7 year old MN Shih Tzu presented to a colleague for suspected IVDD Aug 16th. Responded slowly to conservative therapy.
Represented to a colleague Aug 27th for hematuria/pyuria/crystalluria. Appeared to be leaking urine. Was able to stand, but weak and ataxic. Radiographs confirmed narrowed disk space and possible calcified disks in 2 lumbar spaces. No abnormalities in bladder other than it was large. Attempted to catheterize, but dog wouldn’t allow without sedation. Once sedated, dog leg go of bladder. Was put on prazosin and baytril x 10 days.
7 year old MN Shih Tzu presented to a colleague for suspected IVDD Aug 16th. Responded slowly to conservative therapy.
Represented to a colleague Aug 27th for hematuria/pyuria/crystalluria. Appeared to be leaking urine. Was able to stand, but weak and ataxic. Radiographs confirmed narrowed disk space and possible calcified disks in 2 lumbar spaces. No abnormalities in bladder other than it was large. Attempted to catheterize, but dog wouldn’t allow without sedation. Once sedated, dog leg go of bladder. Was put on prazosin and baytril x 10 days.
Represented Sept 16th for hematuria again. Had finished ABs 8 days ago, hematuria just returned. I examined the dog – weak motor function, CPs pretty much normal. Ultrasounded bladder (see attached videos). Large bladder full of echogenic material that settles out with time, trigone area clear and no stones seen. Did wonder whether there was a slight dilation to lumen in area of prostate. Also don’t remember ever seeing so much motion of urine in and out, but maybe because it is echogenic and we have neurologic issues… No obstruction seen (scanned distal urethra/penis as well). Sent home on more prazosin and baytril, added bethanechol, urine culture pending, switched to urinary tract diet.
Thoughts about the dilation? Fluid motion? Case in general?
Thanks
Jennifer
Comments
Looks like you have a atonic
Looks like you have a atonic bladder secondary to spinal disease with retention cystitis. Is there pyuria/bacteruria on urinalysis? Prazosin and bethanechol is great but some cases require an indwelling urinary catheter for a number of days so that the bladder remaims as small as possible and hopefully some improvement in bladder tone and contractibility.
Looks like you have a atonic
Looks like you have a atonic bladder secondary to spinal disease with retention cystitis. Is there pyuria/bacteruria on urinalysis? Prazosin and bethanechol is great but some cases require an indwelling urinary catheter for a number of days so that the bladder remaims as small as possible and hopefully some improvement in bladder tone and contractibility.
Most of the cases I have seen
Most of the cases I have seen with atonic bladders have secondary cystitis that needs to be treated aggressively and then probably with pulse therapy the first three days of each week for life. I would get a urine culture. You can try a catheter, but most of these bladders are not large because of detrusor muscle stretching- but rather lack of innervation from the spinal nerves. I really don’t think Bethanicol will work either.
I recently had one dog that was getting ready to be euthanized and he has responded to Imipramine.
Other options if you believe in alternative medicine is VOM (Chiropractic), Low Level Laser Therapy or Acupunture.
Most of the cases I have seen
Most of the cases I have seen with atonic bladders have secondary cystitis that needs to be treated aggressively and then probably with pulse therapy the first three days of each week for life. I would get a urine culture. You can try a catheter, but most of these bladders are not large because of detrusor muscle stretching- but rather lack of innervation from the spinal nerves. I really don’t think Bethanicol will work either.
I recently had one dog that was getting ready to be euthanized and he has responded to Imipramine.
Other options if you believe in alternative medicine is VOM (Chiropractic), Low Level Laser Therapy or Acupunture.
Sounds like an MRI or CT
Sounds like an MRI or CT is in order. There is poor urethral tone as there is space and reflux in the pelvic urethra that should be closed down even wehn applying pressur eto the bladder wiht the probe. This type of debris in a dog ios usually infection that goes to Remo’s comments. Resistant infection from prior tc likely so culture and logn term abs and reculture at 4 weeks while on abs.
UMN bladder (incomplete incoordinated voiding) has lesions cranial to L4 and sounds like mutifocal neuro lesions which make surgery problematic. Therapeutic HILT laser where available (as opposed to low level/cold laser as HILT will penetrate much deeper with 10,000 times more power without side effects), chiro, acupuncture and tx the uti and bethanacol would be the next step but x-sectional imaging would give a better overall idea of whats going on.
Sounds like an MRI or CT
Sounds like an MRI or CT is in order. There is poor urethral tone as there is space and reflux in the pelvic urethra that should be closed down even wehn applying pressur eto the bladder wiht the probe. This type of debris in a dog ios usually infection that goes to Remo’s comments. Resistant infection from prior tc likely so culture and logn term abs and reculture at 4 weeks while on abs.
UMN bladder (incomplete incoordinated voiding) has lesions cranial to L4 and sounds like mutifocal neuro lesions which make surgery problematic. Therapeutic HILT laser where available (as opposed to low level/cold laser as HILT will penetrate much deeper with 10,000 times more power without side effects), chiro, acupuncture and tx the uti and bethanacol would be the next step but x-sectional imaging would give a better overall idea of whats going on.