Kajian Pustaka: Pneumonia yang disebabkan oleh bakteri pada hewan

(PNEUMONIA CAUSED BY BACTERIA IN ANIMALS)

Nur Baiti1,
I Nyoman Suartha2

1
Mahasiswa Pendidikan Profesi Dokter Hewan,
2
Laboratorium Ilmu Penyakit Dalam Veteriner,
Fakultas Kedokteran Hewan Universitas Udayana,
Jl. Sudirman, Sanglah, Denpasar, Bali, Indonesia; 80234
Telp/Fax: (0361) 223791
Email: baiti.nur0924@gmail.com

ABSTRAK
Pneumonia adalah penyakit yang berhubungan dengan saluran pernapasan bagian bawah,
terutama yang melibatkan paruparu. Infeksi sering dimulai dari saluran atas dan berkembang ke
bawah ke paru-paru. Patogen umum yang berkonstribusi terhadap penyakit pernafasan pada
ruminansia adalah Pastruella spp dan Mannheimia spp. Tanda-tanda klinis umum dan respon
hewan yang terinfeksi penyakit pernapasan adalah adanya demam (pireksia), kehilangan nafsu
makan, sekret hidung (serosa atau mukoid), batuk, bersin, menunjukkan tanda-tanda kesulitan
bernapas (dyspnea), dan suara paru-paru yang abnormal. Hewan ruminansia seperti sapi, kambing
dan rusa cukup rentan terteka dan tertular penyakit ini.
Kata kunci : Mannheimia, kambing, Pastruella, rusa, sapi
ABSTRACT
Pneumonia is a disease associated with the lower respiratory tract, especially involving the
lungs. The infection often starts in the upper tract and progresses down to the lungs. Common
pathogens that contribute to respiratory disease in ruminants are Pastruella spp and Mannheimia
spp. Common clinical signs and responses of animals infected with respiratory disease are the
presence of fever (pyrexia), loss of appetite, nasal discharge (serous or mucoid), coughing,
sneezing, showing signs of difficulty breathing (dyspnea), and lung sounds. abnormal. Ruminant
animals such as cattle, goats and deer are quite susceptible to being guessed and infected with this
disease.
Keywords : cow, deer, goat, Mannheimia, Pastruella,
 PENDAHULUAN

Sistem respirasi merupakan suatu susunan yang sangat kompleks. Setiap jaringan yang
menyusunnya memiliki fungsi dan perannya tersendiri. Strukturnya yang begitu rumit menjadikan
sistem ini begitu istimewa untuk menopang kehidupan hewan dan manusia. Fungsi utama
pernapasan adalah mengangkut oksigen (O2) untuk digunakan oleh sel tubuh dan untuk
mengeluarkan karbon dioksida (CO2) yang diproduksi oleh sel. Respirasi mencakup dua proses
yaitu ekspirasi dan inspirasi. Ekspirasi merujuk kepada seluruh rangkaian kejadian dalam
pertukaran O2 dan CO2 antara lingkungan eksternal dan sel tubuh, sedangkan inspirasi merujuk
kepada proses-proses metabolik intrasel yang dilakukan di dalam mitokondria, yang menggunakan
O2 dan menghasilkan CO2 selagi mengambil energi dari molekul nutrien (Sherwood, 2014).

Penyakit sistem pernafasan adalah penyakit yang melibatkan sistem pernafasan kerana
beberapa perubahan patologi pada saluran atau organ yang terlibat. Gangguan fungsi organ dan
jaringan akan mempengaruhi saluran udara dan kualitas hidup hewan. penyakit saluran pernafasan
pada hewan ruminansia dapat disebabkan oleh agen infeksius maupun non infeksius seperti virus,
bakteri, parasit, benda asing, luka pada saluran pernafasan dan masih banyak lagi. Patogen umum
yang berkonstribusi terhadap penyakit pernafasan pada ruminansia adalah Pastruella spp.,
Mannheimia spp., mikoplasma; Virus Parainfluenza III (PI3), Infectious Bovine Rhinotracheitis
(IBR), Bovine Viral Di arrhoea Virus (BVDV) (Magstadt et al., 2018).

Pneumonia adalah penyakit yang berhubungan dengan saluran pernapasan bagian bawah,
terutama yang melibatkan paru-paru. Infeksi sering dimulai dari saluran atas dan berkembang ke
bawah ke paru-paru. Pneumonia seringkali lebih parah daripada infeksi saluran pernapasan atas,
dan juga lebih mengancam jiwa (Heather Thomas, 2009). Hewan dari segala usia dapat terinfeksi
penyakit pneumonia. Agen penyebab pneumonia bervariasi dan mungkin karena iritasi yang
menyebabkan kerusakan pada lapisan saluran pernapasan, virus, bakteri, faktor lingkungan, dan
apa pun yang menyebabkan hewan itu kehilangan kekebalan (Plummer et al., 2012). Pyreia,
inappetence, kusam dan depresi, lesu dengan telinga murung, dyspnea dan tachypnea, bukti mata
dan hidung biaya adalah tanda-tanda klinis umum dari hewan menyerah dengan pneumonia
(Thomas, 2009).
 MATERI DAN METODE

Metode penulisan yang digunakan pada penulisan artikel ini adalah menggunakan literatur
dari jurnal penunjang/pendukung. Dengan melakukan pencarian data dari jurnal, buku dan artikel
yang terkait berkaitan dengan pneumonia yang disebebkan bakteri pada hewan. Kriteria artikel
yang di gunakan ialah artikel dengan rentan waktu 3 tahun terakhir pustaka.

HASIL DAN PEMBAHASAN

Hasil

Dari 3 kasus penyakit pneumonia disebabkan oleh bakteri pastreullosis spp. dan
mannheimia spp. yang didapatkan dari beberapa hewan ruminansia diantaranya kambing, rusa dan
sapi, yang menunjukkan dehidrasi, penurunan berat badan, kusam, lesu, dispnea, anoreksia,
demam, hipersaliva, nyeri dada, hidung berlendir, beberapa hewan menunjukkan diare ringan
dengan konsistensi tinja semi-padat. Dari ke tiga hewan tersebut yang sembuh hanya hewan sapi
untuk rusa dan kambing mengalami kematian sehingga diagnosa yang di gunakan meliputi waktu
kematian, faktor usia, isolasi bakteri, pemeriksaan nekropsi, pemeriksaan lesi histopatologi.
Pengobatan menggunakan Ceftiofur sodium 2mg/kg IM, Marbofloxacin 8mg/kg IM diulang
setelah 48 jam, Tolfenamic acid 2mg/ kg IM diulang setelah 48 jam, Chlorpheniramine maleate
10ml IM dan B-kompleks 10ml IM, Isoflupredone 10ml IM.
Pembahasan

Pneumonia adalah peradangan parenkim paru yang biasanya disertai dengan keterlibatan
bronkiolus Broncho-pneumonia dan seringkali pleuritis Pleuro-pneumonia. Secara klinis
dimanifestasikan oleh peningkatan frekuensi pernapasan, perubahan kedalaman dan karakter
pernapasan, batuk, suara napas abnormal pada auskultasi. Berdasarkan etiologi, pneumonia dapat
dari berbagai jenis yaitu. bakteri, virus, mikoplasma, parasit, aspirasi, alergi, hipoplastik dll. Di
antara semua penyakit lainnya, pneumonia menyebabkan kematian yang tinggi pada hewan
(Dhillon et al., 2020). Pneumonia bakteri paling sering disebabkan oleh Mannheimia haemolytica
dan Pasteurella multocida yang lebih sering dikaitkan dengan wabah pneumonia akut dan
kematian kambing pada semua kelompok umur. P. multocida, patogen oportunistik, analog dengan
M. haemolytica dan merupakan salah satu patogen pernapasan yang paling penting dari ruminansia
domestik yang menyebabkan wabah serius pneumonia akut.
 Mannheimiosis merupakan penyakit saluran pernafasan yang penting pada sapi, domba,
kambing dan ruminansia lainnya (Highlander, 2001). Selain mannheimiosis, pasteurellosis juga
dikenal sebagai penyakit pernapasan yang penting pada ternak. Pasteurellosis disebabkan oleh
Pasteurella multocida, yang merupakan genus yang berkerabat dekat dengan mannheimia.
Mannheimiosis pada hewan diketahui disebabkan oleh Mannheimia haemolyt ica dari serotipe A
spesifik (Annas et a., 2017). Pasteurellosis pneumonik, juga dikenal sebagai mannheimiosis
respiratorik, paling umum di antara infeksi saluran pernapasan dengan prevalensi luas pada hewan
ruminansia. Hewan ruminansia kecil seperti kambing cukup rentan dan tertular penyakit karena
terpapar stres fisik atau kondisi lingkungan yang tidak menguntungkan (Annas et al., 2017).

Pada pemeriksaan nekropsi kuda pada traktus respiratorius menunjukkan hepatisasi paru
bilateral, kering, berat dibagian kranioventral aspek paru-paru (Gambar 1). Beberapa nodul irm
dipalpasi pada area paru yang terkena. Potongan kasar paru-paru mengungkapkan beberapa abses
paru dengan berbagai ukuran, dan berbagai ketebalan kapsul jaringan ibrous yang mengandung
kaseasi keputihan (Gambar 2). Penebalan septa interlobularis yang menonjol juga dicatat. Bagian
lain dari paru-paru menunjukkan kongesti paru umum, ringan sampai sedang. Pneumonia
diklasifikasikan bronkopneumonia fibrinosa akut yang ditandai dengan eksudasi serofibrinosa di
lumen bronkiolus. Jaringan paru-paru pneumonia menunjukkan kongesti dan tipe perdarahan pete
chial dan ekimosis (Gambar 3).

Gambar 1. Hepatisasi paru Gambar 2. Abses paru

parah pada aspek multipel dengan penebalan
septum interlobularis
kranioventral paru-paru
 Gambar 3. Lesi henoragik
pada lobus diafragma paru-
paru pneumonia

kranioventral paru-paru
Pemeriksaan lesi histopatologi menunjukka lesi dari nodul terutama kaseosa, dengan
campuran cairan berprotein, dan makrofag dan neutrofil yang mengalami degenerasi dan nekrotik
bercampur dalam matriks ibrin (Gambar 4). Temuan ini konsisten dengan infeksi kronis pada
saluran pernapasan. Koloni bakteri keunguan sering diamati di ruang alveolar. Septa inter alveolus
kapiler terlihat mengalami kongesti sedang, dengan penebalan septa interalveolar akibat kongesti
ini. Disseminated intravascular coag ulopathy (DIC) ditemukan terutama di kapiler kecil paru-
paru. Perdarahan paru sedang sampai berat kadang-kadang diamati. Temuan ini menunjukkan
septikemia akut (Gambar 5).

