Louise - stuck bladder stone in urethra

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Post   » Tue Nov 09, 2021 8:51 am

I have a 3-year old sow, Louise, that is having issues with bladder stones. She recently saw an exotic vet when I noticed a little blood in her urine. The vet could see a stone protruding from her urethral opening and an x-ray confirmed a large stone. Louise was given gas sedation and the vet was able to manipulate the stone out successfully. Several days after the procedure, I noticed more blood in the urine and we went back for a recheck. The vet noticed another stone (much smaller compared to what was removed) that she hadn't originally clocked on during the first x-ray. That stone wasn't quite as "bright" on the x-ray and was in the bladder then. During this visit, it had progressed from the bladder through the urethra and because it was so small, the vet thought we could monitor to see if she was able to pass it on her own.

In the week since that visit, she's had some additional blood in her urine but is eating, peeing, drinking normally. We went back yesterday for a recheck and the stone is still in its same location. The vet thought it was worth trying the sedation and manipulation again. She was able to get a tiny piece but the majority of the stone isn't moving. She couldn't get it flushed back into the bladder or get it to move further out. She thought maybe there was some scar tissue from the earlier larger stone that was keeping this little stone stuck.

Louise is on metacam 1x day and we are going back in Friday morning. She will give Louise extra fluids and try expressing her bladder to see if that can help push it along. If that doesn't work, she suggested a referral to a surgeon, but she felt like due to the location of the stone - if it couldn't be pushed back into the bladder - that a surgery on the urethra would be incredibly risky.

The stone is the shape of the grain of rice - I am unsure of the size but will try to get that information from the x-ray on my next visit. My only comparison is the x-ray of the stone that was removed (which was about 0.5 cm width and 0.75 cm long) and this stone is significantly smaller and had a lighter appearance on x-ray (the removed stone was very bright and a solid white color). I am not sure that means anything though!

Louise is showing no signs of distress and is behaving normally. She is peeing fine currently.

Is there anything I could try at home to help move the stone along? Louise is not a big drinker and I am wondering about syringing extra filtered water to increase urine flow. I am offering her wet green leaf lettuce, cucumber, endive, escarole, tomato, and red pepper.

Has anyone experienced a similar situation with a stuck stone? If surgery is not an option - is it possible to be managed with anti-inflammatories and monitoring?

Thank you!

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Post   » Tue Nov 09, 2021 11:36 am

How about trying some shilintong? Yes, to the anti-inflammatories and monitoring.

It is certainly possible that there was some scarring or injury from the larger stone that passed. What I hope does not happen is that it stays there for some reason. It sounds like your vets are giving you sound advice.

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Catie Cavy
Supporter 2011-2020

Post   » Tue Nov 09, 2021 1:46 pm

In addition to the shilintong, you can try a sedative like Ativan or Valium. They act as a muscle relaxant to help pass stones. Other than that, lots of water may be your best bet. Wet her veggies, syringe liquid, and give her fruits and veggies with high water content.

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Post   » Tue Nov 09, 2021 2:38 pm

Again, thank you both for your time and kindness! This website has been a godsend to me over the years mothering pigs and bunnies - so much great information and support.

I did read about the shilintong and am intrigued! I guess my biggest worry would be sourcing from a trustworthy entity - I will look to see what vendors others have had good luck with. The sedative is also a good idea.

Louise is not having the water syringing at all! I have added a little bit of unsweetened cranberry juice to entice her but that is also a no. She has been eating wet veggies voraciously though and did accept a very runny critical care slurry. I will keep encouraging her!

You can quote me

Post   » Tue Nov 09, 2021 3:24 pm

Another thing you can try -- if you're up for it and Louise will tolerate it -- is administering subcutaneous fluids. The vet can do this, and if you're up for it can show you how to do it and give you the supplies.

Don't push big amounts. I wouldn't go past about 20 cc's at a time for a case like this.

All that said -- if it's not bothering her, and she's eating, drinking, urinating and behaving normally -- I'd just monitor her. If it shifts and starts to block her urine flow, that's an emergency, but this is somewhat less likely to happen in females than in males. You could also have it x-rayed periodically to see if it's growing, shrinking, moving; but if she's comfortable, I'd just monitor her and leave her be.

Good luck and very best wishes in dealing with it to her and to you. Keep us posted!

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I dissent.

