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Stones, Medical Treatments

Denice Moffat

Medical Treatments for Stones Include:

Acetohydroxamic Acid (AHA): If struvite stones cannot be removed, a doctor may prescribe a medicine called acetohydroxamic acid (AHA). AHA is used with long-term antibiotic medicines to prevent the infection that leads to stone growth.

Allopurinol: A doctor may prescribe certain medications to help prevent calcium and uric acid stones. These medicines control the amount of acid or alkali in the urine, key factors in crystal formation. The medicine allopurinol may also be useful in some cases of hyperuricosuria.

Antibiotics: For struvite stones that have been totally removed, the first line of prevention is to keep the urine free of bacteria that can cause infection. A patient’s urine will be tested regularly to ensure no bacteria are present.

Cystotomy: In people and animals the abdomen and bladder are incised and the stones physically  removed and the body cavity and bladder sutured back up after  first flushing the urethra usually with a saline or slightly acid saline solution containing ascorbic acid (one molecule of natural vitamin C).

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Diets that control Urinary pH: Depending on whether stones are formed in an acid or alkaline environment, your doctor may modify your diet to correct the pH of the urine to prevent further stone formation.

Diuretics: Doctors usually try to control too much calcium in the urine (hypercalciuria) with diuretics such as HCTZ (hydrochlorothiazide). These medicines decrease the amount of calcium released by the kidneys into the urine by favoring calcium retention in bone. They work best when sodium intake is low.

Lithotripsy (Shock Wave therapy or Extracorporeal Shock Wave Lithotripsy or ESWL) uses a ultrasound-type machine to make the crystals crumble and break larger stones into more passable ones. Litho means stone. Tripsy means to crush. Two types of shock wave machines exist. With one machine, you sit in a tub of water. With most newer machines, you lay on a table. In both cases, a health technician uses ultrasound or x-ray images to direct the sound waves to the stone. This is the best option for humans.

Parathyroidectomy (surgically removing the parathyroid gland): People with hyperparathyroidism sometimes develop calcium stones. Treatment may include the surgical removal of one or both of the parathyroid glands which are located in the neck. Removing the glands acts to prevent formation of future kidney stones.

Perineal urethrostomy: This is a common procedure in cats with recurrent blocked bladders where the penis is cut off and the urethra spatulated and sutured open (basically a sex change operation!) Most times this is quite effective but recovery is tedious until the sutures are removed. Often they will need to wear and Elizabethan collar and go back to the vet for frequent rechecks until they are totally healed.

Sodium Cellulose Phosphate: This is occasionally given to bind calcium in patients with hypercalciuria. It acts to bind calcium in the intestines, thus preventing it from leaking into the urine.

Thiola and Cuprimine: If cystine stones cannot be controlled by drinking more fluids, a doctor may prescribe medicines such as Thiola and Cuprimine, which help reduce the amount of cystine in the urine.

Tunnel Surgery: In tunnel surgery, the doctor makes a small cut into the patient’s back and makes a narrow tunnel through the skin to the stone inside the kidney. With a special instrument that goes through the tunnel, the doctor can find the stone and remove it. The technical name for this method is percutaneous nephrolithotomy.

Ureteroscope: A ureteroscope looks like a long wire. The doctor inserts it into the patient’s urethra, passes it up through the bladder, and directs it to the ureter where the stone is located. The ureteroscope has a camera that allows the doctor to see the stone. A cage is used to catch the stone and pull it out, or the doctor may destroy it with a device inserted through the ureteroscope. This hurts quite a bit I hear.

Urethrotomy: In male dogs with recurrent urinary tract obstruction, a scrotal urethrostomy creates a permenant opening in the urethra just behind the os penis (the bone within a dog’s penis where those stones often get stuck.) Sheesh. I’ve never done one of these in my 32 years of being around veterinary medicine, but it sounds like a real mess. Wonder if the dog dribbles all the time!

Urohydropulsion: The sedated patient’s urethra is backflushed with a fluid and the bladder massaged in an attempt to allow the crystals, sand and small stones to flow out. With a dog you inject saline into the urethra with a syringe toward the bladder which helps to flush the stones back into the bladder if they are not stuck. It helps to hold the animals front legs up while someone else massages the bladder in an attempt to try to get the stones and sand to pass. This is done under sedation because no matter what the species (human, dog, cat, etc) this can really hurt!

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