In his session, “Canine Uroliths,” presented at the Fetch dvm360 Conference in Atlantic City, New Jersey, Mark Acierno, MBA, DVM, DACVIM, professor and associate dean for clinical affairs at Midwestern University’s veterinary teaching hospital, detailed common canine uroliths, including methods for diagnosis and treatment. One of the uroliths covered was struvite, which is the most common urolith in dogs.

Generally, clinical signs of uroliths include lower urinary tract inflammation, hematuria, pollakiuria, periuria, and stranguria. In male dogs, the presentation of urethral uroliths can vary. Dogs may strain to urinate, but be unable to, and dribbling urine/intermittent incontinence could be observed.

Acierno advises attendees to palpate the bladder in every dog, and although the process will often be unrewarding, an audible crunching noise can occasionally be heard upon palpation, which indicates the presence of a urolith. He also recommends imaging the entire urinary tract, with radiology/ultrasound, also explaining that, in veterinary urology, “ultrasounds are always more important than getting x-rays.” According to Acierno, radiographs will show up to 27% false negatives, largely because of the size and composition of stones.

“Even in the hands of a boarded radiologist, 27% of the time, you are going to miss uroliths if all you’re looking at is x-rays,” Acierno said in his session. “[Using] ultrasound, you’re going to miss about 6%. So, ultrasound seems to be a better way to go.”

The best method for confirming the type of urolith is by collecting a piece of it and sending it off for laboratory analysis. For the removal, Acierno recommends several techniques, including urohydropropulsion, catheter-assisted retrieval, utilizing a stone basket, electrohydraulic lithotripsy, or laser lithotripsy.

Struvite is the most common urolith in dogs. Composed of magnesium, ammonium, and phosphate, the stones are associated with urease-producing bacteria, including 

Staphylococcus intermedius, Proteus mirabilis

 spp. In dogs, struvite is almost always associated with urinary tract infections (UTIs). Meanwhile, in cats with struvite, stones are almost always sterile.

According to Acierno, urea is in the urine, and urease causes it to split into ammonium and bicarbonate. Ammonium then combines with magnesium and phosphate, and bicarbonate raises the pH of the urine. The increased pH results in decreased solubility of the ammonium, magnesium, phosphate complex, which causes struvite crystals and stones to form. Although females are anatomically more prone to urease-producing infections, struvite uroliths can become lodged in the long, narrow urethras of male dogs.

A combination of antimicrobial and dietary therapy is required for the dissolution of struvite uroliths. Acierno recommends a discussion with the pet owner about pros and cons of medical and surgical management prior to any decisions regarding therapies. Antimicrobial therapy is based on a urine culture and sensitivity. Urine should be acquired through cystocentesis.

Acierno explains that bacteria continue producing urate, sequestered in the layers of the struvite stone, implying the importance of continued antibiotic therapy throughout the dissolution process. Struvite dissolving diets are low in protein, phosphate, and magnesium, and work to acidify the urine. He notes, though, that these diets are oftentimes not balanced nutritionally, and are not intended for long-term use.

Acierno sends pet owners home with pH test strips or urine dip-sticks so they can continue to monitor the pH level. “If the pH starts going back up, it means our [UTI] has either changed, or the bacteria has become resistant, and we’ve got a problem again,” Acierno explained. “I usually have them check a couple of times [per] week… if the pH is greater than 7, that suggests we have an issue and we need to get a urine sample [obtained by cystocentesis] submitted for culture.” He notes that complete dissolutions of struvite stones can take more than 3 months, and additional abdominal radiographs and urine analysis should occur monthly.

The prevention of struvite stones requires the prevention of alkaline urine, and therefore, a prevention of UTIs. Again, Acierno advocates for regular at-home urine pH measurements with either dip-sticks or a pH meter. He explained that the presence of alkaline urine would indicate that an office visit is needed, at which point urine should be collected by cystocentesis, and submitted for culture. If necessary, he also recommends radiographs during this visit. For recurrent UTIs, Acierno advises evaluating for structural abnormalities that would predispose the patient to UTIs. Oftentimes, these cases are related to involuted vulvas, which can be corrected surgically. Other patients with recurrent UTIs could benefit from long term, low-dose antibiotic therapy.

