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Improving management of urolithiasis: therapeutic caveats


7. Despite the value of medical dissolution of uroliths, this form of therapy is also associated with the potential for undesirable events. Persistent uroliths increase the risk for UTI's as well as obstructive uropathy. Both risks and benefits of medical versus surgical and medical therapy should be considered in the context of the status of each patient.

8. Drugs may enhance urolithiasis in one or a combination of ways, including: 1) alteration of urine pH in such fashion as to create an environment that decreases the solubility of some calculogenic substances; 2) alteration of glomerular filtration, tubular reabsorption, and/or tubular secretion of drugs or endogenous substances so as to enhance promoters or impair inhibitors of urolithiasis; and, 3) precipitation of drugs or their metabolites (i.e. sulfadiazine) to form a portion of all of a urolith.

9. Medical dissolution (and prevention) protocols should be consistently monitored by appropriate indices of therapeutic response. These include timely evaluation of urine pH, crystalluria, and the number, size and location of uroliths by radiography and/or ultrasonography.

Prevention of urolith recurrence 1. In general, prevention strategies are designed to eliminate or control the underlying causes of various types of uroliths. When specific causes cannot be identified, prevention strategies encompass efforts to minimize risk factors known to be associated with calculogenesis. These strategies commonly include dietary modifications.

2. Veterinarians and their staff often overestimate the degree to which clients comply with management recommendations. To enhance compliance, clients should be included in planning so that the prevention protocol includes what they can do, and excludes what they can't or won't do. Educating clients about the expected benefits associated with therapy, and the expected adverse outcomes if therapy is not implemented, enhances compliance. Therapy requiring changes in lifestyle (i.e. meal feeding versus ad libitum feeding), confusion about instructions, too many medications, and difficult tasks (frequent oral administration of pills to cats) are likely to reduce compliance. However, an expectation of full compliance is often unrealistic. In general, less than full compliance is acceptable as long as the desired therapeutic benefit can safely be achieved.

3. All prevention recommendations should be periodically monitored and adjusted to meet each individual patient's needs. This typically includes follow-up urinalyses, serum chemistry profiles and radiography. Early detection of small urocystoliths that recur despite appropriate medical therapy facilitates non-surgical removal by voiding urohydropropulsion.


Source: DVM360 MAGAZINE,
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