Post   » Tue Nov 09, 2021 4:28 pm

Go on Amazon.com and search for Shilintong. They carry it. The brand I use is Solstice.

I hope something helps Louise. Stones are worrisome.

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Post   » Tue Nov 09, 2021 5:49 pm

Thank you all again! I have done sub-Qs for a rabbit several years ago. It could be worth exploring for Louise. The biggest challenge with my bun was getting her to sit still and it was a traumatic for all of us! I wish I lived closer to the vet (it seems like everywhere I move, the exotic vet is always a 30 minute drive) but I may also ask about bringing her in every couple days for it if I can't muster to fortitude to do it on my own.

Getting x-rays have been really insightful for tracking the stones - is there a general guidance on what is a safe frequency to repeat them?

I appreciate the shilintong recommendation. I've order the Solstice brand sold by Solstice, which should come next week.

I really appreciate all the kind thoughts and advice. I am an anxious piggy owner and all the different options and potential outcomes is overwhelming (especially when I'm dealing with issues in multiple pigs right now!). Thank you for listening!

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Post   » Tue Nov 09, 2021 10:30 pm

There are some subcue techniques explained on this page that might be helpful:

Your vet should be able to advise you on xray frequency if you are concerned.

I hope she can pass it!

For the Love of Pigs

Post   » Thu Nov 11, 2021 10:47 am

The ativan worked well for us - forgot which pig.

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Post   » Fri Nov 12, 2021 3:54 pm

Thank you all again for the suggestions. Louise went back to the vet this morning. They gave a sedative and sub-q fluids to try to push the stone, but that didn't do anything. They then put her under the gas sedation to try a catheter flush. The vet was perplexed because they were able to get the catheter up into the bladder with no trouble. She did an x-ray with the cath in and says you can see the fragment there but it doesn't appear to be impeding the urethra or urine flow. She indicated it was a (relatively) large cath, so in that sense, I guess it is a relief that whatever it is isn't causing a blockage. She did a bladder flush and there was some sludgy stuff that they flushed out.

I did notice this morning some very minor pink spots on her fleece from bleeding, so the vet wasn't sure what was causing that. She thought the sludge my have been irritating her or that it could be a case of IC. She is going to do an ultrasound just to rule out any reproductive causes for the bleeding.

She suggesting trying a potassium citrate supplement for sludge/stone prevention. She wasn't familiar with glucosamine supplements for pigs. I have seen the Oxbow biscuits that contain either 45 mg (urinary) or 90 mg (Joint) to get her opinion on. I need to do some reading on here about that as well to get familiar with dosages. Also to use metacam as needed for bleeding.

So I guess sort of good news although I wish we could understand what was going on with the fragment that is lodged there.

I do have a stone that was initially removed from her and have read about stone testing to determine whether it is oxalate or carbonate based. Has anyone had experience with where you would send for testing? If I am recalling something I read, the potassium citrate might be contraindicated for one of the stone chemistries? Although I feel I've read so many different things, I am not sure if I am jumbling my information!

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I dissent.

Post   » Fri Nov 12, 2021 6:29 pm

Well, that's somewhat good news! Glad to hear there is no blockage, at least.

It has been a while, but if I remember correctly, potassium citrate is an alkalinizer and generally not recommended for guinea pigs---their urine is already highly alkaline (did your vet test pH?). Someone here can correct me if I'm off-base.

UC Davis did a study a few years back and determined that more than 95% of all guinea pig stones tested (and it was a fairly high number in the study) were calcium carbonate in make-up. Oxalates aren't as common in guinea pigs, although they do occur. My vet has been of the opinion in recent years that testing is a waste of time/money since the several we have tested in the past have indeed been carbonate, and we treat the same way regardless---increase fluids, reduce overall dietary calcium, used filtered water, encourage increased activity to try to combat sludge, etc. Some pigs still have recurrences, regardless. Genetics apparently also play a role in all of this, and some pigs are just naturally prone. That said, I can try to look back through some of my old notes as I'm thinking there used to be a lab somewhere in Michigan that has been recommended?

What kind of pellets does she get?

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Post   » Fri Nov 12, 2021 7:13 pm

Sef gave a great summary! Sef was instrumental in getting the stones page up.
I suspect that the insertion of the catheter and process of flushing irritated the urethra, perhaps slightly abrading it, and is the cause of the pink urine you are seeing.

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