Acierno M. Canine Uroliths. Presented at: Fetch dvm360 Conference; October 14-16, 2024; Atlantic City, NJ.

Articles

Common canine uroliths, including struvite, were covered during a session at the Fetch dvm360 Conference in Atlantic City

Diagnosing and treating canine struvite uroliths

Can-Fite BioPharma Ltd, a clinical-stage biopharmaceutical company, recently announced that its veterinary collaborator, Vetbiolix, has achieved encouraging final results from a multicenter clinical trial on Piclidenoson for dogs with osteoarthritis. Vetbiolix—a developer of preventive and treatment products for diseases that affect pets—has successfully concluded the study, according to a news release.

Piclidenoson is an innovative small molecule and the first of its type, acting as an A3 adenosine receptor agonist (A3AR). This drug, which can be taken orally, has shown a strong safety and efficacy profile in a Phase III trial for psoriasis. It works by inhibiting the inflammatory cytokines interleukin 17 (IL-17) and interleukin 23 (IL-23) and inducing apoptosis in skin cell keratinocytes that play a role in the disease's pathology.

The study aimed to investigate the effects of 90 days of treatment with Piclidenoson. Canine patients with arthritis received an oral dose of 100 μg/kg and 500 μg/kg of Piclidenoson twice a day for 90 days. According to Can-Fite, the primary objective was to assess the severity of dogs’ symptoms using the Liverpool OsteoArthritis in Dogs (LOAD) questionnaire, which focused on the dogs' mobility.

Secondary objectives included the Visual Analog Scale (VAS) for pain assessment reported by pet owners, and the Numerical Rating Score (NRS) for evaluating lameness and pain as assessed by veterinarians.

The study met its primary and secondary endpoints, demonstrating a dose and time dependent inhibitory effect on LOAD and VAS from Piclidenoson, according to Can-Fite. There was also a favorable trend in NRS scores, which showed improvements in clinical condition and pain reduction with the 500 µg/kg dosage.

“The final data from the osteoarthritis study are very encouraging and this veterinary indication offers Can-Fite the opportunity to get Piclidenoson onto the market faster to benefit canine, and potentially contribute to near-term revenues,” Sari Fishman, PhD, vice president of business development at Can-Fite Biopharma, said in the news release.

 “We are very pleased to work productively with the team at Vetbiolix.”

According to Can-Fite, Vetbiolix has decided to move forward with a comprehensive in-license agreement with Can-Fite, which includes obligations to make an upfront payment, milestone payments, and provide royalties on sales after gaining regulatory approval. This arrangement is projected to generate $325 million for Can-Fite over the next 10 years. Vetbiolix funded all expenses linked to the veterinary clinical development.

Treatments available for canine osteoarthritis currently involve oral non-steroidal anti-inflammatory drugs (NSAIDs), which only target symptoms and can lead to serious adverse effects, according to Can-Fite. There is also an injectable, disease-modifying osteoarthritis drug (DMOAD), capable of slowing down the disease’s progression.

Significant positive results from osteoarthritis clinical study in dogs treated with piclidenoson. Can-Fite Biopharma Ltd. News release. October 18, 2024. Accessed October 18, 2024. 

https://www.globenewswire.com/en/news-release/2024/10/18/2965580/0/en/Significant-Positive-Results-from-Osteoarthritis-Clinical-Study-in-Dogs-Treated-with-Piclidenoson.html

Piclidenoson, an orally administered drug, has demonstrated a safety and efficacy profile in a Phase III trial for psoriasis

Clinical trial shows promising results for canine osteoarthritis treatment

Jessica Summers, CVT, a practice manager in New Jersey, discusses certification from her perspective as an employer.

Veterinary education for technicians

Jessica Summers, CVT, a practice manager at Banfield Pet Hospital in Marlton, New Jersey, spoke with 

 about National Veterinary Technician Week, along with several peers from the New Jersey Veterinary Technicians and Assistants organization. In her interview with 

—held at the Fetch Coastal conference in Atlantic City, New Jersey—Summers discussed education and certification for veterinary technicians and her perspective as an employer.