Gambar 5. Adanya makrofag alveolar Gambar 5. Pembengkakan dan

dan neutrofil, bercampur dengan penyusutan hepatosit, dengan
ibrin bersama dengan perdarahan di eosinofilia sitoplasma sesekali,
paru-paru kranioventral paru-paru Perhatikan bahwa sinusoid meleba
kranioventral paru-paru
 Hewan mudah terinfeksi bakteri pneumonia bila faktor pemicu stres seperti perubahan
cuaca, transportasi, kepadatan penduduk, defisiensi nutrisi dan faktor lain yang menyebabkan
penekanan kekebalan mempengaruhi hewan tertentu. Gejala klinis yang bisanya di tunjukkan
adalah dehidrasi, penurunan berat badan, kusam, lesu, dispnea, anoreksia, demam, hipersaliva,
nyeri dada, hidung berlendir,diare ringan dengan konsistensi tinja semi-padat (Gambar 6). Bakteri
progresif parah Infeksi pneumonia berakibat fatal bagi hewan yang terkena karena menyebabkan
kerusakan paru-paru yang parah jika tidak diobati untuk waktu yang lama (Plummer et al., 2012).
Infeksi pneumonia kombinasi yang melibatkan virus atau bakteri, seringkali menyebabkan
penyakit yang parah dan fatal pada hewan yang terkena (Duncanson, 2012). Di daerah tropis
khususnya Malaysia penyakit pernafasan yang umum pada ternak ruminansia adalah pneumonia.
Infeksi bakteri saluran pernapasan yang umum pada ruminansia kecil disebabkan oleh Pasteurella
sp. atau Mannhemia sp. Dengan prevalensi tinggi dari kasus klinis yang tercatat (Chung et al.,
2015). Pada ruminansia besar, penyakit pernapasan sapi sering dikaitkan dengan pneumonia
bakteri yang disebabkan oleh Mannheimia haemolytica serotipe 1 dan Pasteurella multocida.
Patogen ini merupakan flora normal yang terdapat pada saluran pernapasan bagian atas dan
patogen oportunistik ini cenderung berkembang biak dan menjadi infeksius ketika pejamu
mengalami imunosupresi (Barac et al., 2018).

Gambar 6. Pernafasan mulut terbuka dan hisung berlendir

Penyakit pernapasan pada ruminansia dapat berhasil diobati tergantung pada penyebab
utama penyakit tersebut (Plummer et al., 2012). Penggunaan antibiotik sistemik (kombinasi
Oxytetracycline dan Sulfa, atau antibiotik spektrum luas apa pun) untuk menghentikan infeksi
lebih lanjut dan antiinflamasi (Dexamethasone, Flunixin meglumine, atau dimethyl sulfoxide)
untuk mengurangi rasa sakit dan bengkak yang akan membantu hewan yang terkena untuk dapat
menelan dan bernafas (Thomas, 2009). Pengobatan dini dan agresif harus dilakukan dengan
menggunakan antibiotik dan NSAID untuk memastikan peluang pemulihan yang tinggi (Steeg,
2011). Dalam sebuah penelitian yang dilakukan oleh Chung et al., (2015), menyatakan bahwa
rehidrasi pada hewan pneumonia dehidrasi melalui pemberian cairan intravena dapat diadopsi
sebagai bagian dari rencana terapi dalam mengobati kasus klinis pasteurellosis pneumonia.
Menjaga hewan yang terkena dampak dalam kondisi yang nyaman dan meminimalkan stres akan
membantu dalam prognosis kasus klinis bersama-sama dengan rezim pengobatan yang tepat
(Thomas, 2009). Kerane prognosa buruk ada semua kasus pneumonia aspirasi, tetapi dalam kasus
hewan sapi, berada dalam tahap infeksi akut awal yang dimana tidak cukup menyebabkan
kematian sehingga merespon pengobatan secara positif. Jadi pneumonia yang bersifat akut dapat
diobati

SIMPULAN

Penyakit sistem pernafasan adalah penyakit yang melibatkan sistem pernafasan kerana
beberapa perubahan patologi pada saluran atau organ yang terlibat. Pneumonia adalah penyakit
yang berhubungan dengan saluran pernapasan bagian bawah, terutama yang melibatkan paruparu.
Infeksi sering dimulai dari saluran atas dan berkembang ke bawah ke paru-paru. Pneumonia
seringkali lebih parah daripada infeksi saluran pernapasan atas, dan juga lebih mengancam jiwa.

SARAN

Dari penulisan kajian jurnal di atas diharapkan pembaca lebih banyak membaca jurnal dan
sumber lainnya untuk menambah wawasan tentang pneumonia pada hewan yang disebabkan oleh
bakteri.

UCAPAN TERIMA KASIH

Pada kesempatan ini penulis mengucapkan terimakasih kepada pihak Pengampu

Koasistensi Ilmu Penyakit Dalam Veteriner, Fakultas Kedokteran Hewan, Universitas Udayana
yang telah bersedia membantu penulis dalam memfasilitasi dan membimbing sampai
terselesaikannya kajian pustaka ini.
 DAFTAR PUSTAKA

Annas WNFS., Azrolharith MR., Jesse FFA., Mohid AS., Haron W. 2017. Mannheimiosis in A
Rusa Deer (Rusa timorensis): A Case Report and A Herd Analysis. J. Vet. Pract. 5(1): 5-11.
Barac A., Ong DS., Jovancevic L., Peric A., Surda P., Tomic Spiric V., Rubino S. 2018. Fungi-
induced upper and lower respiratory tract allergic diseases: one entity. Front. Microbiol. 9:
583.
Chung ELT., Abdullah FFJ., Abba Y., Tijjani A., Sadiq MA., Mohammed K., Osman AY., Adamu
L., Lila MAM., Haron AW 2015. Clinical management of pneumonic pasteurellosis in boer
kids: A Case Report. Int. J. Livest. Res. 5(4): 100-104.
Dhillon KS., Kaur SJ., Gupya M. 2020. A case report on aspiration pneumonia in a cow. Journal
of Entomology and Zoology Studies. 8(3): 186-188
Duncanson GR (2012). Veterinary Treatment of Sheep and Goats. Chapter 11: Respirat. Circulat.
Syst. Pp 153 - 161.
Highlander SK (2001). Molecular genetic analysis of virulence in Mannheimia (Pasteurella)
haemolytica. Front. Biosci. 1. D1128-1150.
Magstadt DR, Schuler AM, Coetzee JF, Krull AC, O’Connor AM, Cooper VL, Engelken TJ. 2018.
Treatment history and antimicrobial susceptibility results for Mannheimia haemolytica,
Pasteurella multocida, and Histophilus somni isolates from bovine respiratory disease cases
submitted to the Iowa State University Veterinary Diagnostic Laboratory.
Plummer PJ, Plummer CL, Still KM (2012). Sheep and Goat MEDICINE 2nd Edition. Chapter 7
Dis. Respirat. Syst. Pp 126-149. Elsevier Saunders Inc. Publication.
Steeg PS, Camphausen KA, Smith QR (2011). Brain metastases as preventive and therapeutic
targets. Nat. Rev. Cancer. 11(5): 352.
Thomas HS (2009). The Cattle Health Handbook. Chapter II : Respiratory Problems. Pp 208 - 224.
Storey Publication.
Thomas HS (2009). The Cattle Health: Preventative Care, Disease Treatments Emergency
Procedures. Storey Publishing.

ISSN (E): 2277- 7695
ISSN (P): 2349-8242
NAAS Rating 2017: 5.03
TPI 2017; 6(12): 249-252
© 2017 TPI
www.thepharmajournal.com
Received: 25-10-2017
Accepted: 27-11-2017
K Jagan Mohan Reddy
Department of Veterinary
Surgery & Radiology, College of
Veterinary Science, Rajendra
nagar, Hyderbad, PVNR
Telangana Veterinary
University, Telangana, India
Correspondence
K Jagan Mohan Reddy
Department of Veterinary
Surgery & Radiology, College of
Veterinary Science, Rajendra
nagar, Hyderbad, PVNR
Telangana Veterinary
University, Telangana, India
The Pharma Innovation Journal 2017; 6(12): 249-252
Surgical management of canine Urolithiasis a report of
3 cases
K Jagan Mohan Reddy
Abstract
Three dogs of which two female and one male dog with ages ranging from 5-12 years old were presented
to the clinics with a history of urinary incontinence, haematuria, anorexia and dehydration. Clinically the
dogs found to be dull, depressed and dehydrated. Palpation of abdomen revealed urinary bladder
distention and the same was evident on lateral abdominal radiograph as radio-opaque cystic calculi
Cystolithectomy was performed via caudal ventral midline laparotomy under general anesthesia and an
indwelling catheter was fixed. The calculi measuring various sizes from approx. 4 to 25 mm.
Cystolithoectomy should be performed over urethrotomy in male dogs, if stones can be flushed into the
bladder pre-operatively or intraoperatively. The indwelling catheter was removed after 10 days and the
three dogs recovered uneventfully.
Keywords: Calculi, Cystolith, Cystolithoectomy, Cystotomy, hematuria, Urinary bladder and
Urolithiasis
Introduction
Uroliths are aggregates of crystalline and occasionally non crystalline solid substances that
form in one or more locations within the urinary tract (Koehler et al., 2009). Urethral
obstruction from stones is more common in males and show varied clinical signs based on
obstruction and occasionally the bladder ruptures causing uroabdomen (Dehmiwal et al., 2016)
[1]
. Survey abdominal radiographs or ultrasonography is indicated with urolithiasis for
confirmative diagnosis. Medical dissolution of calculi is impossible, if the urolith size is bigger
enough to obstruct the urine flow and surgical removal is necessary (Yadav et al., 2011) [4]
Cystolithectomy in female dogs and Cystolithoectomy over urethrotomy in male dogs are the
surgical options (Fossum 2013) [2] The present paper reports surgical management of cystic
calculi in three dogs.
History and clinical signs
In the first case, 5 years old female dog with the history of haematuria, anorexia, dehydration
and abdominal pain. Anamnesis revealed that the animal had hematuria for the last 10 days.
Upon clinical examination the dog was found dull, depressed and dehydrated. In the second
case, 8 years old male dog with the history of urinary incontinence, anorexia, dehydration.
Upon clinical examination the dog was found dull, depressed and dehydrated. The third,
female dog aged 10 years having clinical signs of haematuria and straining on urination. In all
the cases, palpation of abdomen revealed urinary bladder distended which was evident on
lateral abdominal radiograph. Radio-opaque cystic calculi were evident on radiographic
examination (Fig. 1).
Surgical Management and Treatment
After confirmation of the calculi in urinary bladder, the two female dogs were operated for
Cystolithectomy, and the third, male dog for Cystolithectomy and urethrotomy as per the
procedure adop;ted by Fossum (2013) [2]. The surgical procedure was done under induction
with xylazine (@1mg/kg) and ketamine (@10mg/kg) intramuscularly and maintenance with
propofol (@4mg/kg). The operative site was prepared aseptically. Animal was controlled in
dorsal recumbency. The bladder was approached through caudal midline incision. Urinary
bladder was exteriorized, Sterile, moistened mops were packed around the bladder to prevent
urine spillage into the abdominal cavity. The avascular margin of bladder was located and stab
incision was made on its dorsal surface. (Fig. 2) The interior of the bladder were searched for
calculi and concretions.
~ 249 ~ 
The Pharma Innovation Journal
The calculi were located and removed and rinsed with normal
saline, then a sterile polyethylene catheter was attempted to
pass from urinary bladder through the urethra in normograde
manner. In male dog, the catheter got stucked behind os penis.
Then prescrotal urethrotomy incision was given along the
midline of the of penis just caudal to os penis (Fig.3). The
calculi were removed and urethra was rinsed with normal
saline. The polyethylene catheter was then passed from
external urethral orifice to the urinary bladder. The external
end of the catheter was fixed with prepuce skin by stay
sutures. The incision of the urinary bladder was closed by
double layer cushings suture pattern using 3-0 chromic catgut
(Fig.4). The urethral incision was also closed using 3-0
chromic catgut in simple continous suture pattern. The calculi
measuring various sizes from approx. 4 to 25 mm were found
(Fig.5 and 6). Post operatively systemic antibiotics,
intravenous fluids, Non steroidal anti-inflammatory drugs
were given for 5 days. The catheter and skin sutures were
removed on 10th post operative day.

