Uroliths in dogs: what the ACVIM consensus says

Question

7-year-old spayed female Bichon Frise with mild pollakiuria. Radiographs show several radiopaque cystoliths of 6–8 mm, with no urethroliths or signs of obstruction.

According to the ACVIM consensus on urolithiasis, which statement is correct?

chevron_right Show answer and explanation

A. A cystotomy should be performed first to know the composition before deciding anything

Composition can be reasonably predicted (breed, sex, radiopacity, pH, crystalluria, culture) and, if struvite, urate or cystine is likely, medical dissolution is tried first.

B. Voiding urohydropropulsion can only be used in females

It is also used in males if the uroliths are small enough to pass through the urethra; the limiting factor is urolith size relative to the urethral lumen.

C. Cystotomy should not be the first choice if the uroliths can be dissolved or removed by minimally invasive techniques

Correct. The consensus prioritises medical dissolution of dissolvable uroliths and, for the rest, urohydropropulsion, cystoscopic retrieval, laser lithotripsy or percutaneous cystolithotomy. Cystotomy carries more morbidity and frequently leaves residual uroliths.

D. All uroliths can be dissolved with diet if the urine is acidified enough

Calcium oxalate, calcium phosphate, silica and xanthine cannot be dissolved. Moreover, acidification favours oxalate, urate and cystine formation.

lightbulb Key takeaway

Before operating, predict the urolith composition and ask whether it can be dissolved or removed without opening the bladder. If the patient is not obstructed, there is time to try it safely.

References: Lulich JP et al. ACVIM Small Animal Consensus Recommendations on the Treatment and Prevention of Uroliths in Dogs and Cats (2016)

According to the ACVIM consensus on urolithiasis, which statement is correct?

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