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Cat Forum / General Topics / July 2006Cat Urolithiasis
hello, my cat (male, 3.5 years old) had urethra blockage twice before (in a 1.5 year period) due to struvite crystal formation in his bladder he has been on a specific diet (hills c/d) which is a low-magnesium acidifying food in order for the crystals to be dissolved. he was also fed another acidifying medicine (named methygel) yesterday he had another blockage, i took him to the vet and he has been catheterized. the vet took urine samples and measured the pH which was very acidic (6) and checked them at the microscope but couldnt definitely determine if the crystals were sturvite or calcium ocalate. one logical explanation is that the acidifying diet aimed at struvite crystals made way for the formation calcium oxalate ones. but the clues tend to sturvite.. my questions are: 1. is it possible for sturvite to be formed in such an acidic environment (pH = 6)? (though today, after being fed a normal food, the pH was 8.5!) 2. how easy is it to determine wether it's struvite or calcium oxalate? in the microscope there can be seen a variety of shapes and forms of crystals (but not a great number of them). is there another more accurate method? any help would be valuable thank you > hello, > [quoted text clipped - 16 lines] > (pH = 6)? > (though today, after being fed a normal food, the pH was 8.5!) Whenever you find crystals in acid urine it means that either the urine is not sufficiently acidified or insufficient time has elapsed for the crystals to dissolve. If urine pH is high for any length of time crystals can form. Also, a single determination of acidic urine does not mean the urine was sufficiently acidic to be undersaturated with struvite before the obstruction --- the fact that you found crystals proves it wasn't. Another thing to remember is anorexia usually develops after cats devlop a urethral obstruction - most cats aren't brought to vet for at least 24 hours after their last meal -- this increases the probability that the urine pH will be acidic when its tested. > 2. how easy is it to determine wether it's struvite or calcium oxalate? in > the microscope there can be seen a variety of shapes and forms of crystals > (but not a great number of them). is there another more accurate method? Optical crystallography, thermal analysis, infrared spectrophotometry, electron microprobe analysis, x-ray diffraction, -- or a combination of these methods. Microscopic examination only identifies the outside of a urolith. Some uroliths have a mixed composition - IOW, they have a nucleus composed of calcium oxalate and a shell composed of struvite. That's why quantitative mineral analysis, rather than qualitive analysis is so important. Also, there's a big difference between struvite uroliths and struvite urethral plugs. Uroliths are made up of mostly of magnesium ammonium phosphate (MAP) and small amounts of matrix. Struvite plugs are usually made up of large amounts of matrix mixed with small amounts of MAP.. Some urethral plugs are made up of organic matrix, sloughed tissue, blood, and/or debris, and others are form in association with an infection (infection-induced struvite). Plugs are more common in male cats than actual uroliths - which are more common in females. If your cat has struvite plugs, the prescription diet isn't going to help that much. hth, Phil thanks for your response >Optical crystallography, thermal analysis, infrared >spectrophotometry, >electron microprobe analysis, x-ray diffraction, -- or a >combination of these methods unfortunately, most of these methods arent available where i live (a small town in greece). the only thing they could do to identify the case was the cat to have formed a stone and this stone to be surgically removed and examined.. anyway, the vet has come to the conclusion that it is sturvite uroliths (there werent any signs of infection, the cat was in perfect health even during the hospitalization) and we are currently feeding with Hill's s/d diet in order to dissolve them -but meanwhile he had a couple of blockages which we got over with temporary catheterization i think the last resort will be urethrostomy.. the vet assured me that there wont be any side-effects by urethrostomy though i have read that the cat will be more prone to bladder infections and the stone formation is going to get more intense- it just wont induce blockage, can you shed any light to this? is urethrostomy to be considered as the last resort or is it a common procedure? thanks > thanks for your response > [quoted text clipped - 21 lines] > is urethrostomy to be considered as the last resort or is it a common > procedure? Perineal urethrostomy sure is a last resort; the procedure literally turns a male cat into an anatomical