Fig1: Radiography of the left lateral abdomen of Female dog evident of cystolith

Fig 2: Cystolecthectomy and cystolith seen

Fig 3: Prescrotal Urethrotomy incision in male dog

~ 250 ~ 
  
The Pharma Innovation Journal
 

Fig 4: closing the bladder incision by double layer cushings suture pattern

Fig 5: Cystoliths removed from the Bladder

Fig 6: Cystolith removed from the bladder.

~ 251 ~ 
  
The Pharma Innovation Journal
 
Results and Discussion
Post operatively, the three dogs recovered uneventfully and
restoration to normal urination after 10 days of surgery.
Confirmatory diagnosis is done by using radiography shows
the presence of radio-opaque masses located in the bladder.
The choice of the management of the patient arrived based on
the size of the calculi. Cystolithectomy to remove the calculus
is recommend for large calculus in female which cannot be
dissolved by medical management. When urine becomes over
saturated with lithogenic substances, uroliths may be formed
and these can interfere with the complete or frequent voiding
of urine.
Uroliths are aggregates of crystalline and occasionally non
crystalline solid substances that form in one or more locations
within the urinary tract (Koehler et al., 2009). Urethral
obstruction from stones is more common in males. Clinical
signs of urinary tract infection (i.e. hematuria, pollikiuria, and
stranguria) are common in dogs with cystic or urethral calculi
(Dehmiwal et al., 2016) [1]. Small stones lodging in urethra of
male dogs may cause partial or complete obstruction. Bladder
distension, abdominal colic, stranguria, perceived
incontinence due to partial obstruction and or signs due to
post – renal azotemia (i.e. anorexia, vomiting and depression)
may develop. Occasionally the bladder ruptures causing
uroabdomen. Survey abdominal radiographs or
ultrasonography is indicated with urolithiasis. Although
medical dissolution of calculi is possible, surgical removal is
necessary if the urolith size is bigger enough to obstruct the
urine flow (Yadav et al. 2011) [4]. Cystolithectomy in female
dogs and Cystolithoectomy and urethrotomy was performed
in male (Fossum 2013) [2] as in the present case.

References
1. Dinesh Dehmiwal, Behl SM, Prem Singh, Rishi Tayal,
Madan Pal, Sandeep Saharan, Chandolia RK. Diagnosis
and Surgical Management of Cystolith in Dogs. Haryana
Vet. 2016; 55(1):103-105.
2. Fossum TW. Small Animal Surgery, Fourth Edition
Mosby, Inc., an affiliate of Elsevier Inc: 2013, 735-756.
3. Koehler LA, Osborne CA, Buettner MT, Lulich JP,
Behnke R. Canine Uroliths. Vet. Clin Small Anim. 2008;
39:161 -181
4. Yadav S, Shrestha RD, Joshi N. Bladder Stones in a
Female Dog and its Surgical removal Intas Polivet. 2011;
12(II):372-374.

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ISSN (E): 2277-7695
ISSN (P): 2349-8242
NAAS Rating: 5.23
TPI 2022; SP-11(7): 791-793
© 2022 TPI
www.thepharmajournal.com
Received: 12-04-2022
Accepted: 15-05-2022
RC Sundararajan
Department of Veterinary
Medicine, Veterinary College and
Research Institute, TANUVAS,
Tirunelveli, Tamil Nadu, India
K Preethi
Department of Veterinary
Medicine, Veterinary College and
Research Institute, TANUVAS,
Tirunelveli, Tamil Nadu, India
V Vijayanand
Department of Veterinary
Medicine, Veterinary College and
Research Institute, TANUVAS,
Tirunelveli, Tamil Nadu, India
S Kokila
Department of Veterinary
Medicine, Veterinary College and
Research Institute, TANUVAS,
Tirunelveli, Tamil Nadu, India
K Gopal
Department of Veterinary
Medicine, Veterinary College and
Research Institute, TANUVAS,
Tirunelveli, Tamil Nadu, India
M Balagangatharathilagar
Department of Veterinary
Medicine, Veterinary College and
Research Institute, TANUVAS,
Tirunelveli, Tamil Nadu, India
E Madhesh
Department of Veterinary
Medicine, Veterinary College and
Research Institute, TANUVAS,
Tirunelveli, Tamil Nadu, India
Corresponding Author
RC Sundararajan
Department of Veterinary
Medicine, Veterinary College and
Research Institute, TANUVAS,
Tirunelveli, Tamil Nadu, India
The Pharma Innovation Journal 2022; SP-11(7): 791-793
Nephro-cysto urolithiasis induced kidney disease in two
dogs: A case report
RC Sundararajan, K Preethi, V Vijayanand, S Kokila, K Gopal, M
Balagangatharathilagar and E Madhesh
Abstract
Two dogs viz. Spitz and Doberman was presented to Veterinary Clinical Complex with a history of
anorexia, vomiting and difficulty in urination for past one week. Clinical examination revealed severely
congested conjunctival mucous membrane, enlarged popliteal lymph node and pain on palpation of the
abdomen. Hematological analysis revealed leukocytosis and neutrophilia. Serum biochemical analysis
revealed increased blood urea nitrogen, creatinine, ALP, sodium and decreased glucose levels.
Radiographical examination revealed distended bladder with various uroliths. Ultrasonography of two
dogs revealed the presence of calculi also in both the kidneys and penile urethra of Spitz. Urinalysis
revealed presence of numerous WBCs, RBCs and few phosphate crystals in the urine with acidic pH. The
cases were diagnosed as urolithiasis induced kidney disease. The animals were managed with retrograde
urohydropropulsion, fluid therapy, antibiotics, diuretics, anti-inflammatory drugs and anti-histamines
along with oral urine alkalizing agents and anti-lithiatic tablets. The details of the cases will be discussed.
Keywords: Anti-lithiatics, urolithiasis and retrograde urohydropropulsion
Introduction
The sediment formation anywhere within the urinary tract is called as urolithiasis [3]. Urolith is
also defined as the accumulation of crystalline and matrix minerals in one or more locations of
the urinary tract due to the oversaturation of urine with crystallogenic substances. Multiple
physiological and pathological processes are involved in the formation of urolithiasis [1]. It is
more common in the lower urinary tract than the upper urinary tract [1, 3]. There are four main
types of uroliths, namely urate & uric acid, cystine, magnesium ammonium phosphate and
calcium. Magnesium and calcium containing uroliths are the most prevalent types of uroliths
[1]
. The diagnosis of cystic and urethral calculi is to be done by clinical history, physical
examination, radiography and ultrasonography [3]. The minimum analysis required to diagnose
renal affections includes, blood urea nitrogen, creatinine, urinalysis, haemoglobin, total
protein, albumin and electrolyte assays [5]. The most accurate method to count and diagnose
calculi is double contrast radiography [1]. Both the radiopaque and non-radiopaque calculi can
be diagnosed in ultrasonography [1].
The crystals formed can cause a different kidney injuries induced by minerls, metabolites,
proteins or dietary components and drug metabolites [2]. The mechanism involved in the
formation of crystal induced injuries are varied [2, 5]. There are three types of crystal
nephropathies depending on their location. They are, Type 1 Crystalline nephropathy: Renal
cholesterol embolism, Type 2 Crystalline nephropathy: Intratubular crystal formation and
Type 3 Crystalline nephropathy: Urolithiasis [2]. Uroliths can also causes certain uncommon
conditions like pancreatitis, vomiting and inappetence of undetermined etiology, and persistent
signs of lower urinary disease [4].
Case history and observation
Twelve years old male Spitz and seven years old female Doberman were presented to
Veterinary Clinical Complex of Veterinary College & Research Institute, Tirunelveli with the
history of anorexia, vomiting and dysuria for past one week. Clinical examination revealed
severely congested conjunctival mucous membrane and enlarged popliteal lymph node with
the temperature of 39.2 0C & 38.5 0C in Spitz and Doberman respectively. Hematological
analysis revealed leukocytosis and neutrophilia. Serum biochemical analysis revealed
increased blood urea nitrogen, creatinine, ALP, sodium and decreased glucose levels. The
hematological, serum biochemical and urine analysis of Spitz and Doberman were mentioned
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in table 1. Radiological examination revealed distended

bladder with radiopaque calculi (Fig.1 & 2). Ultrasonography
of the abdomen of the Spitz revealed caliculi in both the
kidneys (Fig.4), bladder (Fig.3) and penile urethra (Fig.5).
Ultrasonography of the abdomen of Doberman revealed
calculi in both the kidneys (Fig.7) and bladder (Fig.6). Based
on the above findings, the case was diagnosed as urolithiasis
induced kidney disease (Type: 3 Crystalline nephropathy) and
the cases were managed with retrograde urohydropropulsion
(Fig.8), anti-lithiatic therapy and management of chronic Fig 2: Radiograph showing the presence of calculi in bladder of
kidney disease. Doberman