The following is a transcript of the video:

: As an employer, one of the things that is a big differentiation for me is between a certified veterinary technician or an LVT or RVT, and our veterinary assistants. [Our Veterinary assistants] have an incredible skill level—they've been doing this for 20, 30, years—but the education level is very different between someone that has on-the-job training versus someone that has gone to school and truly learned to do this and has a passion for it, has that education. So, it's very important for me as an employer to make that differentiation between a certified veterinary technician and a veterinary assistant [and] for them to be able to practice at the top of their license and truly exhibit the skills and education that they've earned.

 for more coverage and interviews from the recent Fetch dvm360 Conference.

Videos

Jessica Summers, CVT, a practice manager in New Jersey, discussed certification from her perspective as an employer, in a dvm360 interview.

Michael Azzarello, MBA, CVT, LVT, president of New Jersey Veterinary Technicians and Assistants shares why he chose veterinary technology

A veterinary technician’s role as an animal helper

Michael Azzarello, MBA, CVT, LVT, president of New Jersey Veterinary Technicians and Assistants (NJVTA), sat down with 

 to talk about his career as a veterinary technician, among other things, at the 2024 Fetch Conference in Atlantic City, New Jersey. In the interview, Azzarello shared what drew him to the veterinary field and talked about what his favorite thing about being a veterinary technician is.

I think we have a unique role. Animals can’t talk to us. It's one of the best jobs we get to have, and probably one of the hardest at the same time. We are everything for the animals, everything from giving them their daily food to making them better when they're not feeling well. So, I just like that role in life, to be a helper. I've been involved in many different roles—emergency services, police officer, fireman, EMT. This is probably my favorite, because it's the most challenging.

During his conversation with dvm360, Azzarello detailed the 

 he sees for veterinary technicians. Visit our dedicated 

 for more from the recent Fetch dvm360 Conference.

Michael Azzarello, MBA, CVT, LVT, president of New Jersey Veterinary Technicians and Assistants, shares why he chose the veterinary field

Bash Halow, LVT, CVPM, explains why conversations can get emotional, and how they should be approached

Bash Halow why emotionally charged conversations happen, and how to approach them

At the Fetch dvm360 Conference in Atlantic City, New Jersey, Bash Halow, LVT, CVPM, delivered his session titled, "Navigating Emotionally Charged Conversations," in which he discussed why conversations often become emotional, and how he likes to approach them. Oftentimes, they extend from clients, or coworkers, not being able to properly express how they're feeling.

I talked to a therapist once about, you know, why people... work themselves up into a snit, and then how they behave when they're in that snit. And... he said, "Imagine your leg really hurts, and you're trying to express how it really hurts, but you're not really ready to do it. You don't have the language to do it. So, the way that you express that your leg hurts is you go up to the other person and you kick them in the leg."... and as soon as he told me that, I recognized that behavior in me, and I recognized that behavior in a lot of other people. So, I think a lot of times, you're going to go into these conversations and they're not going to go right, but that's just the nature of the beast.

Bash Halow, LVT, CVPM, explains the root of emotionally charged conversations in the clinic, and how he approaches them

Why conversations become emotional and how to approach them

A lateral x-ray of a large dog with a gastric dilatation and torsion is shown.

Andrea Pace, CVT, VTS (ECC), training mentor for the emergency department at Mount Laurel Animal Hospital, discussed the initial stages of managing patients in a variety of emergency cases, during her presentation of, “Emergency Surgeries: What a Vet Tech Needs to Know from the ER to the OR,” at the 2024 Fetch dvm360 Conference in Atlantic City, New Jersey. Gastric dilatation volvulus (GDV) is commonly known as bloat, and it was among the emergency surgery cases covered during the lecture, and it can be life-threatening.

“What happens is, a dog’s stomach, or occasionally a cat’s stomach… fills with air, either [because] they swallow a lot of air, or sometimes because of fermentation in their stomach of their food product, and [the stomach] swells up and twists on itself,” Pace explained in an exclusive 

 interview. “When it twists, it closes off the entrance and exit, and can continue expanding, especially if there’s a fermentation component. When it does this, it pushes on the diaphragm, and it pushes on the vena cava.”

