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Advancing treatment of urolithiasis


DVM: You're known for developing the technique of voiding urohydropropulsion, a nonsurgical method to remove uroliths. Tell us about that and how you devised it.

Lulich: We anesethize the dog, fill the bladder with saline, stand the dog up like a human stands, express the bladder, and in seconds, out come the stones. I do these all the time at the clinic. In 1990, someone brought me a dog to euthanize because it was getting stones. I agreed to take the dog and fix the problem. I thought about the canine anatomy and compared it with human anatomy. A human can pass a stone by urinating standing up. I thought perhaps dogs could do the same. It worked!

DVM: What kinds of results are being seen with laser lithotripsy?

Lulich: If you don't mind me being a bit folksy: It's a smashing success. Owners love it, because now we have a procedure that eliminates the need for surgery and is less invasive. What's even better than lithotripsy is our ability to medically dissolve struvite stones in cats. For example, we can dissolve these stones in about 10 days with therapeutic diets. This, in turn, has reduced the cost to the client, as well as reduced pain and suffering of the animal. It lets clients know we're a profession that's very compassionate.

DVM: How about with shock wave lithotripsy?

Lulich: Unfortunately, the machines are designed for humans and aren't very adaptable to pets. The focal point is so precise on these machines that, when used for pets, they're just not as effective. Or maybe we're just not effective at using them.

DVM: When should a veterinarian recommend surgery for urolithiasis, and what types of surgery tend to work best?

Lulich: In our hospital, we spend a lot of time utilizing nonsurgical procedures, so I may not be the best person to answer this question, but here goes: The most common reason for doing surgery is to treat a urethral obstruction that can't be removed by any other means. This is especially so in male cats whose anatomy in this regard is so small that using modern extraction equipment simply isn't possible. Numerous stones and large stones are removed faster with surgery. So clients have a choice: minimally invasive or surgical incision.

DVM: Are there any popular misconceptions in the veterinary community about urolithiasis treatment that you'd like to dispel?

Lulich: There's a myth that you shouldn't dissolve stones in males because of fear of obstruction. The truth is that obstruction is possible, but it occurs far less often than predicted. Of course, not all stones can be medically dissolved anyway.

There's also a myth that stones are a disease. The truth is they're the result of pathologic and physiologic factors leading to excessive excretion and precipitation of compounds in the urine to form stones. You have to correct the underlying condition if you want to prevent stone formation.

Donna Loyle is a freelance medical editor and writer in Philadelphia and the former primary editor of the North American Veterinary Licensing Examination.


Source: DVM360 MAGAZINE,
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