I'm gonna rock this bladder!

Two months ago I was presented with a beautiful and timid miniature schnauzer.  Her owner complained that the dog was urinating frequently.  She had worried about it previously, but now...there was blood. 

The little dog was very sweet for her exam.  She allowed me to examine her well and was quite relaxed when I went to palpate her abdomen.  I gently pressed my hands into the abdomen and was astonished to feel a giant rock push back.  I gently palpated the dog and what I felt gave me the feeling you get when you hear fingernails being pulled across a chalkboard.  I felt the grinding of stones one upon another.

 

"I need to take an x-ray," I explained the owner, "I feel a lot of stones in this bladder."  

"Do you think they'll pass," She asked innocently. 

"Well, that's exactly why I need to take this x-ray."

Money was tight, but she allowed me to take one view.  It was obvious from the one x-ray that there was no hope of passing the stones her dog had been carrying around for months. 

I explained to this owner that her dog would need surgery for the stones to be removed.  I explained that we could try changing her diet and drinking water in the meantime, but the surgery would be necessary.  I gave her an estimated cost of the surgery, the name of the food she would need, and left her to schedule the surgery as soon as she possibly could. 

Today, over two months later, I saw the patient for surgery.  The owner had brought the dog back for a recheck two days ago.  She was frustrated that the dog was still urinating blood.  Again, she was told that the dog would not get better unless the stones were removed and the diet changed.  This time, the clinic owner and fellow practitioner reiterated the news.  The owner explained that she had not been able to have the surgery because there was simply no money.  The clinic owner worked out a payment option with the owner.  She was told to fast the pet the night prior to surgery and return today for the cystotomy.  It was one of those bean-bag-feeling bladders the clinic owner would later tell me. 

I try to make the smallest incision possible, so that the healing time and discomfort will be minimal.  I made the size of incision that I had expected to suffice and then gently struggled with this bladder to make it come out it of the abdomen.  It was packed so tightly with various shapes of stones that it could not distort its shape to join us on the outside.  I elongated my incision and finally welcomed it into surgery room with the rest of us. 

It was a vascular angry mess.  The vessels were engorged and made tortuous journeys across the serosal surface.  It was clear that this bladder had been putting up a fight for a long time. 

I found the least vascular portion on the dorsal aspect of the bladder and made my incision.  We marveled as stone after stone was gently milked to the opening.  It took a long time to evacuate the bladder.  Then we flushed to make sure none were left behind.  The fun part was over, it was time to put this bladder back together and wake this schnauzer up. 

The moment was near for removing her endotracheal (breathing) tube, when she began to gag.  A well trained team leaped into action.  They tilted her upside down with her head low.  They opened her jaws wide and pulled out her tongue.  They stood back for the splatter.  Hot dog weenies and gastric juices showered the floor.  This is the very reason your veterinarian asks you to fast your pet before surgery.  How sad it would have been to live through the removal of 60 stones only to choke and die on a weenie?! 

The final stone count was 60.  There were 5 large stones, 8 medium stones, and 47 small stones.  When cleaned and dried, the stones weighed 2 ounces.  That is a lot of stones for a 20 lb dog!