Percutaneous nephrolithotomy for kidney stone removal

Percutaneous nephrolithotomy for kidney stone removal

A minimally invasive option to treat this common occurrence in pets
Mar 01, 2012

Urolithiasis is a common clinical problem in small animal veterinary patients. See how a minimally invasive technique helped a Bichon frise.

Initial findings

  • Signalment: 3-year-old spayed female Bichon frise
  • Presenting complaint: Recurrent urinary tract infections and intermittent hematuria
  • Pertinent history: Two years of recurrent intermittent dysuria, hematuria and pollakiuria with three documented urinary tract infections consisting of Staphylococcus species
  • Previous diagnostic tests performed

Urinalysis: Urine specific gravity = 1.021; pH = 8; too numerous to count cocci bacteria/hpf; 10 to 20 WBC/hpf; 5 to 10 RBC/hpf; protein 3+
Urine culture: Staphylococcus intermedius > 100,000 colonies
CBC: All results normal
Serum chemistry profile: Blood urea nitrogen = 38 mg/dl; creatinine = 2.1 mg/dl (slightly elevated)
  • Previous medications: Amoxicillin trihydrate-clavulanate potassium (15 mg/kg orally b.i.d. for 14 days), four different treatments periods
  • Progression: Each course of antibiotics improved the dysuria and hematuria. These signs recurred within one to four weeks after discontinuation of antibiotics.
  • Physical examination findings: Bright, alert, good body condition; lightly hooded vulva

Problem list

  • Recurrent urinary tract infections
  • IRIS stage 2 chronic kidney disease (elevated creatinine concentration with low specific gravity)

Differential diagnoses

  • Pyelonephritis
  • Possible urolithiasis (suspected struvite)

Further diagnostics tests

Figure 1: A radiograph of a female dog with bilateral large staghorn nephroliths.
  • Abdominal radiography: See Figure 1
  • Abdominal ultrasonography: Large nephrolith in each kidney measuring 3.5 cm on the left and 2.8 cm on the right; small bladder stones (< 2 mm)


  • Bilateral staghorn nephrolithasis: suspected struvite stones
  • Cystolithiasis