female. First the scrotal skin and prepuce are removed to free and expose the penis. Then the muscles that hold the penis to the pelvic bones are cut - this allows the penis to be pulled outside of the body a little more than it normally is. The penis is then split along the urethra to the widest part of the urethra. Then, the opened urethra is (very delicately) sutured to the skin, part of the penis is removed, and all skin edges are closed. If its done right, the cat is now sort of an anatomical female with a w i d e urethral opening so stones or crystals can't jam and plug the cat. But the cat will not have the host defense system of a female and will be prone to UTIs. I watched a few procedures and I can tell you its not as bad as it sounds... although I did get the chills. P.U.s are usually only necessary for calcium oxalate cases because CaOx can't be dissolved. If your vet is recommending a PU in a struvite case, its quite possible he damaged the urethra during catheterization. This is *definitely* a last resort procedure so I would seek a second opinion if I were you. Good luck. Phil. hi, today my cat had another blockage which was due to a stone which had moved down in the urethra. the vet had great difficulty passing the cathetere and could feel the resistence by the stone (it is almost certain that its struvite stone) but eventually it went through the urine was quite clear of crystals (and blood) so we presume that it was a sole stone that has pretty much been dissolved by the catheterization but how safe is this assumption? should we proceed to PU even knowing that it is a struvite case? would an x-ray show anything? i'm really hopeless.. ps i am in close contact with the vet so i'm aware of all her movements > hi, > [quoted text clipped - 10 lines] > > ps i am in close contact with the vet so i'm aware of all her movements Struvite is radiodense so it should detectable on x-rays - an ultrasound would be idea. I would certainly opt for x-rays or ideally ultrasounds before going forward with such a drastic procedure or risking another obstruction. Remember, if an obstruction occurs over the weekend or your vet is unavailable, your cat could die - complete obstruction produces a pathophysiologic state equivalent to oliguric acute renal failure. If the problem was caused by a single stone, the cost of the imaging is negligible compared to the surgery and treatment for recurring UTIs - not to mention sparing the cat of the trauma and stress. Phil hi, an x-ray showed nothing and its hard for the vet to analyze an ultrasound, she is not an expert at that.. after the removal of the cathetere (second catheterization in 2 weeks) the urine still contained a few crystals which showed in the microscope as typical struvite ones (rectangular envelope-shaped). is it logical since the cat is being fed canned hills s/d for the last 2 weeks? he is now straining to urinate but he eventually manages to empty his bladder.. the vet said if he has another blocakge he'll go for urehtrostomy.. what else is there to do ? thanks.. > hi, > [quoted text clipped - 9 lines] > > thanks.. Are you free feeding (ad libitum) your cat or do you feed him twice a day (b.i.d.)? Feeding releases bicarbonate which produces an alkaline tide that causes transient alkalinization of the urine. Free-feeding protracts postprandial alkalinization of the urine throughout the day. Although the alkaline tide is much "higher" after b.i.d. feeding, its shorter in duration. Enough time elapses between meals for natural acidity to return and disolve struvite. At urine pH less than 6.1, struvite does not form regardless of the magnesium concentration of the diet. So if you're finding struvite in pH 6 urine, the crystals may not be struvite. Buy a tube of urine dipsticks and monitor his urine pH throughout the day. I hope you find a solution quickly. Good luck. Phil no luck... i'm feeding him twice a day but he seems to have been blocked again i took him to the vet and she pressed his bladder and only a tiny flow came out. so there must be a stone in his urethra which cant be removed and the only solution is PU.. if there are any final suggestions please let me know thank you very much > no luck... > [quoted text clipped - 6 lines] > > thank you very much I'm running out of alternatives to surgery. In some cases acidifers are administered and a urinary catheter is sewn in place for several days to keep the urine flowing while the stone dissolves. This is a little risky because acidification of the urine is not without potential toxicity (hemolytic anemia, met hemoglobinemia, and Heinz body formation, and possibly renal damage). Acidification may be of no benefit if your cat is obstructed with a plug instead of a stone. Also, a difinitive analysis of struvite has not been made. There are