Dear Dr. John,
Our six-year-old Maltese is a neutered male and has never had any health issues until very recently. He recently was struggling to urinate and had some blood in his urine, so I took him to our vet. They diagnosed that he had some stones in his urethra. We elected to have them try and push the stones back into the bladder but apparently there was a lot of debris there as well. A procedure was done to open the bladder and remove all of the contents. What caused all of this? We were also told that there might be a possibility that our dog could have a liver shunt. They are suggesting some follow up tests to assess him for the shunt but, as I write, he is straining to urinate again, so I have scheduled a recheck. What could that be, another infection or more stones? K.F.
Dear K.F.,
Bladder stones develop in various species, including dogs, for different reasons. These can include inborn errors of metabolism, diet, etc. It is less traumatic surgically to retro pulse the stones, known as uroliths, back into the bladder for retrieval and removal rather than cutting down onto the urethra. Sometimes a cut down is required for stones that do not move.
Once removed, it is important to have an analysis of the removed uroliths since there are various types and this will dictate follow up care including the possible use of prescription diets to prevent or reduce the likelihood of recurrence. Maltese are a breed of dog that is more prone to liver shunts called portosystemic shunts (PSS), that are either congenital and present at birth or that might develop later in life. The uroliths associated with shunts in older dogs are urate stones. If that is what was found then appropriate testing will include checking bile acids, liver enzymes, ultrasound, and urinalysis. If a shunt is indeed found in your dog, surgery can possibly be done to correct it.
Diagnostics will dictate what needs to be done. Urate stones, and others, can also be minimized or prevented with diets and medication. Good luck.
Dr. John de Jong is President of the World Veterinary Association. He owns and operates the Boston Mobile Veterinary Clinic and can be reached at 781-899-9994.
