- 12 year old mn cat had a cystotomy performed 3-4 weeks ago as the rDVM suspected stones based upon radiographs. Upon opening the bladder, instead of stones, he found lots of calcium oxalate sand.
- Since the surgery, the cat continues to have problems with stranguria, dysuria, and urinating outside the box.
- Urine culture was positive for E. coli. The cat was placed on a fluoroquinolone and buprenorphine but clinical signs persist. Urinalysis shows ongoing hematuria.
- 12 year old mn cat had a cystotomy performed 3-4 weeks ago as the rDVM suspected stones based upon radiographs. Upon opening the bladder, instead of stones, he found lots of calcium oxalate sand.
- Since the surgery, the cat continues to have problems with stranguria, dysuria, and urinating outside the box.
- Urine culture was positive for E. coli. The cat was placed on a fluoroquinolone and buprenorphine but clinical signs persist. Urinalysis shows ongoing hematuria.
- Bladder ultrasound shows a somewhat linear, echogenic density originating from the dorsal wall at the caudal end of the bladder. To me, it looks like suture except that it is in the wrong place (suture would be ventral). It is NOT gravity dependent and remains in the same location regardless of the cat’s position. I don’t think it is an artifact because it shows up in multiple views.
- I would have liked the cat’s bladder to have been more distended, but he urinates frequently.
- Any other ideas as to what this may be? Blood clot? Adherent stone?
Comments
I usually do not comment
I usually do not comment cause not expert, however… Just for thinking… Did you see the sutures in the ventralwall? Or the scar? May be check with surgeon which approach was done? I have seen sutures in dorsal/ cranial aspect…
Anyway, let’s see the experts comments:)
Doppler?
Doppler?
You dont hgave to be an
You dont hgave to be an expert to comment we are all a family here so comment away:)
Those are all great points…. this is a typical inverted suture polyp assuming the surgeon did a retroflexion of the bladder and entered dorsally. Just check the sx log to the technique. This typically goes away over a couple of months but sometimes suture that embeds a vessel or has a reaction can have hematuria… aside from this, blood coming form resistant infection, renal disease such as infarcts.. stone movement or idiopathic cystitis can play a role too. Did the surgeon get hostopath of the bladder wall to assess the mural inflammation? I have found over the years that interstitial cystitis (lymphoplasmacytic-pred responsive inflammatory bladder disease… the “IBD” no one talks about officially yet)) is often the issue and the sand/stones are secondary and this scenario as you describe occurs post sx…. owner thinks stone go away >>> problem solved… but when that’s not the case we hope we have histopath or morphological decsription of something else causing it…. then there is the old pride environment at home and idiopathoc cystitis to consider… the multiple litter box safe haven high places and all the Buffington et. al. behavior work out there that we have to consider.
With those clinical signs
With those clinical signs underlying interstitial cystitis is highly possible. Density can be an adherent organized hematoma/stone/sediment. From its position it is unlikely to cause stranguria or dysuria. Can consider sedating the cat and filling it via a catheter to better delineate it.
Thank you for your comments.
Thank you for your comments. The surgical report says it was a ventral approach which is why suture seems unlikely. I did not do CF ( good idea) but in live scanning, it did not look like a wall mass at all. I will see if histopath was done on the bladder wall. I will also see if I can fill the bladder under sedation on a recheck exam. Thank you all for your help!
Thanks,EL. I have developed
Thanks,EL. I have developed my own routine with urinary cases…I strongly advice my colleagues to book them in the morning…so, that if empty bladder, I will keep them in for 1-3 hours for filling up, sometimes I consider SQ fluids in cats if not drinking and re-scan later (im not a mobile service…so this may not always be possible if busy busy mobile like EL), in very few cases…one very recently, when a lesion really is very complex and bladder will not fill up (due to polaquiuria)…and I really need to assess a potential mass…, Im very clear with owners…if not catheterized and distended bladder, then I cannot diagnose…so…no answers/no treatment…So…they accept much better the sedation and procedure (which if not blocked is actually quite fast and straight forward…).
I also try to persuade my colleagues to sample bladder walls at any surgical oportunity. Even for apparently “just a small stone” or “just sand”.
Interesting post. I always learn something new. love it. Thanks
Just found out from the
Just found out from the surgeon that he did make a dorsal incision and used monomend. As such, I am pretty well convinced now that this is suture with some adhered blood and or calcium oxalate. The moral of the story is, if it looks like suture, it probably is. Or as my histology professor used to say, “Call it as you see it”. Thank you so much for all of your input in this case! It is much appreciated!
Ah! That’s great news!! At
Ah! That’s great news!! At least doesn’t mean something more sinister! I like your histology professor… My reports are very descriptive… So that… If it happens that I don’t quite know the diagnosis, at least anybody can imagine what I see;) although I’m getting better at less description and providing
more practical ” way forward” options.:)
Great thread… sample sample
Great thread… sample sample sample is key whether bladder or intestine or anything…at least get it in a jar and send out later if need be. I see this omission of sampling bite so many practitioners in the back side after the fact. TCC runs with stones in dogs, interstitial cystitis runs wiht sandy bladder cats, IBD or LSA runs with older dogs that have FBs… it goes on and on.
Intraoperative US to delineate the best lesion to sample is fun, fast, precise and owners are amazed when you describe it to them. You have a probe and a scalpel so use them together.