In her session, Pace explained that that emergency cases of GDV often occur in deep-chested dogs. She warns, however, that this can be tricky, giving the example that Basset hounds are technically deep-chested dogs, despite their shorter legs and general perception. Dogs with GDV will usually present panting, uncomfortable, and oftentimes with swollen abdomens.

With that said, Pace shared that she has seen cases of dogs presenting with seemingly normal abdomens, and swelling wasn’t recognizable until she felt underneath the ribcage. Although this is the textbook presentation, Pace admits that there are outlier cases. “Sometimes, [the patients] will surprise you,” she said in her session. “I’ve seen [GDV] in dachshunds, I’ve seen it in a cat once, so it’s rare, but it [can happen].” For this reason, it should be included on differential lists, and not ruled out simply on account of breed.

Usually, dogs with GDV will be observed being generally restless, in addition to gagging, retching, and engaging in nonproductive vomiting. Pace explained that these dogs will show other normal signs of pain and anxiety, and can engage in seemingly unusual stretching, and other movement movements, as they attempt to relieve the pain themselves.

She encouraged both pet owners and practitioners to be proactive, explaining that it’s better to assume it’s GDV, assess it, and rule it out, rather than assume the gagging is simply a sign of nausea. An x-ray of a dog’s right lateral abdomen can confirm a GDV diagnosis, with Pace explaining that it will be immediately obvious when it’s GDV, as there will be a large pocket of air in the abdomen.

“We usually warn people that if they have any of these signs in a dog, [they should] just bring it in,” Pace said. “Worst case scenario, we can do an x-ray, and 1 x-ray can be a quick diagnostic that will tell us [whether] this is a problem, or if it’s something else that’s bothering them, and maybe it’s not a surgical emergency.”

Once a diagnosis is confirmed, it’s advised to begin treatment immediately. Pace recommends a fluid bolus, starting at ¼ shock dose, and indicating that bigger catheters are preferred in these cases to account for the large amount of fluid required. Patients should also be started on pain medication, and Pace recommends pure-mu opioid, because of their reversibility.

For baseline bloodwork, she emphasized the importance of lactate. According to Pace, the clearance of lactate in GDV can inform a prognosis, with high lactate levels being a solid indication that treatment will be effective, as the patient likely has less gastric necrosis, or other secondary issues. Additionally, she advocated for decompression of the stomach pre-surgery, which involves shaving the stomach, and slowly releasing some air.

In surgery, the stomach should be de-rotated immediately upon opening the abdomen. Cuts should be made in the muscle of the body wall and in the muscularis of the stomach, before the stomach is finally securely sewn to the body wall.

After using pure-mu opioid as pre-medication, Pace advocates for lidocaine, midazolam, and then propofol, or alfaxalone during induction. Throughout, she recommends constant rate infusions (CRIs) of fentanyl and lidocaine, and potentially inhalant, if needed. In recovery, she deploys a bupivacaine liposome injectable suspension, general pain control, antiarrhythmics, prokinetics, and behavior medications.

For anesthetics, she recommends the following, depending on additional complications:

For distributive shock, treat with resuscitation, fluids, and adjust pressors.

For ventricular arrythmias, treat with lidocaine CRI, and adjust fluid intake.

For compression of the vena cava, treat with more fluids and adjustment of colloids.

For gastric necrosis, treat with resection or euthanasia.

For splenic infarct, treat with a splenectomy.

“Usually, with that twisted off organ, you have enough tissue damage that it will kill a dog within about 12 hours,” Pace explained. “The sooner you treat it, the better. I have seen some [dogs] survive… about 14 to 16 hours, and they have survived surgery, but they have a much harder road for recovery.”

Page A. Emergency Surgeries: What a Vet Tech Needs to Know from the ER to the OR. Presented at: Fetch dvm360 Conference; October 14-16, 2024; Atlantic City, NJ.

Methods for dealing with GDV, from triage through the initial recovery period, were discussed during a session at the Fetch dvm360 Conference in Atlantic City.