Table 1: Hemato-biochemical and urine analysis

Parameters Spitz Doberman
Hematological analysis
Haemoglobin (g/dl) 15.1 15.7
Packed cell volume (%) 39.9 47.2
Red blood cells (m/cmm) 7.49 9.8
White blood cells (/cmm) 19,600 25,000
Platelets (/cmm) 439,000 242,000
Neutrophils (%) 82 90
Lymphocytes (%) 18 7
Fig 3: USG showing the thickened urinary bladder with calculi in
Monocytes (%0 - 3
Spitz
Eosinophils (%) - -
Basophils (%) - -
Serum biochemical analysis
BUN (mg/dl) 201.23 211.74
Creatinine (mg/dL) 4.1 3.2
Total proteins (g/dL) 4.6 4.8
Albumin (g/dL) 2.1 2.3
ALT (IU/dL) 26 54
ALP (IU/dL) 108 183
Calcium (mmol/dL) 13.6 10.1
Phosphorus (mmol/dL) 9.1 6.2
Glucose (mg/dl) 43 44
Fig 4: USG showing the calculi on both right and left kidney of
Sodium (mmol/dL) 179.44 176.34
Spitzs
Potassium (mmol/dL) 4.23 3.39
Chloride (mmol/dL) 109.17 109.23
Urinalysis
Colour Reddish Dark yellow (Fig.10)
pH 6.0 6.0
Specific gravity 1.020 1.020
Protein +ve +ve
Glucose -ve -ve
Bilirubin -ve -ve
Leukocyte ++ +++
Ketone bodies -ve -ve
RBC +++ ++ Fig 5: USG showing the calculi on penile urethra of Spitz
Bile salts -ve -ve
Bile pigments -ve -ve
Urobilinogen -ve -ve
Sediments -ve Few phosphate crystals

Fig 6: USG showing calculi on thickened urinary bladder of

Doberman

Fig 1: Radiograph showing the presence of calculi in the bladder of

spitz

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The Pharma Innovation Journal
Fig 7: USG showing calculi on right kidney of Doberman
Fig 8: Retrograde urohydropropulsion to relieve the obstruction by
pushing the calculi back to the bladder
Fig 9: Calculi removed from Doberman
Fig 10: Dark yellow coloured urine from Doberman
Treatment and Discussion
Retrograde urohydropropulsion was performed as per the
standard protocol to relieve the uretheral obstruction. In
Doberman, the uroliths present in the vaginal end of urethra
ware manually removed (Fig.9). Both the cases were managed
with anti-lithiatic tablets (Tab. Cystone in Spitz & Tab.
Tamsulin in Doberman) was advised b.i.d. P/O along with
urinary alkalizer (Syrup. Neeri KFT in Spitz & Syrup. Noculi
in Doberman). The chronic kidney disease was managed with
Inj. Ringer’s lactate @ 10ml/kg b.wt I/V, Inj. Amoxycillin &
Cloxacillin @ 10mg/kg b.wt I/V, Inj. Pantoprazole @ 1mg/kg
b.wt I/V, Inj. Frusemide @ 2mg/kg b.wt I/V and Inj.
Chlorpheniramine maleate @ 0.5mg/kg b.wt I/M was
administered. Suspension Sucralfate was administered at the
dose of 0.5g/kg b.wt P/O as a phosphate binder. This
treatment was continued for 10 days and the animals
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succumbed to death several days after the treatment.
The reason for urolithiasis induced kidney disease in dogs
might be due to the fact that persistence of hypersaturated
urine in the urinary tract for a long period of time, promotes
crystal formation and results in tubular obstruction & tissue
remodelling [2]. The spitz was suspected for calcium oxalate
containg crystals. Hence, anti-lithiatic tablet Cystone (Herbal
preparation) was given as it inhibits calculogenesis and causes
disintegration and expulsion of crystals by binding with
mucin. As phosphate crystals were found in Doberman, Tab.
Tamsulin, a alpha blocker was given as it boosts the passage
of crystals by relaxation of smooth muscles in the urinary
tract. In majority of the dogs, a combination therapy of anti-
lithiatics, antibiotics along with diet often caused dissolution
of the urolith [4]. Urinary alkalizer, Syrup. Neeri was advised
in Spitz, because maintaining the urinary pH between 5.5-6.0
helps in prevention and dissolution of uroliths [1]. Urinary
acidifier, Syrup. was advised in Doberman, as the alkaline
urine increases the chance of phosphate crystals in the urine
[1]
.
Conclusion
Removal of uroliths will not alter the underlying condition
responsible for its formation. Hence, additional therapies
should be given to prevent its recurrence. The diagnosis of
composition of urolith is highly helpful in providing proper
medical and dietary treatment. A proper balanced diet with
adequate water intake prevents crystal formation. A better
understanding of the pathophysiology of crystalline
nephropathy is essential to provide prognosis and treatment.
Reference
1. Tion MT, Dvorska J, Saganuwan SA. A review on
urolithiasis in dogs and cats. Bulgarian Journal of
Veterinary Medicine. 2015;18(1):1. ISSN 1311-1477.
DOI: 10.15547/bjvm.806
2. Mulay, Shrikant R, et al. Novel insights into crystal-
induced kidney injury. Kidney Diseases. 2018;4(2):49-
57.
3. Begum M, Madeena S, Tina Roshini, Bhuvaneshwari V.
Cystic and Urethral Calculi-A Case Study of Surgical
Management in a Two Year Old Labrador Dog. Indian
Vet. J. 2019;96(05):64-66.
4. Wingert, Allie M, et al. Efficacy of medical dissolution
for suspected struvite cystoliths in dogs. Journal of
veterinary internal medicine. 2021;35(5):2287-2295.
5. Kumar Vijay, Adarsh Kumar, Varshney AC.
Ultrasonographic imaging for structural characterization
of renal affections and diagnosis of associated chronic
renal failure in 10 dogs. International Scholarly Research
Notices, 2011.
 CASE REPORT

Surgical Management of Urolithiasis in a Male Labrador:

A Case Report
Chhotan Kumar Ghosh1*, Subhasis Roy1, Pradip Sarkar2, Anil Singh1

Ind J of Vet Sci and Biotech (2020): 10.21887/ijvsbt.16.1.20

U rinary stones (urolithiasis) are a common condition

responsible for lower urinary tract disease in dogs. The
formation of calculi is associated with precipitation and
1
Dept of Veterinary Clinical Complex, West Bengal University of
Animal and Fishery Sciences, Kolkata-700037, WB, India
2
Dept of Veterinary Gynaecology & Obstetrics, West Bengal
crystal formation of a variety of minerals. Urinary calculi can University of Animal and Fishery Sciences, Kolkata-700037, WB,
damage the lining of the urinary tract, causing inflammation, India
which may predispose to bacterial infection. If calculi become Corresponding Author: Chhotan Kumar Ghosh, Department
lodged in the ureter, causing an obstruction, it may result in of Veterinary Clinical Complex, West Bengal University of
serious kidney damage. Unilateral ureteral obstruction may Animal and Fishery Sciences, Kolkata-700037, WB, India, e-mail:
result in hydronephrosis with loss of function of the kidney. ghoshchhotan82@gmail.com
Urine retention may rupture the bladder with distension of How to cite this article: Ghosh, C.K., Roy, S., Sarkar, P., Singh,
the renal capsule (Tion et al., 2015 and Mudasir et al., 2018). A., Vinayaka, M.N., Ghosh, K., Bhujel, R. & Ramudamu, S. (2020).
So, an urgent cystotomy for removal of uroliths is the most Surgical Management of Urolithiasis in a Male Labrador: A Case
commonly performed surgical procedure to save the life of Report. Ind J Vet Sci and Biotech, 16(1):77-79.
the pets. Source of support: Nil
Conflict of interest: None.
C a s e H i s to ry and O b s e r vat i o n s
Submitted: 08/08/2020  Accepted: 18/08/2020  Published: 04/09/2020
A male Labrador Retriever dog of 10 years age was presented
to the veterinary clinical complex, WBUAFS, Kolkata with a
history of vomition, stranguria, and hematuria. The dog was
depressed and mildly dehydrated. There was dribbling of
blood tinged urine which in later stages stopped completely.
The local veterinary physician tried with diuretics but failed.
Apparently, the dog was in good physical condition having
rectal temperature 100.2ᵒF, respiration rate 26/min, heart
rate 86/min, and visible mucous membrane looking normal.
A simple radiograph of lateral view of caudal abdomen
showed multiple uroliths like a bunch of grapes in urinary
bladder (Fig. 1). Then some haemato-biochemical parameters
were considered before performing surgical intervention.
Results showed Hb 13.8 g/dL, PCV(%) 64, TLC 18.4x103/
cmm, DLC(%)-Neutrophil 84, Lymphocyte 14, Eosinophil 6,
Monocyte 0.4, Platelet count 106x105/cmm, BUN 62 mg/
dL, creatinine 1.2 mg/dL, ALT 78I U/L, AST 46I U/L. Urine
analysis showed specific gravity 1.008 with the presence of
epithelial cells. Retrograde hydro propulsion was attempted
by inserting the Ryle’s tube (size 6) through the urethral orifice
upto the obstruction at the level of os penis. 2% lignocaine gel
was used topically before the insertion of Ryle’s tube. Several
attempts were made to increase by infusing normal saline
to facilitate the movement of the uroliths into the urinary Fig. 1: Radiograph showing Bunch of grapes like uroliths inside
bladder. The procedure was attempted repeatedly with a urinary bladder

