Use of Electrohydraulic Lithotripsy in 28 Dogs with Bladder and Urethral Calculi

Abstract

Background: Electrohydraulic lithotripsy (EHL) has been used as an alternative to cystotomy in human medicine to remove urinary calculi. This prospective study evaluated the efficacy and safety of EHL to remove urinary calculi in dogs.Hypothesis: EHL is an efficient and safe method of treatment of bladder and urethral calculi in dogs. Methods: Dogs presented between January 1, 2005 and June 1, 2007 with lower urinary tract calculi diagnosed by radiographs or ultrasound examination were included in the study. Physical examination, CBC, biochemistry, urinalysis, and urine culture were performed at presentation. EHL and voiding urohydropulsion were performed under general anesthesia. Patients received IV fluids for 12 hours after which they were rechecked by ultrasound examination and discharged with antibiotics and anti-inflammatory drugs for 5 days. All patients were reevaluated 1, 3, and 6 months after presentation by physical examination, urinalysis, and ultrasonography.Results: Twenty-eight dogs (19 males, 9 females) presented with bladder or urethral calculi or both underwent lithotripsy. Their median weight was 8.3 kg. Calcium oxalate calculi were present in 22 dogs, struvite in 4, and mixed calculi in 2. Fragmentation was done in the bladder (23 dogs) and in the urethra (12 dogs). Calculus-free rate was higher for urethral than for bladder calculi in males and higher for bladder calculi in females than in males. No major complications were reported. Twelve dogs relapsed within 6 months.Conclusions: Results of this study support the use of EHL as a minimally invasive treatment for bladder calculi in females and for urethral calculi in male dogs.

Influence of Ureteral Stone Components on the Outcomes of Electrohydraulic Lithotripsy

“…Ureteroscopic fragmentation of ureteral stones by use of intracorporeal lithotripsy is a popular, effective, minimally invasive technique and is considered to be the treatment of choice for lower ureteral stones [5]. Previous studies have reported success rates ranging from 72 to 100% [4,5,14,15], which is similar to the success rate in our study for patients who were treated by URS with EHL (98.5%).…”

“…The more lamellated and harder a stone, the more difficult it is to break [1,4]. Stone surface characteristics may also play a role in fragmentation efficiency because rough stones have been reported to fragment more easily than smooth ones [1].…”

“…However, larger ureteral stones require lithotripsy for the safe extraction of the stone fragments. To date, four techniques are available for intracorporeal lithotripsy: electrohydraulic lithotripsy (EHL), laser lithotripsy, ultrasonic lithotripsy, and ballistic lithotripsy [4]. …”

Interventional Urology

“…With proper case selection, all uroliths can be fragmented by laser lithotripsy and removed in approximately 85% of male dogs and nearly all female dogs. [24][25][26][27] In the author's experience this technique is best suited to female dogs with a small number of bladder or urethral uroliths and male dogs with ureteroliths. Animals with larger stone burdens are better suited for a PCCL procedure (see later discussion).…”

Cystoscopy

“…Publications of the use of these modalities in small animal patients are scarce, and more are under way. [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] This section will discuss some additional equipment that is used for these interventional modalities that has not been previously discussed, and each area of the urinary tract will be addressed. The sections will separately expand on the current veterinary literature and procedural descriptions ( …”