usually only 2 places where a stone/plug can lodge. One place is where urethra narrows, sort of like a funnel, where its passes over the pelvis into the penis. (see illustration on my site). http://www.maxshouse.com/Anatomy/anatomy_urogenital_sys.jpg The other place is in the tip of the penis where urethra is the narrowest. *If* the obstruction is in the tip of the penis, and your vet has keen surgical skills, you just might, *might* get through this crisis with a urethrotomy instead of a urethrostomy. A urethrotomy differs from a urethrostomy in that only a temporary opening is made in the penis and urethra to remove a lodged stone or plug and to provide an opening for temporary urine flow. The layers of skin, penis, and urethra are opened, then sutured closed in reverse order. The cat gets to keep his penis. Since the technique is very similar for both procedures, perhaps your vet can begin with a urethrotomy and continue on to a urethrostomy if the stone is not lodged in the tip of the penis. However, I'm very concerned about the patency of the urethra. Repeated blockages and catheterizations may have severely damaged the urethra leaving no alternatives to a perineal urethrostomy. At this stage, and due to the likelihood of urethral damage and the high risk of obstruction-induced oliguric acute renal failure, and the discomfort and stress of repeated blockages and catheterizations, if he were my cat, I think I would go ahead with the urethrostomy. UTIs are trivial in comparison to the other alternatives. But that's merely my opinion and I could be wrong. It looks like we're back to where we started. I wish I could be more helpful. Please keep me posted. Best of luck. Phil how are plugs identified? he hadnt any signs of infection or too much blood in his urine there were certainly many crystals though, could it be a combination of the two? while trying to pass the cathetere the last time, the vet met an obstacle (she could sense it) she cleaned the edge of the cathetere and analyzed the contents in the microscope where many crystals were visible she believes that the cathetere eventually passed *by* the stone in the urethra so the catheterization or the acidification (by s/d food) hadnt had any effect on the real problem. is that possible? i think the cathetere is quite wide for that to happen the good thing is that the cat is in good shape, he is almost used to the procedure (he was even once catheterized without sedation) and he was never anorexic. oh and he peed quite a bit after coming home from the vet today.. is it possible his current difficulty to urinate to be due to urethra inflammation and not stones? i'm still having second thoughts about PU but am i just putting off the inevitable? > how are plugs identified? he hadnt any signs of infection or too much blood > in his urine > there were certainly many crystals though, could it be a combination of > the two? Urethral plugs are a combination of a small amount of calculus (usually struvite) and large amounts of mucus, which is probably secreted by mucosal cells in the bladder and urethra - most likely in response to some mucosal irritant and/or inflammation. Struvite uroliths contain larger quantities MAP and smaller quantities of mucus and other debris. > while trying to pass the cathetere the last time, the vet met an obstacle > (she could sense it) > she cleaned the edge of the cathetere and analyzed the contents in the > microscope where many crystals were visible > she believes that the cathetere eventually passed *by* the stone in the > urethra She may have pushed the obstruction back to a wider point in the urethra. A technique called "retrograde urohydropropulsion" is often used flush an obstruction back into the bladder by distending the urethra around the stone with fluid - this is only for temporary relief. Voiding urohydropulsion is used to eliminate urethral stones if the stones/plugs are small enough. so the catheterization or the acidification (by s/d food) hadnt > had any effect on the real problem. is that possible? i think the > cathetere is quite wide for that to happen I think you're right. > the good thing is that the cat is in good shape, he is almost used to the > procedure (he was even once catheterized without sedation) and he was > never anorexic. oh and he peed quite a bit after coming home from the vet > today.. > is it possible his current difficulty to urinate to be due to urethra > inflammation and not stones? Sure its possible. Crystals alone can inflame the urethra - and repeated catheterizations can certaily inflame the urethra. Perhaps an antiinflammarory med might help. Inflammation in the urethra is analogous to rust and corrosion inside a pipe. Reducing the inflammation would probably increase (restore) urethral diameter. Its also possible that