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org/licenses/by/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to
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 Surgical Management of Urolithiasis in a Male Labrador: A Case Report
Fig. 2: Standard surgical procedure (cystotomy)
Fig. 3: Uroliths of different shapes and sizes.
digital pressure applied to the urethra, and then cystotomy
was performed.
Surgical Procedure and Discussion
The preoperative stabilization of the patient included
antibiotic prophylaxis with the combination of ceftriaxone
and tazobactum (562.5 mg + 262.5 mg) i/v and 1 litre normal
saline i/v @ 40 drops/minute throughout the procedure.
78 The Indian Journal of Veterinary Sciences and Biotechnology, Volume 16 Issue 1 (July-September 2020)
Fig 4: Catheterization of urethra with ryle’s tube and skin suture.
General anesthesia was achieved by administering atropine
(0.04 mg/kg b.wt., s/c) followed by xylazine (1 mg/kg
b.wt., i/m), with diazepam (0.5 mg/kg b.wt., i/v). After 10-12
minutes, 1% propofol (6 mg/kg b.wt.) was administered i/v
for induction of complete anesthesia. A standard surgical
procedure for cystotomy (Fig. 2) was achieved. Repeated
vigorous attempts with forced normal saline infusion
through urethra was made to expel all uroliths (Fig. 3). So
that the complete opening of urethral passage can be done.
The bladder was flushed with normal saline and antiseptic.
The catheter was again carefully inserted up to the bladder
and cut from the urethral orifice. The catheter was fixed to
prepuce with a single simple interrupted silk suture (Fig. 4).
Post-operative care included ceftriaxone with tazobactum
(562.5 mg + 262.5 mg) i/v bid, for 7 days, followed by oral
cefpodoxime proxetil 200 @ 1 tab bidpc for 2 weeks , NS @
250 ml i-v bid for 3 days, inj. melonex (0.2 mg/kg b.wt., i/m)
od for 5 days along with multivitamin syrup @ 1 tsf bidpc.
Urinary antiseptic Cystone tablet @ 2 tabs bidpc with urinary
alkalizer syrup @ 1 tsf bidpc for 14 days were given. The owner
was advised to flush the catheter with normal saline twice a
day. Local dressing with Betadine lotion every alternate day
was done. The urethral catheter was removed on day 9, and
the skin sutures were removed after 15 days. The dog showed
uneventful recovery.
Long urethra in male dog often face partial or complete
urethral obstruction due to this anatomical peculiarity
(Franti et al., 1999). Of the hematological parameters, the
increase in TLC, DLC, and PCV was observed as a result of
infection and dehydration. BUN, AST, ALT were also above
normal as a result of dehydration, urinary retention, and
 Surgical Management of Urolithiasis in a Male Labrador: A Case Report
stress to the kidney (Cowgill and Francey, 2005). Before
attempting surgery, forceful retrograde hydro propulsion
with normal saline was made to expel the uroliths from
the urethra into the urinary bladder. The technique has
also been described by Osborne et al. (1999). After giving
an incision to the distended urinary bladder, more than
30 numbers of uroliths of different shapes and sizes from
oval, round to semilunar, were retrieved from the bladder.
Chances of urinary tract infection were considered and
followed up by antibiotics, urinary antiseptics, fluid, and other
supportive care as postoperative prophylaxis. The owner
was advised to increase water consumption to facilitate
the diuresis and reduce the possibility of aggregation of
mineral deposits. Oral disodium hydrogen citrate syrup
was prescribed to check renal tubular acidosis helping to
increase the excretion of toxic substances from the kidneys,
thus helping to inhibit bacterial growth in the urinary tract
(Byer and Khan, 2005). The antibiotics like cefpodoxime was
recommended for another two weeks to prevent recurrent
infections. Cystone tablet is an herbal formulation that acts
as a urinary antiseptic, prevents the formation of lithogenic
substances and causes disintegration of urinary calculi
(Erickson et al., 2011). The higher specific gravity of urine
indicates the concentrated urine as a result of dehydration,
and the presence of epithelial cells suggests the removal
from the lining of the bladder that is a common finding in
urolithiasis.
It was concluded that appropriate dietary management
can reduce the chances of calculi formation to a great
extent. However, prompt diagnosis and surgical intervention
improve the outcome of urolithiasis.
The Indian Journal of Veterinary Sciences and Biotechnology, Volume 16 Issue 1 (July-September 2020)
Acknowledgement
The authors are thankful to Late Prof. (Dr) Asit Kumar Maji,
Department of Veterinary Surgery and Radiology, WBUAFS,
Kolkata for guiding to perform this successful surgical
intervention.
References
Byer, K., & Khan, S.R. (2005). Citrate provides protection against
oxalate and calcium oxalate crystal induced oxidative damage
to renal epithelium. Journal of Urology, 173, 640-646.
Cowgill, L.D., & Francey, T. (2005). Acute uremia. In: Ettinger,
S.J., Feldman E.C., editors, Textbook of Veterinary Internal
Medicine. 6th edn, St. Louis: Elsevier Saunders, pp. 1731-
1756.
Erickson, S.B., Vrtiska, T.J., & Lieske, J.C. (2011). Effect of cystone on
urinary composition and stone formation over a one year
period in phytomedicine: International Journal of Phytotherapy
and Phytopharmacology, 18(10), 863-867.
Franti, C.E., Ling, G.V., Ruby, A.L., & Johnson, D.L. (1999). Urolithiasis
in dogs: regional comparisons of breed, age, sex, anatomic
location, and mineral types of calculus. American Journal of
Veterinary Research, 60, 29-42.
Mudasir Ahmad Shah, Abas Rashid Bhat, Mohammed Arif Basha, &
Abhishek Saxena. (2018). Surgical management of urolithiasis
in male dogs: A clinical review of 10 cases. The Indian Journal
of Veterinary Sciences & Biotechnology, 13(3), 75-78.
Osborne, C.A., Lulich, J.P., Polzin, D.J., Sanderson, S.I., Koehler, L.A.,
Ulrich, L.A., Birds, K.A., Swanson, I.I., Pederson, I.A., & Sudo,
S.Z. (1999). Analysis of 77,000 canine uroliths. Veterinary Clinics
of North America: Small Animal Practice, 29, 17-38.
Tion, M.T., Dvorska, J., & Saganuwan, S.A. (2015). A review on
urolithiasis in dogs and cats. Bulgarian Journal of Veterinary
Medicine, 18(1), 1-18.
79

E-ISSN: 2320-7078
P-ISSN: 2349-6800
JEZS 2018; 6(1): 924-927
© 2018 JEZS
Received: 11-11-2017
Accepted: 12-12-2017
S Uma
Department of Veterinary
Pathology, Rajiv Gandhi
Institute of Veterinary
Education and Research,
Kurumbapet, Puducherry, India
R Kumar
Department of Veterinary
Pathology, Rajiv Gandhi
Institute of Veterinary
Education and Research,
Kurumbapet, Puducherry, India
AW Lakkawar
Department of Veterinary
Pathology, Rajiv Gandhi
Institute of Veterinary
Education and Research,
Kurumbapet, Puducherry, India
MG Nair
Department of Veterinary
Pathology, Rajiv Gandhi
Institute of Veterinary
Education and Research,
Kurumbapet, Puducherry, India
Correspondence
MG Nair
Professor & Head, Department
of Pathology, Rajiv Gandhi
Institute of Veterinary
Education & Research
Kurumbapet, Puducherry, India.
Journal of Entomology and Zoology Studies 2018; 6(1): 924-927
Cystolith in a dog: A case report
S Uma, R Kumar, AW Lakkawar and MG Nair
Abstract
A two-year old dachshund female dog was presented to a private clinic with a history of dysuria and
hematuria since 5 days. The other signs exhibited included vomiting, anorexia and abdominal discomfort.
The temperature, pulse and respiratory rates were elevated. On abdominal palpation, the bladder was
found to be distended and yet the dog could not be induced to urinate. Abdominal radiography showed a
radioopaque oval calculi in the urinary bladder. After anaesthetizing with xylazine @ 1 mg/kg and
ketamine @ 5mg/kg, mid ventral laparotomy followed by cystotomy was performed and a single large
calculi (4.5 cm x 3.5 cm) was removed. The urinary bladder wall was moderately thickened. The calculi
was ellipsoidal in shape, white to light yellow in color with surface porosity and weighed 45 g.
Biochemical analysis of the crystals revealed presence of calcium and magnesium phosphates. Following
cystotomy and its management, the animal had an uneventful recovery.
Keywords: Cystotomy, radiography, urine incontinence, urolithiasis
Introduction
Urolithiasis is a general term referring to aggregates of crystalline and occasionally non
crystalline solid substances that form in one or more locations within the urinary tract [1].
Uroliths that develop in the bladder are cystoliths. When urine becomes oversaturated with
lithogenic substances, uroliths may be formed and these can interfere with the complete and
frequent voiding of urine [2]. Increased urine salt concentration, decreased water intake,
increased irreversible water losses, increased mineral excretion, urinary tract inflammation,
change in urine pH are the major predisposing causes that may lead to the formation of calculi
in the urinary tract.
Three main contributing factors involved in urolith formation are 1) matrix—the inorganic
protein core that facilitates initial urolith formation, 2) crystallization inhibitors—organic and
inorganic crystallization inhibitors may be lacking or dysfunctional in animals with uroliths,
and 3) precipitation crystallization factors—a complex relationship among urine solutes and
other chemical factors in the urine that can lead to conditions favoring crystallization.
Regardless of the underlying mechanism(s), uroliths are not produced unless sufficiently high
urine concentrations of urolith-forming constituents exist and transit time of crystals within the
urinary tract is prolonged and for certain stones (eg, struvite, cystine, urate), other favorable
conditions (eg, proper pH) for crystallization must also exist. These criteria can be affected by
urinary tract infection, diet, intestinal absorption, urine volume, frequency of urination,
therapeutic agents, and genetics [3]
Urolith analysis provides essential information in the management and prevention of further
urolith formation.
Materials and methods
A two-year old dachshund female dog was presented to a private clinic with a history of
dysuria and hematuria since 5 days. The other signs exhibited included vomiting, anorexia and
abdominal discomfort. After general clinical examination, venous blood sampling was carried
out for complete blood count (CBC) and the serum biochemical analysis for blood urea
nitrogen and creatinine. Following abdominal radiography, cystotomy was performed.
Results
The blood picture showed mild leukocytosis (16,000 cells/cmm). The DLC revealed
neutrophilia (94% neutrophils, 6% lymphocytes). The serum blood urea nitrogen and
creatinine levels were 78 g/dl and 3.1 mg/dl respectively.
~ 924 ~ 
Journal of Entomology and Zoology Studies
On abdominal palpation, the bladder was found to be
distended and yet the dog could not be induced to urinate.
Abdominal radiography showed a radioopaque oval calculi in
the urinary bladder (Fig. 1). Clinical and imaging findings
were compatible with the diagnosis of urolithiasis and
associated uraemia.
Fig 1: Abdominal radiography showing radioopaque oval calculi in
the urinary bladder
After anaesthetizing with xylazine (@ 1 mg/kg) and ketamine
(@ 5mg/kg), mid ventral laparotomy followed by cystotomy
was performed. The urinary bladder wall was moderately
thickened and oedematous and the blood vessels on the
serosal surface were severely engorged (Fig: 2).
Fig 2: Urinary bladder with engorged serosal blood vessels.
A single large calculi that measured 4.5 cm x 3.5 cm was
removed from the bladder (Fig. 3). The calculi was ellipsoidal
in shape, white to light yellow in color with surface porosity
and weighed 45 g. Post-operatively, the animal was given
Ceftrioxone @ 20mg/kg BW IV daily for five days,
Meloxicam @ 0.2mg/kg BW IM and DNS @ 15ml/kg BW IV
daily for five days. The animal had an uneventful recovery
and no recurrence was observed during the six month follow
up period.
Microscopic analysis of the urolith revealed struvite crystals
with characteristic coffin lid appearance (Fig: 4). Biochemical
analysis of the crystals revealed presence of calcium and
magnesium phosphates.
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Fig 3: Single large ellipsoidal cystolith with surface porosity
Fig 4: Struvite crystals from the cystilith
Discussion
The urinary system is designed to dispose of metabolic wastes
in liquid form. However during urolith formation, sustained
alterations in urine composition promote over saturation of
one or more substances eliminated in the urine and result in
their precipitation and subsequent growth. Renal calculi are a
common problem in dogs [4].
In this report, a urolith has been surgically removed from the
urinary bladder of a two year old dachshund female dog.
Dachshund breed has been reported to have a higher
frequency of urolithiasis [5, 6]. Contrary to human beings, the
kidneys are not the common sites for calculi lodgment in dog
as about 95% of calculi in dogs are found either in the bladder
or urethra and bladder together [7]. The most frequent
anatomical location of calculi in male is urethra followed by
urinary bladder, however, calculi in females are usually
located in the urinary bladder [8-10].
The clinical signs exhibited by the dog were in accordance to
those reported in earlier reports of canine urolithiasis [11, 12].
Haematuria and dysuria exhibited by dogs might be due to
irritation of bladder mucosa caused by uroliths. lncreased
level of BUN and creatinine have been recorded in cases of
urolithiasis in canine and is attributed to prolonged retention
of urine [11,12,13]. Elevated creatinine level could be due to
renal damage caused by hydrostatic pressure on the kidney
and increased reabsorption of creatinine from bladder due to
prolonged stasis of urine in the urinary bladder [14].
Radiography can be used to diagnose the conditions of cystic
 
