie replied:

You can definitely respond to this question tomorrow. I may not be able to answer right away as I am seeing patients tomorrow, but hopefully I can help if you have questions.

It is really hard to say whether a urethrostomy is going to be helpful or not. It sounds like it may be an option. But, I am a little concerned that if your vet didn't mention it to you it may be that it may not work in Cooper's situation. It all depends on where the stones are and how "lodged" they are.

I am heading to bed now, but I will wait for your reply tomorrow.

Dr. Marie.

Dr. Marie replied:

Oh, I am so sorry to hear this news. I had a similar case to this several years ago. We thought the dog had a bladder stone as we could see something that looked like a stone on the xray. When we went into the bladder to remove it, there was no stone there, but there was a swelling in the bladder wall. It turns out that what we thought was a stone was a calcified tumor.

What you do from here will be a hard decision. If your vet is very certain that this is a tumor then it is not likely to go away. In cases like this, I often will suggest euthanasia because we know that he does not have a chance of fully recovering.

You can ask your vet about a medication called piroxicam. This is a non steroidal anti-inflammatory medication that has been shown to work well to shrink tumors in the bladder or urinary tract. However, you can't use piroxicam along with steroids, so if your vet feels steroids are the best medicine right now then stick with what he is saying. When there is severe swelling that is preventing urination then the steroids may be necessary for the first little while.

I don't like having a catheter left in long term. I do believe that it is uncomfortable for the dog. It is also fairly common for these to develop infections.

I think it is reasonable to keep him at home with a catheter for a day or two to see how he does and to give you some time to come to a decision. But, if this is a tumor then unfortunately he will not have a lot of time left.

I'm very sorry for the bad news.

Dr. Marie replied:

It sounds to me that your vet is doing all of the right things.

Don't ever be worried about asking too many questions! That's why I have this site...to help when things are confusing with our pet's medical care.

Most tumors in the bladder or urinary tract are something called a transitional cell carcinoma. Unfortunately there are almost all cancerous. But, the right thing to do is to biopsy (as your vet has done) to determine what it is that we are dealing with.

Unfortunately it is not a simple matter to remove a tumor from the urethra as it is likely imbedded into the wall of the urethra.

I think 3-4 days of catheterization is just fine. I do think that it is worthwhile to give this treatment a try. I am afraid though that things are not sounding good and we do need to prepare ourselves for euthanasia.

Dr. Marie replied:

From what you have described, I can see a few possible outcomes to Cooper's situation:

1. If the catheter comes out in 3-4 days and he is still not able to urinate on his own despite medications then this is not good, and I personally would not want to put him through any more discomfort.

2. If the catheter comes out and he is able to urinate better then, with medication we may get anywhere from a week to 3 months of him doing ok and then the tumor will eventually start to affect him again.

3. It's possible that this is not a tumor. (But it sounds like your vet is quite confident in this.) If the biopsy comes back as this not being a tumor, and possibly being stones after all then we could consider the surgery in Saskatoon. But, from what you have described this sounds less likely.

I hope that helps.

Just so you know, I'll be heading offline shortly...bedtime here.

Dr. Marie replied:

OK Jill...I pray that Cooper feels better and that you have wisdom and clarity in your decision making.

Dr. Marie.

Dr. Marie replied:

Hi Jill. Piroxicam can have some effect against prostate cancer, depending on which type of cancer it is. There are sometimes other drugs that we use along with piroxicam which can work as well.

It sounds like your vet wants to try to shrink the tumor with prednisone and then most likely wants to see what the biopsy results say first before deciding whether to go with piroxicam and other drugs.

Dr. Marie replied:

This really sounds like excellent news Jill! I am so pleased to hear that Cooper is able to urinate. The plan sounds like a good one.

I have several dogs in my practice that are on Piroxicam long term (i.e. several years) and have done fine. It is an NSAID and that means that it can cause issues if a dog has existing kidney problems. Some dogs can get some stomach upset on it as well, but most do ok.

It sounds like your vet is doing all of the same things I would.

I hope Cooper continues to improve!

Dr. Marie replied:

Sounds great and thanks for your kind words!

Dr. Marie replied:

Hi Jill. I'm sorry to hear that Cooper is not eating. This is usually a sign that there is something medically wrong. It may be a good idea to have your vet take another look and possibly repeat a blood profile.

As far as supplements go, you can try some canned food instead of dry (if he is not already on canned.) Iams makes a gravy that you can buy to put on dog food which sometimes helps as well. This is the product here.

However, you need to consult with your vet before adding too many things to the food as Cooper is likely on a special food and supplements can change the effect of the food.

If I have a dog on urinary food and they won't eat the food I will often have the owners try the dog's regular food for a couple of days to see if this is simply because they don't like the food. If so, then there are other options as far as urinary foods go. But if not, then we have to go looking for medical reasons for him to not want to eat.

Dr. Marie replied:

Piroxicam can cause some stomach upset, but the omprazole should really be helping with this. There really shouldn't be a difference between the liquid or pill form. Unfortunately if he's continuing to not eat then I am concerned that there is either some pain or that it is due to his body fighting cancer.

Dr. Marie replied:

Denamarin is a drug in the family called SAM-e. It's a supplement that we know helps to support the liver, but it has other good effects as well. It's not specifically for cancer though.

Previcox is another type of non steroidal anti-inflammatory very similar to Deramaxx. Some people believe Previcox may be as good as Piroxicam at fighting cancer, but there are no studies to prove this. Previcox is gentler on the stomach however.

The best advice I can give here is to keep trusting the advice of your vet!

Dr. Marie replied:

Oh, I'm sorry to hear that Cooper is not doing well. I think you're right and it may be time to make the hard decision. I'm so sorry.

Dr. Marie.