From The Vet: The Curious Case of Chloe's Urinary Woes

by Animal Care Centre
The Newsy Neighbour
October Issue 108

Cool Case: "The curious case of Chloe’s urinary woes"

History:

Chloe is a 10 year, 9 month old, spayed female Bichon Frise Mix dog that presented to the Animal Care Centre on August 13^th, 2016 because her owners were concerned about her urination.

Initial Examination and Diagnosis:

In the days leading up to Chloe’s first visit to the Animal Care Centre, her family noticed that she was urinating more frequently than normal, and had started to have blood in her urine (hematuria). She was otherwise bright an alert, and eating and drinking normally.

Her physical examination was relatively unremarkable (her temperature, heart rate and respiration rate were all normal). The attending veterinarian decided to run a urinalysis to check for bacteria and white blood cells in Chloe’s urine and an X-ray of her abdomen to look at her bladder. Using an ultrasound probe on her abdomen to identify her bladder, a sterile needle was gently guided into her bladder to collect a representative sample of urine. Using the in-house laboratory equipment, the urine was assessed and Chloe was diagnosed with a urinary tract infection. X-rays (radiographs) are not always taken when a pet has a urinary tract infection; however in this case, the attending doctor was concerned about the possibility of bladder stones (urolithiasis), which can also lead to blood in urine. Struvite stones are the most common type of bladder stone in dogs, are almost always 'radiodense', meaning that they can be seen on X-rays. Shih Tzu, Miniature Schnauzer, Lhasa Apso, Yorkshire Terrier and Bichon Frisé are the dog breeds most commonly diagnosed with bladder stones. Chloe’s radiograph is shown here. The red circle denotes a radiodense structure that is suspicious of a bladder stone. There are three primary treatment strategies for struvite bladder stones: 1) feeding a special diet to dissolve the stone(s), 2) non-surgical removal by urohydropropulsion and 3) surgical removal. Treatment for stones is important because they can predispose to future UTIs and even urethral obstruction (blockage so the pet cannot urinate). In Chloe’s case, the location of the suspected stone (high in the bladder adjacent to the colon) is somewhat unusual. When a patient is lying on their side to take an X-ray, the stones usually roll down to the lowest portion of the bladder.

Treatment: 

Chloe’s UTI was treated with 10 days of oral antibiotics, and repeat X-rays were booked 14 days later to reassess for any changes in the suspected bladder stone. When Chloe came in 2 weeks after her initial visit, the clinical signs of her UTI had resolved, but the object remained in the same place (see second X-ray). At that time, it was determined that surgical removal of the suspected stone was necessary. But alas, when the surgeon opened her bladder, no stones were identified! Based on the location of the object on X-rays, the veterinarian decided to explore the abdomen further to see if the object could be located. When the bladder was moved out of the way to expose the colon, 5 congealed, calcified lumps were identified in an accumulation of abdominal fat in the exact location denoted on X-rays! These objects were identified as Bates Bodies, which are benign, nodular areas of fat necrosis (dead fat cells). They appear on X-rays as mineralized soft tissue masses that can commonly be confused as tumors, foreign bodies or stones depending on their location. Bates bodies do not require removal, but in Chloe’s case, surgery was necessary to rule out a bladder stone and confirm the object seen on X-ray was nothing to be worried about!

Chloe remained in hospital overnight for observation to make sure she was urinating normally. She was sent home the following day on a Non-Steroidal Anti-inflammatory (NSAID) medication to help with pain and inflammation as well as a further week of antibiotics. She is doing very well at home since surgery and her family is happy to know that she is free of troublesome bladder stones. They continue to feed her Royal Canin Urinary SO food in order to reduce the risk of developing struvite bladder stones in the future.

Please give credit to Dr. Kate Mueller for this article and case.