Journal of Entomology and Zoology Studies
calculi but the diagnosis becomes challenging if urinary
stones are radiolucent [15, 16]. In the present case the calculi
could be visualized clearly by radiography. Magnesium
ammonium phosphate, calcium oxalate, calcium phosphate, 2.
silica and cystine crystals are often radiodense
Physical characteristics may serve as a preliminary and
tentative indicator of the composition of the calculi and
thereby assist in establishing the etiological factors. 3.
Microscopic examination of crystals in urine is of diagnostic
importance as different crystals have different appearance. In 4.
the present case, the calculi was single, large, ellipsoidal in
shape with surface porosity. Similar physical characteristics
has been described for phosphate uroliths in earlier reports [17,
18]
. 5.
Urolith analysis is a well-established procedure in the
characterization of urolithiasis. A major deficiency of the
qualitative method is a failure to identify the major
component of mixed uroliths. Mixed uroliths represents a 6.
problem in classification that can be clarified only by using a
quantitative method measurement. Knowledge of the mineral 7.
composition of calculi helps direct appropriate management
of urolithiasis. In the present case, chemical analysis of the
urolith revealed presence of calcium and magnesium
phosphates. Microscopic analysis of the urolith was 8.
suggestive of struvite. The bladder is the most common site of
phosphate urolith, and phosphate has been reported as the
main constituent in canine urolithiasis especially uroliths of
female dogs [5, 19, 20, 21, 22]. The major component of phosphate 9.
uroliths is magnesium ammonium phosphate (Struvite) [6, 23].
lnfrequent urination, as a result of confinement, lack of
regular exercise, reduced water intake contribute to formation
of crystals and uroliths. High levels of minerals in the diet and 10.
sometimes calcium have been directly linked to canine
urinary bladder calculi formation. A diet with excess protein
can also contribute to calculi formation [24].
Urine retained for more than 24 hours becomes alkaline due
to release of ammonia from the breakdown of urea [25]. 11.
Phosphate calculi are formed rapidly in alkaline urine but are
more soluble in acidic urine. Alkaline urine may lead to
precipitation of struvite, calcium carbonate and calcium 12.
phosphate calculi [26, 27]. Urinary tract infection may
predispose the urinary tract to the formation of calculi.
Struvite calculus in dogs is primarily linked to urinary tract 13.
infections [28].
Conclusion 14.
Following surgical intervention, proper general and dietary
management is required to prevent reoccurrence of cystoliths.
A general recommendation for prevention of urolithiasis is to 15.
increase water consumption to encourage diuresis and reduce
time for aggregation and crystallization [29]. Hypercalciurea,
alkaline urine pH, increased matrix, decreased crystallization 16.
inhibitors, urinary hyperconcentration and retention of urine
are the major risk factors involved in phosphate lithiasis.
Urine acidifiers are useful prophylactic agents for phosphate
calculi. Dogs must be fed diets that lower urinary phosphate 17.
and magnesium and maintain acidic urine.
Acknowledgement 18.
The Dean, Rajiv Gandhi Institute of Veterinary Education and
Research (RIVER), Puducherry, India for providing necessary
facilities and encouragement. 19.
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Scott AB. Urolithiasis in Small Animals. 2016.
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Kim-chae Wook, Choi-Ulsoo, Chegal-Jun, Bae B, Lee
DH, KoYH et al. Canine urolithiasis - lnterrelation
between breed age sex anatomic location urine pH crystal
and mineral composition of uroliths (270 cases) Journal
of Veterinary Clinics. 2004; 21(3):264-269.
Vijaykumar G, Nambi AP, Vasu K, Dhanapalan.
Ultrasonographic diagnosis of cystic calculi in a dog - A
case report. Indian Veterinary Journal. 1999; 76:438-439.
Ravindran R, Vinu DP, Baby PG. Chronic urethrocystisis
in a dog - A case report. Indian Veterinary Journal. 2001;
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nephrolithiasis in a dog - A case report. Indian Veterinary
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Kerr MG. Veterinary Laboratory Medicine: Clinical
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Saini NS, Singh SS. Ultrsonographic and radiographic
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Veterinary Surgery. 2002; 23(1):55.
Larson MM. The Kidneys and Ureters In: BSAVA
Manual of Canine and Feline Abdominal Imaging.
O’Brien R and Barr F (edts). British Small Animal
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Konwar B, Sarma K, Saikia B, Talukdar DJ, Shah S,
Cheda M et al. The diagnosis of struvite cystolith with
imaging techniques. 2017; 9(03):48071-48074.
Makkena S, Hari Krishna NVV, Rao KV. A case of
cystic calculi in a bitch. Indian Veterinary Journal. 1999;
76:728-729.
Clark WT. The distribution of canine urinary calculi and
their recurrence following treatment Journal of Small
Animal Practice. 1974; 15(7):437-444.
Scholz D, Schwille PO, Ulbrich D, Bausch WM, Sigel A.
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Composition of renal stones and their frequency in a

stone clinic - Relationship to parameters of mineral
metabolism in serum and urine. Urological research.
1979; 3:161-70.
21. Lewis LD, Morris NL. Canine urolithiasis: Diagnosis and
treatment. Modern Veterinary Practice. 1984; 65(5):375-
378.
22. Singh V, Tiwari A, Tiwari GP, Gupta RS. Urolithiasis in
dog : A case report. lntas Polivet. 2001; 2(1):71-73.
23. Doreen MH, Andrew EP, Moore MG, Favrin BH. Canine
urolithiasis: A look at over 16000 uroliths submission to
the Canadian Veterinary Urolith Centre from February
1998 to 2003. Canadian Veterinary Journal. 2004;
45:225-230.
24. Griffith DP. Urase stone. Urological research. 1979;
7(3):215-221.
25. Brodey RS. Canine urolithiasis - A survey and discussion
of fifty two clinical cases. Journal of the American
Veterinary Medical Association. 1955, 126-129.
26. Prien EL, Prien EL. Comparison and spectrum of urine
stone. American Journal of Medicine. 1968; 45(5):654-
622.
27. Osborne CA, Kruger JP, Lulich JP, Barlges JW, Polzin
DJ, Molitor T et al. Feline matrix crystalline urethral
plugs - A unifying hypothesis of causes. Journal of Small
Animal Practice. 1992; 33:172-177.
28. Weaver AD, Pillinger R. Relationship of bacterial
infection in urine and calculi to canine urolithiasis.
Veterinary Record. 1975; 97:48-50.
29. Tion MT, Dvorska J, Saganuwan SA. A review on
urolithiasis in dogs and cats. Bulgarian Journal of
Veterinary Medicine. 2015; 18(1):1-18.

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Cystic Urolithiasis in Dogs: A Case Report and Review of the Literature

Article · March 2022

DOI: 10.17582/journal.vsrr/2022.8.1.1.7

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 Veterinary Sciences: Research and Reviews

Case Report

Cystic Urolithiasis in Dogs: A Case Report and Review of the Literature

Chandrakala Rana1*, Deepak Subedi1*, Shanti Kunwar1, Rajesh Neupane1, Birendra Shrestha2, Khan
Sharun3, Dinesh Kumar Singh4 and Krishna Kaphle2
1
Paklihawa Campus, Institute of Agriculture and Animal Science, Tribhuvan University, Rupandehi, 32900, Nepal; 2Veterinary
Teaching Hospital, Paklihawa Campus, Institute of Agriculture and Animal Science, Tribhuvan University, Rupandehi,
32900, Nepal; 3Division of Surgery, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, 243122,
India;4Director, Adjunct Professor, Department of Veterinary Pathology and Clinics, Institute of Agriculture and Animal Science,
Tribhuvan University, Rupandehi, 32900, Nepal.
Abstract | A mildly dehydrated dog was presented at Veterinary Teaching Hospital, Paklihawa Campus,
Tribhuvan University with symptoms of urinary inconsistency, haematuria, and inappetence. Radiography
and ultrasonography revealed the presence of calculus in the urinary bladder. Cystolithotomy was performed
and the dog responded to the intervention and recovered uneventfully.
Editor | Muhammad Abubakar, National Veterinary Laboratories, Park Road, Islamabad, Pakistan.
Received | December 03, 2021; Accepted | March 04, 2022; Published | March 11, 2022
*Correspondence | Chandrakala Rana and Deepak Subedi, Paklihawa Campus, Institute of Agriculture and Animal Science, Tribhuvan Univer-
sity, Rupandehi, 32900, Nepal; Email: chandrakalarana12@gmail.com, subedideepu26@gmail.com
Citation | Rana, C., D. Subedi, S. Kunwar, R. Neupane, B. Shrestha, S. Khan, D.K. Singh and K. Kaphle. 2022. Cystic urolithiasis in dogs: A case
report and review of the literature. Veterinary Sciences: Research and Reviews, 8(1): 1-7.
DOI | https://dx.doi.org/10.17582/journal.vsrr/2022.8.1.1.7
Keywords | Calculus, Cystolitotomy, Cystic-urolithiasis, Haematuria, Veterinary teaching hospital

Copyright:   2022 by the authors. Licensee ResearchersLinks Ltd, England, UK.

This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://
creativecommons.org/licenses/by/4.0/).

Introduction the mode of formation (Sharun et al., 2021). However,

there are mainly four types of mineral deposits

C ystic-urolithiasis is defined as the formation

of one or more urine crystalloids (uroliths) in
the urinary bladder that may grow to fill the entire
cavity. Uroliths are organized organic and inorganic
solutes that precipitate around the nidus because of
oversaturated urine (Breshears and Confer, 2017).
The organic component known as mucoprotein acts
as a cementing agent for the formation of calculi
(Blood and Henderson, 1997). Cystolithotomy refers
to the surgical opening made in the urinary bladder
to remove the formed stones from the bladder. The
formation of urolith has many etiological factors, and
their chemical composition also differs according to
June 2022 | Volume 8 | Issue 1 | Page 1
in uroliths: Urate, cystine, struvite (magnesium
ammonium phosphate), and calcium (Tion et al.,
2015).
The most common mineral deposits are struvite
and calcium-containing urolith (Low et al., 2006).
The etiology of struvite urolithin dogs is due to the
concurrent urinary tract infection (Tiruneh and
Abdisa, 2017). In addition, the urethra of a female
is shorter than that of a male, which leads to more
possibility of infection to reach the bladder from
the urinary tract and vagina. This implies a higher
incidence of cyst urolithiasis in females than males
 Veterinary Sciences: Research and Reviews
(Tiruneh and Abdisa, 2017). saline and some essential nutrients of vitamins in the
250 ml of normal saline injection.
This case report explained the successful diagnosis
and treatment of cystic-urolithiasis at the Veterinary
Teaching Hospital (VTH) of the Institute of
Agriculture and Animal Science (IAAS), Tribhuvan
University, Nepal. A Japanese Spitz bitch with a
reasonably big-sized urolith was successfully treated.

