Internal Medicine Update | Minimally invasive therapy for urinary stones: Laser lithotripsy at CTVRC
Central Toronto Veterinary Referral Clinic
Did you know that not all urinary bladder stones have to be surgically removed?
Laser lithotripsy is a minimally invasive alternative to surgical approaches for management of urinary stones. It is considered the standard of care for urolith removal in humans and has been used in veterinary medicine for over 10 years. It is associated with shorter hospitalization and recovery times compared to traditional cystotomies.
For this procedure, patients are placed under general anesthesia and a scope of the urinary bladder is performed to visualize the stone(s). A special laser known as a Ho: YAG laser is used to break up the stone. A laser fiber is passed through the scope and laser energy is used to break up the larger stone into smaller pieces for removal via voiding urohydropulsion and/or basket retrieval.
Factors that are considered when assessing whether or not lithotripsy is appropriate include:
- Location of urinary stone
Bladder and urethral stones can be fragmented by lithotripsy. Stones within the ureter and kidneys are not amenable to laser lithotripsy.
Lithotripsy is only being performed in dogs at CTVRC during this time.
- Sex and patient size
Urethral diameter of the patient must be able to accommodate at minimum an 8Fr urinary catheter. Lithotripsy is not advised for male miniature and small breed dogs such as Chihuahuas and Yorkshire Terriers.
- Size and number of urinary stones
Imaging of the urogenital tract will help determine whether or not lithotripsy is advised. The smaller the size and fewer the number of stones will result in increased success of the procedure.
- Urinary stone composition
Stone removal is recommended only if the patient is clinical for the stone or at an increased risk of urethral obstruction.Any patients clinical for urinary stones should have them removed whether amenable to medical dissolution or not.
- Presence of concurrent urinary tract infection
Patients should be evaluated for a urinary tract infection.Those with an active infection should be receiving antibiotic therapy based on a recent urine culture and sensitivity acquired by cystocentesis at the time of lithotripsy.
As each case is individual, if you have any questions as to whether your patient would be a good candidate for lithotripsy, Dr. Kimberly Ho would be happy to review any diagnostics you have performed and discuss the case with you before referring the case for a consultation.
Dr. Kimberly Ho is a Board Certified Small Animal Internist who is part of the Healthcare Team at the Central Toronto Veterinary Referral Clinic. She is available for referrals and consultations Tuesday to Friday. Please contact her with any medicine questions or concerns at 416-784-4444.
Posted by: Michael Goldstein, DVM, Diplomate ACVIM
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