Lola is a 9 year old spayed female shih tzu dog who presented to REACH with difficulty urinating. As a result of her problem she was also reluctant to eat or drink; she even had some vomiting as reported by her owner. She had a history of urolithiasis (urinary stones) and there was high suspicion that this was a relapse of the previous problem. When she arrived at REACH it was reported that she had urinated 12 hours before with a successful void. Yet since that time she’d been straining to urinate with no success, once again supporting the suspicions that her urinary tract was obstructed. Prior to visiting REACH she had been to her primary care veterinarian to see if it was indeed a relapse. Her visit resulted in her regular vet scheduling her for surgery on that following Monday morning. Unfortunately Lola would need attention to her problem before then. Addressing the problem began with diagnostics and concluded with surgery and supportive care to correct the problem.
Before Lola could go to surgery the diagnosis had to be verified through diagnostic measures. She had lab work done that week, and it showed everything to be normal, but analysis of her bladder and urinary tract still needed to be performed. Therefore a radiograph (or x-ray) was taken to see if any visible uroliths (or stones) were present in the urinary tract or the bladder. Upon taking this radiograph it was clearly visible that Lola had multiple stones filling her urinary bladder as well as her urethra. Her owner was informed of the findings and was told that Lola needed surgery; the surgery could wait until Monday if her owner desired that but the urinary obstruction would need to be done as soon as possible to prevent Lola from going into renal failure. To ensure Lola better health and comfort her owner decided to go ahead and have the surgery done at REACH.
Lola’s surgery began with an anesthetic induction that brought her into a safe anesthetic plane to allow the doctor to perform the procedure. The procedure consisted of making an incision along the ventral midline of the abdomen allowing the doctor to gain access to the bladder. Next the bladder was drained of 60 mls of urine via a needle. This is referred to as a cystocentesis; this aided in exteriorizing the bladder so it could be operated on. Once this was complete, a ventral incision was made into the bladder allowing the doctor to remove all the stones that were present in the bladder. Then a urinary catheter was placed from the vulva into the urinary tract that advanced up to the bladder; this forced the obstructing stones out of the urethra and into the bladder, hence freeing the urinary tract from obstruction. After this was completed the bladder and urethra were thoroughly lavaged with sterile saline to remove any additional stones that may have been unseen by the naked eye. The bladder was then sutured closed in a pattern that would allow it to perform in a normal fashion. Following this the abdominal wall was closed by suturing it shut. The patient was allowed to wake up from anesthesia and recover. At that point only post-op monitoring and supportive care would be the plan for Lola’s remainder of hospitalization.
After surgery Lola was monitored closely, especially during her recovery from anesthesia. She was kept on heat support and IV fluids to maintain adequate body temperature and circulation. Antibiotics and pain medications were given appropriately to keep her comfortable and to prevent any infection. Urinations were monitored very closely to ensure no problems arose. Overall the remainder of Lola’s stay was quite uneventful, which is fortunate because that usually means no additional problems. However, she did come back into REACH a few days later when her owner thought she seemed uncomfortable. An ultrasound found her bladder walls a bit thickened, probably from post-op inflammation. She was prescribed an anti-inflammatory and sent home. She’s been doing much better since.