30. Noncompliance with diet and/or antimicrobial drug recommendations can be expected to be associated with poor treatment outcomes. In our experience, veterinarians and their staff typically overestimate rates of compliance among their clients, and are also unable to identify noncompliant individuals. Therefore, special effort should be made to educate clients about the reasons why special diets and drugs are being given, and the expected outcome if they are unable or unwilling to comply with the dissolution protocol. Consult Table 3, p. 8S for a summary of expected changes in clinical, laboratory and radiographic findings during and following successful therapy.

31. In most situations, the expectation of full compliance with diet recommendations may be unrealistic. Clients should be advised of what types of "treats" will have minimal impact on the success of therapy, and the types of treats that will significantly reduce the likelihood of urolith dissolution. In general, less than full compliance is acceptable to us, as long as the desired therapeutic benefit can safely be achieved in an appropriate time.

32. Clients should be educated about the importance of antimicrobial drug therapy for bacterial UTI. The dosage of antimicrobic and the frequency with which it is administered should be devised in cooperation with the client's input of what is realistic for them.

34. The struvitolyic diets are relatively high in fat, which serves primarily as a source of calories. Because dietary fat is a risk factor for pancreatitis, patients known to be at higher risk for pancreatitis should be carefully evaluated prior to dissolution therapy, and closely monitored during dissolution therapy. We emphasize that Miniature Schnauzers are at increased risk for infection-induced struvite uroliths, lipid abnormalities and pancreatitis.

Likewise, patients with hyperadrenocorticism are at increased risk for UTI (which could include staphylococci) and pancreatitis. Although risk factors are not to be considered as synonymous with cause and effect, clients should be informed of these associations and advised of how to respond to adverse events if they occur. They should be informed of adverse events that need medical attention and those that need medical attention only if they continue or are bothersome.

35. The diet (Prescription Diet Canine s/d, Hill's) designed to dissolve canine struvite uroliths is restricted in protein and supplemented with sodium chloride. Both could affect fluid balance. Therefore, it should not be routinely given to patients with concomitant diseases associated with positive fluid balance (heart failure, nephrotic syndrome, etc.) or hypertension.

Prevention 36. Infection-induced struvite uroliths will not form in the absence of urease-positive microbial infections. Therefore, perform appropriate diagnostic studies with the goal of detecting and eradicating or controlling bacterial UTI. We emphasize that eradication or control of UTI by urease-producing bacteria is the most important factor in preventing recurrence of most infection-induced struvite uroliths.

36. In context of the effectiveness of diets in inducing dissolution of struvite uroliths, use of dietary modification to minimize recurrence of uroliths is logical and feasible. Studies are in progress to evaluate the preventative efficacy of mild to moderate restrictions in protein, magnesium and phosphorus of acidifying diets.