she broke up the stone - don't forget, he's on s/d - so struvite would be soluble in an acidic urine. > i'm still having second thoughts about PU but am i just putting off the > inevitable? Maybe not. Lets keep our paws crossed! Phil i sent him for PU afterall.. the PU vet told me that it is almost certain that it will happen again, even if he gets well now, so there's no point avoiding it i am regretting it now but i hope it will turn out ok thanks for all the information and the support.. > i sent him for PU afterall.. > the PU vet told me that it is almost certain that it will happen again, > even if he gets well now, so there's no point avoiding it > i am regretting it now but i hope it will turn out ok > thanks for all the information and the support.. At this stage, you didn't have much choice, not with repeated blockages. Urinary tract obstructions are potentially fatal and there's always the risk of not getting him to an emergency clinic in time -- not to mention the stress and discomfort. The only other suggestion I can make is keep his litterboxes immaculately clean. The PU will turn him into an anatomical female but he will not have the host defenses of a female. Infections can easily ascend to the bladder - meaning literally, they crawl up from outside and have a shorter distance to travel. You did the right thing. Best of luck. Phil. thanks.. the PU vet also had big difficulty in passing the cathetere in order to make the urethrostomy so i guess it was the right thing to do.. i got him back home today, he has a small cathetere sewed on (for 5 days) i will be using shredded newspaper for litter he is a housecat and doesnt go out, is it possible to get infected by sitting to a dirty place or something like that? thanks again it is so tragic, he blocked again after being PUed and with a cathetere 3 times wider of course this cathetere is only 2 cm long and wont reach in the bladder so this happened before the cathetere i'm afraid that the problem will be worse when the cathetere will be removed and once again we will be where we started (except that now the cat has no genital system and has been tormented as hell) i wish we could fight the cause and not just the symptoms.. > it is so tragic, he blocked again after being PUed and with a cathetere 3 > times wider [quoted text clipped - 4 lines] > cat has no genital system and has been tormented as hell) > i wish we could fight the cause and not just the symptoms.. This should not have happened. Apparently, the PU wasn't performed correctly. I think a big part of your cat's problem is a bungling, incompetent vet. I strongly suggest you seek a second opinion - quick - before you lose your cat to acute renal failure due the vet's gross incompetence. I'm sure you have veterinary teaching college in your country, contact them for a referral to another vet and ask about their procedure for submitting crystals for analysis. If he's still forming uroliths in a highly acidic urine, there's a very good chance that the crystals aren't struvite - or completely struvite. I'm sorry if I sound harsh - I'm infuriated by the stress and trauma this matchbook vet is putting your cat through. Please do not hesitate in obtaining a referral and second opinion. Phil hmm the vet who performed the PU was different than the casual one and she is much experienced in situations like this (although she found a small stone during the operation but lost it!!! there goes our chance identify the exact composition of the stones..) the casual vet has contacted at least two other vets to get their opinion, and is much caring, i wouldnt say she is not competent.. i just think that my cat is cursed, the first day he traumatized the wound with the e-collar and he was bleeding like hell today the small cathetere got lost inside the opening (the stitches were cut) and fortunately the vet managed to pull it out the urine PH was 6 (5-6 hours after the feeding) but maybe there are stones which take time to dissolve (he's been on s/d for 3 weeks) the vet is definite about it being struvite.. we had also sent an urine sample to a microbiologist who found crystals with an ammonium phosphate compsition i dont know what else to expect..