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Dr. Howie Seim, Colorado State University
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A 6-year-old female Akita was hospitalized with a diagnosis of cystic calculi, which can be seen on a lateral radiograph. Because all the calculi look as though they could easily pass through her relatively large-diameter urethra, urohydropropulsion is going to be attempted in this case.
Related Article: The Case: Remnant Urethral Calculus After Cystotomy
With the patient under general anesthesia, the urethral papilla is accessed and a catheter passed into the urinary bladder (a 22 Fr red rubber catheter is used). The bladder is completely emptied of urine; when it is refilled with sterile saline, the exact volume is known, which lessens the chance of overfilling the bladder. The bladder is palpated to make certain that it is not too distended and the urethra is gently compressed around the catheter to prevent saline from leaking out of the bladder.
The dog is then held in an erect position so the stones can move into the neck of the bladder. Once sufficient time has passed to allow the stones to settle in the neck of the urethra (generally 60 – 90 seconds), compression of the urethra around the catheter is released, the urinary catheter removed and the bladder compressed via abdominal compression. The sterile physiologic saline solution is forced out of the bladder, carrying with it the stones and sand.
Related Article: Struvite Urolithiasis
The cluster of stones that were removed appear similar in size and shape to the stones seen on the initial radiograph. Before the patient is taken off anesthesia, a postprocedure radiograph is taken to ensure that all stones have been removed from the bladder and urethra.
Urohydropropulsion has been reported to be successfully performed in males and females.1 Due to the relatively large diameter urethra in the female, much larger stones can be successfully hydropropulsed than in the male. The major limiting factors in using this technique in males are their relatively small-diameter urethra at the level of the os penis and their long urethral length. The clear benefit of this procedure over cystotomy is avoiding an invasive approach to retrieve the stones. The potential complications of urohydropropulsion are either not removing all the stones from the bladder or getting a stone stuck in the urethra.
This video was authored by Howie Seim, DVM, DACVS. Other surgical videos are available through VideoVet. Surgeon’s Corner is intended as a forum for those with specialized expertise to share their approaches to various techniques and procedures. As such, the content reflects one expert’s approach and is not subject to peer review.
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