Case history
A seven years old intact female Japanese Spitz dog
named Toffy was presented to VTH of IAAS on 20th
November 2019 with complaints of inappetence for
four days and dullness, depression and, hematuria for
three days. The bitch was vaccinated against DHPPL
Figure 1: Abdominal radiograph (lateral) showing large uroliths
(canine distemper, hepatitis, leptospirosis, parvovirus, inside the urinary bladder of the dog.
and parainfluenza) and rabies, the recommended ones
in this area. It was fed family meals supplemented
with bones and sometimes commercial pet food. Toffy
was kept under close observation, and further clinical
as well as physical examination was performed.
The physical examination revealed normal rectal
temperature, heart rate, and respiratory rates of 101.2
F, 124 beats/min, and 22 cycles/min, respectively
(Table 1). Observed clinical findings were hematuria,
abnormal gait, urinary inconsistency, abnormal
urinating position, and dysuria. Likewise, abdominal
palpation revealed a hard mass in the bladder.

Table 1: Physical parameters of the dog.

Parameters Test result Reference value Figure 2: Hyperechoic focal echogenicity (arrows) creating distal
(Bukowski and acoustic shadow (arrowheads) in the dependent portion of the
Susan, 2011) bladder, confirming the presence of cystic calculus.
Heart rate 124 beats/min 70-120 beats/min
Respiration rate 22 cycles/min 18-34 cycles/min Table 2: Haemato-biochemical parameters of the dog.
Rectal temperature 101.2 Fahrenheit (F)
o
100.2 F-103.8 F
o o
Parameters Test result Reference value
Dehydration Mild: Skin tenting time Normal 2 sec (Fielder, 2015)
White blood cells (WBC) 36.2×109/l 5-14.1×109/l
Lymphocytes (%) 25 8-21
Diagnosis
Monocytes (%) 10 2-10
Based on the radiographic (Figure 1) and
Granulocytes 29×10 /l
9
4.0-12.6×109/l
ultrasonography (Figure 2) findings, supported by
the haemato-biochemical alterations (Table 2), the Hemoglobin (g/dl) 14.2 11.9-18.9
case was diagnosed to be a fairly large size cystic- PCV (packed cell volume) % 42.7 35-57
urolithiasis and surgery performed by experienced ALT (alanine 36 10-109
veterinarians. aminotransferase) (U/l)
Total Bilirubin (mg/dl) 0.1 0-0.3
Total Protein (g/dl) 7.0 5.4-7.5
Treatment
Given the size and condition of Toffy, immediate Albumin (g/dl) 2.9 2.3-3.1
surgery was recommended, and she was kept under BUN (mg/dl) 75 8-28
supportive therapy, including intravenous (IV) normal Creatinine (mg/dl) 2.7 0.5-1.7

June 2022 | Volume 8 | Issue 1 | Page 2


Anesthesia protocol
The animal was fasted for 12 hours, and the water was
withheld three hours before surgery.
Sedation: Xylazine @ 1mg/kg slow IV.
Pre-operative medication: Pre-operative analgesia:
Meloxicam @ 0.2 mg/kg IV; Pre-operative antibiotics:
Ceftriaxone@ 20mg/kg IV.
Induction: Diazepam: Ketamine (1:1) @ 1ml/10kg
IV.
Maintenance : Diazepam: Ketamine (1:2) ratio IV.
After Toffy was sedated, the surgical site was shaved
and prepared for aseptic surgery from the umbilicus to
the cranial brim of the pelvis using 2% Chlorhexidine
and 70% methyl alcohol. The animal was placed in the
dorsoventral position, and the limbs were tied to the
surgical table. The sterile fenestrated drape was placed
over the incision site to create a sterile field.
A ventral midline abdominal incision was made
through the skin and Linea alba. The urinary bladder
was located, which was distended and congested
(Figure 3a). Next, a stab incision was made into
the base of the bladder and extended cranially and
caudally with scissors. The bladder was found to be
distended with calculus (Figure 3b), and three large
calculi were removed (Figure 3c). Each calculus had
approximate dimensions of 2×3×2 cm and weighed
35 grams. After removing the calculi, a catheter was
passed through the bladder to the urethral opening to
check the patency (Figure 3d). However, obstructions
were not evident. Then, the bladder was first flushed
with normal saline, followed by a diluted iodine
solution.
The bladder was sutured in double-layer using Vicryl
3-0 in Cushing followed by a Lembert suture pattern
including serosa, muscularis, and submucosa avoiding
the mucosa (Figure 3e). The bladder incision was
apposed in an inverted fashion, and a leak test was
performed. Then, muscle and subcutaneous layers
were sutured with Vicryl 2-0 in a simple continuous
pattern separately, whereas the skin was sutured with
Nylon 2-0 in a simple interrupted pattern (Figure 3f ).
Vital signs like heart rate, respiration rate, and rectal
temperature were monitored throughout the surgery.
The dog recovered from anesthesia after 15 minutes
of completion of surgery.
June 2022 | Volume 8 | Issue 1 | Page 3
Veterinary Sciences: Research and Reviews
Figure 3: Image showing the steps of cystotomy in a dog. Distended
bladder incised at the base of the bladder (a), Bladder distended with
calculi (b), Removed three bladder calculi (c), Inserting catheter from
bladder to urethral opening (d), Double-layer suturing of the bladder
(e), Skin closure by simple interrupted pattern (f ).
Postoperative care
The patient was kept on postoperative antibiotics
(ceftriaxone @20mg/kg), pain medication (meloxicam
@ 0.2 mg/kg) for a week, and herbal medication
Cystone tablets and Neeri tablets (urinary antiseptic
and calculi dissolver). In addition, the surgical site
was checked regularly for any swelling and discharge
with a fresh dab of iodine solution.
The owner was advised to restrict the dog’s movement,
keep it clean, and provide a simple, balanced diet of
boiled plain chicken with steamed rice or mashed carrot
with a sprinkle of salt to induce thirst and production
dilute urine. Toffy showed remarkable progress and
the wound healed without any complications, and the
skin sutures were removed on the 14th postoperative
day.
Results and Discussion
VTH, IAAS, located close to the international
with India in the Nepalese city of Sidharthanagar
(gateway of Lumbini), is a relocated facility. It is
now the center of referral for Western Nepal and
part of India. The population of pet dogs in campus
surroundings is fairly healthy. Besides the college
animal farm, community dogs, cows, and rural farming
communities are the primary beneficiaries of VTH’s
services. Complicated cases, including urolithiasis, can
be handled comfortably. Urolith can develop in the
kidney, ureter, bladder, or urethra and are referred to as
nephrolith, ureterolith, urocystoliths, and urethroliths,
respectively. Early detection of urolithiasis can be
treated with dissolution therapy where clinical signs

are mild. Haematuria, polydipsia, polyuria, dysuria
are the common clinical signs of cystic-urolithiasis in
dogs. However, a definitive diagnosis cannot be made
based on history and clinical signs. This emphasizes
that diagnostic imaging is crucial for confirmative
diagnosis of urolithiasis.
A hematological profile showed leukocytosis
(36.2×109/l), which reveals the presence of infection.
A marked increase in the blood urea nitrogen (BUN)
and creatinine level correlates with partial or complete
obstruction of urine due to calculi in the bladder. A
plain abdominal radiograph was done, which revealed
radio-opaque calculi in the urinary bladder (Figure
1). The ultrasonographic image revealed the subtly
increased opacity over the dependent part of the
bladder. Hyperechoic focal echogenicity creating
distal acoustic shadow in the dependent portion
of the urinary bladder can be noticed in the image
(Figure 2). Surgery (cystolithotomy) was performed
with minimal damage to the surrounding structure.
The mechanism of each calculi formation is different,
and it varies with etiological factors; however, the
physicochemical mechanism for every urolith is the
same as shown in Figure 4.
Figure 4: Steps involved in lithogenesis (supersaturation, nucleation,
crystal growth, and aggregation irrespective of crystal nature)
(Espinosa-Ortiz et al., 2018).
Factors associated with lithogenesis are:
1. Crystal formation depends on various factors
such as supersaturation of urine, urine pH,
absence or presence of crystallization inhibitors
(nephrocalcin, osteopontin, crystal adhesion
inhibitors, chondroitin sulfate, heparin sulfate,
fibronectin) or promoters (collagen,hyaluronic acid,
myeloperoxidase,nucleolin) (Aggarwal et al.,2013).
2. Hypercalciuria is the most common
pathophysiologic condition associated with
calcium uroliths patients (O’Kell et al., 2017)
and oxalate concentration in urine enhances
it (Bartges and Callens, 2015). High sodium
intake reduces calcium reabsorption and increases
calcium concentration in urine. Excessive protein
use decreases the urine pH, ultimately increasing
calcium through bone turnover and reducing
tubular calcium reabsorption. Vitamin C helps in
calculi formation via the conversion of ascorbic
June 2022 | Volume 8 | Issue 1 | Page 4
Veterinary Sciences: Research and Reviews
acid into oxalate (Butterweck and Khan, 2009).
3. Medicine that is insoluble in urine induces the
precipitation of urine. For example, Sulfadiazine,
ciprofloxacin, acyclovir, and oral sodium
phosphate-containing preparations are known
to cause crystal nephropathy (Yarlagadda and
Perazella, 2008).
4. The urate crystal is formed due to liver disease or
congenital defects in the metabolism of purines
(Dalmatians and English Bulldogs) (Bartges and
Callens, 2015).
5. The high concentration of cysteine amino acids in
urine leads to cystine crystals (Espinosa-Ortiz et
al., 2018).
6. Urine pH influences crystal precipitation and
calculi formation. At low pH, ammonium ion
gets accumulated, but phosphate concentration
is reduced. Moreover, at high pH, phosphate
concentration is high, but ammonium ion is low.
Therefore, struvite uroliths are formed only in
the alkaline urine, while urate and cystine calculi
are associated with acidic urine (Breshears and
Confer, 2017).
7. Urinary tract infection (UTI) with urease
producing bacteria, as the kidney cannot
form struvite crystal (consist of ammonium,
magnesium, and phosphate ion), produces
urease that leads to urine alkalinization as well
as increased concentration of ammonium and
phosphate, ultimately forming uroliths (Coe and
Parks, 2016).
The presence of calculi in the urinary tract (UT) results
in obstruction, which leads to anuria. Uroliths act as
foreign bodies that initiate irritation and damages the
epithelium of UT. Chronic cases of urolithiasis may
result in renal failure. The severity of pain varies from
mild to severe, and it ends when there is no further
obstruction in the flow of urine (Coe and Parks,
2016). The presence of calculi in the bladder causing
hematuria and dysuria.
Differentiation of different crystals may be difficult
as they vary in shape, size, and structure. However,
crystals can be identified accurately by polarization
microscopy, x-ray diffraction, and infrared
spectroscopy (Coe and Parks, 2016). CT scan also
is used for uroliths identification (Espinosa-Ortiz et
al., 2018). Urinalysis can be done for the detection
of crystalluria. However, it does not present the
definitive diagnosis for urolithiasis but can suggest