(hope not a renal failure) hi, i followed your suggestion and took the cat to another vet. he did a urine analysis and concluded (with complete certainty- as much as the other vets had for the opposite conclusion) that there were calcium oxalate crystals in the urine. fortunately i have already stopped feeding him s/d food for a few days now (i'm giving him waltham's urinary which is supposed to prevent both kinds of stones) and he has managed to pee (i dont know if this was due to the food's effect or it was simply coincidental) the PU vet cut the stiches today and stiched again a broad cathetere for 2 days to prevent a symphysis from occurring i am really outraged with all this, i dont know what to believe. can these people be called scientists? i think not.. maybe they think my cat is a guinea pig and can do experiments to him > hi, > > i followed your suggestion and took the cat to another vet. > he did a urine analysis and concluded (with complete certainty- as much as > the other vets had for the opposite conclusion) that there were calcium > oxalate crystals in the urine. I knew the first vet screwed up the stone analysis, goddamit. Struvite doesn't form in urine pH at 6.1 or lower. > fortunately i have already stopped feeding him s/d food for a few days now > (i'm giving him waltham's urinary which is supposed to prevent both kinds > of stones) and he has managed to pee (i dont know if this was due to the > food's effect or it was simply coincidental) > the PU vet cut the stiches today and stiched again a broad cathetere for 2 > days to prevent a symphysis from occurring > > i am really outraged with all this, I'm pissed as hell -- and he's not even my cat! If he were my cat, I'd probably need to be restrained. This was not simply a mistake. It was gross negligence by failing to have the stone analyzed properly before prescribing a treatment. i dont know what to believe. can these > people be called scientists? i think not.. maybe they think my cat is a > guinea pig and can do experiments to him I'd tell the bungling vet that you want to renegotiate the bill or else she can negotiate a malpractice suit for performing an unnecessary *irreversible* drastic surgery and causing you and your cat unnecessary pain, suffering and stress - not to mention the cost of surgery and repeated vet visits. I would take legal action, not only because of you and your cat's experience, but also for the health and welfare of other animals that this incompetent vet might affect. Lets hope he's on the road to complete recovery. Phil Hi Tunic and Phil, I am new to this board so please forgive me if it is not proper ettiquite to join your conversation. Tunic, I am so sorry to hear about your cat's troubles. I sincerely hope you have found a solution that will bring relief to the both of you. I can empathize with your situation - my cat has been struggling with repeated blockages as well. I have never experienced anything so frustrating. Best of luck to you and your kitty. Phil, you seem extraordinarily knowledgable about this condition. Are you a vet? Hats off to you for supporting Tunic and her kitty through their ordeal. > Hi Tunic and Phil, > I am new to this board so please forgive me if it is not proper ettiquite to join your conversation. Discussions are open to everyone. There are no private conversations in newsgroups. ;-) > Tunic, I am so sorry to hear about your cat's troubles. I sincerely hope you have found a solution that will bring relief to the both of you. I can empathize with your situation - my cat has been struggling with repeated blockages as well. I have never experienced anything so frustrating. Best of luck to you and your > >kitty. I'm concerned because I haven't seen an update in a few weeks. I hope all is well. > Phil, you seem extraordinarily knowledgable about this condition. Are you a vet? No. I just work with a lot of cats. >Hats off to you for supporting Tunic and her kitty through their ordeal. Thanks. I just hope the cat is finally doing well. I get nervous when I don't see an update. Phil.  Signature"With the qualities of cleanliness, discretion, affection, patience, dignity, and courage that cats have, how many of us, I ask you, would be capable of being cats?' --Fernand Mery Feline Healthcare & More: <http://maxshouse.com This message is for Phil P. or others who are extremely knowledgeable on this subject. You seem extremely knowledgeable concerning the issues mentioned here. I came across this site while searching veterinary negligence urethrostomy. I am aware this is a site for cats, but our 8 year old AKC champion sired male Shih Tzu passed away 9/30/05 due to veterinary negligence. This occured 3 days after surgery to remove a stone blocking his urethra. The entire chain of events is online for all to see at: http://stempy.bravehost.com/ We are still trying to figure out just exactly what this vet did to our little boy. If you could look over the website (timeline, timeline cont., and the acepromazine factor are 3 of the pages on the site that details exactly what happened) and give us your opinion as to what might have happened, we would sincerely appreciate it. Thank you very much. Greg Munson >> Hi Tunic and Phil, >> I am new to this board so please forgive me if it is not proper ettiquite to join your conversation. [quoted text clipped - 18 lines] > >Phil. |
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