Case 3

Ava Jones
Female rat terrier mix
Bladder stones (cystoliths)
Cystotomy performed 11/5/14

Ava is a seven year old rat terrier mix that presented to us at the clinic for lethargy, poor appetite, and frequent urination.  Ava was depressed during her appointment and her abdomen seemed painful.  Dr. Dutton suggested completing a full blood panel and x-rays of her abdomen right away. Ava’s blood panel was done first and we could see that she had a very high white blood cell count.  The type of white blood cells that were elevated are called neutrophils.  These cells become active and multiply whenever there is an infectious process going on.  Now we knew that Ava had a pretty serious infection.  We just didn’t know where.  Her blood panel also showed that her kidneys and liver were working normally.

Ava X-RayAva's X-Ray

Next, we completed Ava’s x-rays.  Oh boy!  We could see what was wrong right away.  Can you see what is abnormal on Ava’s x-rays?  Those big white structures towards the back of her abdomen are in her bladder.  They’re bladder stones!  And they’re huge!

Ava is such a good dog; her owners couldn’t tell she was in any discomfort until the bladder stones got to be this size.  She also didn’t have the typical signs of bladder stones such as frequently urinating until just before we saw her at the clinic.

With the Jones’ approval we started Ava on an antibiotic and pain medication and scheduled her for a bladder surgery (cystotomy) with Dr. Dutton the very next day.  A cystotomy is performed by making an incision into the abdomen and another incision into the bladder.  The stones, which are called cystoliths when they are located in the bladder, are removed with careful manipulation and saved for further analysis.  Ava’s many cystoliths ranged in size from a golf-ball size to gritty material like sand.  Because she had that gritty material, Dr. Dutton turned the bladder inside out and wiped out the inside with sterile moist gauze.  A urinary catheter was placed through the urethra which exits the vagina.  Dr. Dutton used this catheter to make sure no cystoliths were left within the urethra.  After removing the catheter, she sutured the bladder and abdomen closed.  A post-operative x-ray was taken so that we were absolutely certain all of the cystoliths were removed.  Doesn’t it look better than the original x-ray!

The cystoliths were sent off to a laboratory in Minnesota to be analyzed.  The lab determined they were triple phosphate, commonly known as struvite, cystoliths.  Dr. Dutton called the Jones’ and they decided to keep Ava on a prescription dog food called c/d that changes the pH of the urine so that these stones are not able to form.  Without this food, Ava would have likely formed cystoliths again in the future.

This was her bladder before the stones were removed. Dr. Dutton reports the bladder was enlarged and completely filled with stones. It felt like "a bag of marbles."

Look at all the stones Dr. Dutton was removing!


The stones greatly varied in size, from
large marble size to sand.

The inside lining of Ava's bladder was
greatly inflamed from the stones. Ouch!


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