urine supersaturation (Bartges and Callens, 2015).
Evaluation of the chemical nature of urine by
estimating urine pH can also act as a practical
measure. Urine with a pH of less than seven favors
cystine, calcium oxalate, and purine crystal formation,
while pH greater than seven favors struvite crystal
growth (Bartges and Callens, 2015). In the case of
infection-induced struvite crystal, urine culture and
sensitivity test may additionally act as diagnostic as
well as therapeutic tools, and measurement of urea,
creatinine, minerals, and electrolytes may assist in
diagnosis (Bartges and Callens, 2015). According
to Houston et al. (2004), struvite uroliths were most
common in female dogs, whereas oxalate uroliths were
common in male dogs. Calcium oxalate urolithiasis
was more common in shorthair, neutered dogs, male
dogs, intact male dogs, and small breed dogs. Male
dogs had the highest levels of cysteine and urate.
Urate urolithiasis was most common in Dalmatians
(Burggraaf et al., 2021). In a study in Mexico, male
dogs over the age of six and big breeds, particularly
Labradors and Golden retrievers, were at high risk of
canine silica urolithiasis (Mendoza-López et., 2020).
The line of treatment may vary with crystal nature,
size, degree of obstruction, and location. However,
some of them are as follows:
Surgical management
Surgical therapy for canine urolithiasis is successful,
according to studies, with a cure rate of over 87.5
percent (Sodhi et al., 2021). Every urolithiasis patient
does not require surgery; however, the presence
of large size, increased number of calculi, and
unresponsiveness to therapy suggest surgery (Bartges
and Callens, 2015; Kumar et al., 2019). Open surgical
procedures such as cystotomy, urethrotomy can be
done for urolithiasis. Anatrophic nephrolithotomy
is a surgical procedure with a longer recovery period
than endoscopic methods, where the elimination rate
is 80-100%. Robotic surgery is also successful for
calculi removal with high efficacy (Espinosa-Ortiz et
al., 2018). Therefore, minimally invasive techniques
have replaced the open surgical procedure.
Minimal invasive techniques
Extracorporeal shock wave lithotripsy (ESWL),
percutaneous nephrolithotomy (PCNL), ureteroscopy
with laser lithotripsy is used to break and remove the
stone fragment (Espinosa-Ortiz et al., 2018).
ESWL is a non-surgical approach where shock
June 2022 | Volume 8 | Issue 1 | Page 5
Veterinary Sciences: Research and Reviews
waves are used for fragmentation of calculi, and
it is useful only for small calculi. The success rate
depends on wave frequency, stone composition, size,
and location. Damage to the surrounding structure
is reported, and mostly renal hemorrhage is seen
with hypertension and diabetes mellitus for the long
term (Butterweck and Khan, 2019). Ureteroscopy is
an endoscopic procedure used to treat lower ureteral
stones and can be used safely for patients with
coagulopathy disease (Espinosa-Ortiz et al., 2018).
PCNL is mainly used for large stones in renal with
ultrasonography or fluoroscopy support. After the
passage of the endoscope, the urolith can be broken
with the help of laser, ultrasound, or pneumatic
energy. The stone elimination rate is higher in PCNL
as compared to internal surgery after an operation.
However, complications such as infection, damage to
the surrounding structure, hemorrhages are observed
(Espinosa-Ortiz et al., 2018).
Medical management
Struvite crystal: Treatment of sterile struvite
(without infection) can be done by consuming
dissolution and prevention diets that have limited
amounts of magnesium, phosphorus, acidifying diets,
and increased water intake, and in case of infection-
induced struvite, appropriate antibiotics should be
used (Sodhi et al., 2021; Bartges and Callens, 2015).
Calcium oxalate crystal: Hypercalciuria can be
reduced by bicarbonate administration. Calcium
oxalate should be removed physically because
a dissolution diet doesn’t work. So, prevention
strategy includes reducing calcium and oxalate
concentration in urine by using urine alkalizing
agent, increasing urine volume, increasing inhibitors
(citrate, magnesium, pyrophosphate, nephrocalcin)
concentration and function (Bartges and Callens,
2015). Thiazide diuretics can be used due to their
hypocalciuric action. Also, potassium citrate increases
the pH of urine and citrate, which has an inhibitory
effect on calcium oxalate crystallization (Butterweck
and Khan, 2019).
Urate crystal: Uric acid is the metabolic product of
purines. Dissolution therapy includes an alkalizing
agent, purine limited diet, xanthine oxidase inhibitors,
allopurinol with the proper functioning of the liver.
However, without the proper function of the liver,
such treatment may be inefficient (Bartges and
Callens, 2015).

Herbal treatment
Either in the use of medicine or surgical approach,
there is the presence of side effects. So, herbal use
may have a beneficial effect on it. For example, extract
from the herb Herniariahirsuta, Phyllanthusniruri,
Dolichosbiflorusare used to treat calculi through their
inhibitory effect on the lithogenesis process since
they interfere with calcium oxalate crystallization
(Butterweck and Khan, 2019).
Increasing urine volume is the major preventive
approach for every crystal because it increases
urination frequency, decreases crystal growth and
aggregation time, and dilutes solutes in urine
(Bartges and Callens, 2015). Treatment protocols for
urolithiasis are well advanced. However, its formation
cannot be eradicated because of broad etiology, and
it also varies with individuals. A lot of research was
done on urolithiasis but couldn’t cover every etiology
and its mechanism. Therefore, further study can be
done on it.
Nutritional management of urolithiasis
The goal of urolithiasis dietary therapy is to dissolve
calculi (struvite, urate, cystine) and/or limit the risk of
recurrence. Dietary treatment for mixed or compound
stones should be dependent on the salt content of the
nidus. When it comes to any form of stone, the goal
should always be to promote urine dilution, which
is best accomplished by giving high-moisture meals
whenever feasible. Controlling the quantity of crystal
precursors in the food as well as the pH of the urine
is critical for all stones, while the case for calcium
oxalate is less clear (Queau, 2019).
Conclusions and Recommendations
The occurrence of urolithiasis relies upon various
etiologic factors. Each crystal has a distinct etiological
mechanism of formation and chemical composition.
Furthermore, the therapeutic and preventive measures
additionally fluctuate with crystal composition and
mode of formation. Concisely, the predisposing
elements can be stated as kidney disease, urinary
infection, medication, and congenital disorder. With
the assist of appropriate diagnostic testing and surgical
intervention, the dog recovered well. However, there
would be continually the threat of reoccurrence of
stone. Recurrence can be prevented by measures like
using a urinary alkalizer or acidifier according to
the nature of the crystal. Moreover, increased water
June 2022 | Volume 8 | Issue 1 | Page 6
Veterinary Sciences: Research and Reviews
intake along with regular veterinary consultation is
beneficial. Mishandling by quacks and most likely
excess medication could have played a part in the
genesis of the problem in the first place. Hence, IAAS
needs to support VTH in its outreach activities to
sensitize pet owners on ethical and proper care of pet
animals from the welfare and prevention of zoonotic
disease perspectives.
Ethical animal research
The dog owner signed a release form to consent to
perform clinical study and surgery on his pet dog. The
study was approved by Veterinary Teaching Hospital
(VTH), Paklihawa Campus, Institute of Agriculture
and Animal Science (IAAS), Tribhuvan University
(TU).
Acknowledgments
The authors like to acknowledge Dr. Saurav Pantha,
Dr. Rabina Ghimire and Dr. Subash Rimal for their
unreserved support.
Novelty Statement
This case report describes the successful diagnosis and
treatment of cystic-urolithiasis along with a detailed
literature analysis.
Author’s Contribution
Conceptualization C.R., manuscript preparation
C.R., D.S., S.K. (Shanti Kunwar), and R.N., review
and editing C.R, D.S., B.S, S.K. (Sharun Khan), K.K,
and DK.S. All authors have agreed to the final version
of the manuscript.
Conflict of interest
The authors have declared no conflict of interest.
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 KAJIAN PUSTAKA
UROLITHIASIS PADA ANJING

NUR BAITI
2209611024
 PENDAHULUAN

Urolithiasis merupakan kondisi

terbentuknya kalkuli akibat terjadinya
supersaturasi pada urin yang terdiri
dari satu atau beberapa jenis mineral
Urolith yang terbentuk dapat
dibedakan atas empat berdasarkan
jenis mineralnya
SINYALEMEN DAN ANAMNESIS

 Muntah, stranguria, hematuria, anoreksia, depresi,

dehidrasi.
 Palpasi : mengalami kesakitan
 Pemeriksaan penunjang :
 pemeriksaan hematologi
 ultrasonografi
 pemeriksaan radiografi
Hasil dan Pembahasan

Tabel 1. Hasil pemeriksaan

Hematologi
Gambar 1. USG Ginjal kanan dan
kiri
Gambar 2. Radiologi menunjukkan urolit
pada kandung kemih
 DIAGNOSA PROGNOSIS

 Berdasarkan hasil anamnesis,  Berdasarkan pemeriksaan dan

pemeriksaan klinis, dan beberaa kondisi hewan secara umum
pemeriksaan penunjang, anjing prognosis yang di dapat adalah
mengalami Urolithiasis fausta
 PENANGANAN

 injeksi amoxicillin 1,5 mL,

 Ibuproven sirup 5 mL per 12 jam secara oral selama
lima hari
 Nefrolit dibuat dalam bentuk pulveres dijadikan 2 kapsul
diberikan 2 kali sehari
 ciprofloxacin tab 500 mg (15mg/kg BB, q 8 jam, selama
5 hari)
 Urolithiasis adalah kondisi terbentuknya urolith atau
kalkuli yang berlebihan pada saluran perkencingan,
seperti pada vesika urinaria, ginjal, ureter dan
uretra. Kejadian terbentuknya urolith pada vesika
urinaria biasa terjadi pada hewan domestik (anjing dan
kucing) terutama karena pola pakan yang buruk.
TERIMAKASIH