Daignostic imaging findings
The plain lateral survey radiographs of affected dogs revealed presence of single to multiple radiopaque calculi in urinary bladder (58.62%) followed by location at posterior to os penis alone and in bladder simultaneously (17.24%, each, Fig 2) and uroliths located at post-scrotal urethra (6.90%). These findings of location are in agreement with findings of
Pal (2015) in dogs. Radiographically a case of lodged catheter in the bladder was diagnosed in one and half year old male Saint Bernard (Fig 3).
Sahoo et al., (2016) radiographycally confirmed the lodged catheter in urinary bladder in six years Spitz. In the cases of cystitis in dogs, plain radiography coupled with ultrasonography revealed thickening of wall in a distended bladder. No other comparable scientific reports about diagnosis of cystitis are found on the same line in the published literature. The huge mass in urinary bladder was diagnosed by negative contrast radiography (pneumo-cystography) in an eight years old male German Shepherd dog (Fig 4) and this findings was in agreement with
Nandini et al., (2016).
The ultrasonographic examination of the affected dogs revealed the presence of hyperechoic calculi followed by acoustic shadow in urinary bladder (Fig 5) and urethra (Fig 6) and a lodged catheter in urinary bladder. The findings of the present study with regards to USG technique for diagnosis of urolithiasis, cystitis and masses in the bladder are supported by findings of
Singh et al., (2005). Other features of ultrasonographic imaging characteristics,
viz., presence of sludge in urinary bladder, distension of urinary bladder, hyperechoic wall of urinary bladder in haemorrhagic cystitis and thickened wall of urinary bladder in cystitis (Fig 7) were noticed. The findings of the present study are in agreement with the findings of
Nandini et al., (2016). The ultrsonographic evaluation for location of neoplasia in urinary bladder revealed the highest involvement of dorsal wall of mid bladder (37.50%) (Fig 8) followed by apical bladder and ventral border of mid bladder (25.00%, each) and the entire wall of bladder (12.50%). No comparable reports could be located on the same line for masses in the bladder. However,
Ranganath and Mahesh (2009) also reported cystic carcinoma at apex of bladder. USG technique, when combined with direct abdominal X-ray, is able to provide a definitive diagnosis of lower urinary tract affections. USG technique proved to be very useful adjunct diagnostic modality for guiding while performing non-interventional procedures like voiding hydropulsion and introduction of medicines in bladder.
A total of seven dogs comprising two females and five males were subjected to urethro-cystoscopic examinations revealed a cystolith in a bitch, the other had a mass in urinary bladder, while among male dogs, one dog had cystolith, one had cystitis and other had haemorrhagic cystitis while remaining two had masses in bladder. The dogs having cystitis evinced the mucosa to be oedematous, hypermic and prominent vessels (Fig 9) while the dog having haemorrhagic cystitis had a thickened wall with haemorrhagic patches and ulceration. The vessels appeared thick and tortuous indicating chronic cystitis (Fig 10). The urehtro-cystoscopic examination in dogs having urolithiasis revealed yellowish brown irregular masses attached to each other in urinary bladder (Fig 11). Urinary bladder near stone appeared to be thickened due to chronic inflammation and in the other dog, two small sized white coloured calculi could be seen. In dogs having mass in bladder appeared large sized round shaped hang on dorsal wall and borders of mass appeared free at ventral floor of bladder (Fig 12) while in other female dog the mass appeared as a whitish irregular surface attached to bladder wall. The findings are supported by the observations of
Sutherland-Smith et al., (2004) who stated that rigid human adult and paediatric cystoscope can be used in female dogs whereas males require flexible cystoscopes.
Gupta (2014) used 2.7 mm diameter, 18 cm long, 30° angle rigid endoscope for urethro-cystoscopy limited to female dogs only. Based on the observations made in the present study and foregoing discussion it can be surmised that use of 1.2 mm diameter direction of view: 0° angle and working length: 100 cm flexible fiberoptic-endoscope could be used very effectively for diagnosis of lower urinary tract affections in male and female dogs.
The urine samples from dogs having cystitis (Group 1C) were subjected to cultural isolation of bacteria and antibiotics sensitivity testing revealed
Staphylococcus spp
. (35.29%) was the highest followed by
Streptococcus spp
. (23.53%),
Proteus spp
., gram negative cocci and rods, gram negative bacilli and
Corynebacteruim spp
. (5.88%, each) and no isolates in four (23.53%) samples. Similar findings were reported by
Suarez et al., (2002) and
Yogeshpriya et al., (2018).
In the present study,
Staphylococcus spp. and
Streptococcus spp. were found to be sensitive to Ceftriaxone and Cefotaxim only, whereas
Proteus spp. was found sensitive to Cefotaxim, Gentamycin and Enrofloxacin. Gram negative cocci and rods were found sensitive to Ceftriaxone, Cefotaxim, Gentamycin, Ampicillin, Ampicillin and Amoxycillin/clavulonic acid while gram negative bacilli and
Corynebacteruim spp. were sensitive to Chloramphenicol only. Among the antibiotics tested for sensitivity, Ceftriaxone and Cefotaxim (35.29%, each) were the most sensitive, followed by Gentamycin and Ampicillin (11.76%, each) and Ampicillin, Amoxycillin /clavulonic acid, Enrofloxacin and Chloramphenicol (5.88%, each) (Table 1). The findings of the present study are in agreement with the findings of
Papini et al., (2006).
The cytohistopathological examination of urine samples from the dogs (n=7) having mass in bladder revealed presence of cell aggregation, vacuolated cells, variable cytoplasmic basophilia with marked anisocytosis and anisokariosis indicative of transitional cell carcinoma (Fig 13).
Freeman (2007) also reported key features of transitional cell carcinoma in dogs similar to the present findings.
Therapeutic management
The dogs having urinary calculi covered under Groups 1A and 1B were subjected to catheterization and voiding hydropulsion under sedation induced by Inj. Xylazine@ 1mg/kg body weight, wherever required. This procedure found to be very effective, non-surgical approach for dislodgement of calculi towards the bladder and fruitful enough for not only recovery of small sized multiple calculi (Fig 14 A, B) after the bladder lavage but confirmative diagnosis along with collection of urine samples as well as mineral analysis of calculi can be dissolved therapeutically or removed by cystotomy but having limited scope for lodged calculi in urethra or larger size calculi.
The treatment regimen advocated to the dogs under Groups 1A and 1B resulted into complete dissolution of calculi within 60 days in 10 dogs and 3 dogs had incompletely dissolved uroliths requiring continuation of therapeutic management up to three months. Two dogs from Group 1A and four dogs from Group 1B did not responded to medicinal dissolution and were subjected to surgical management (Group 3) (Table 2). Similarly,
Taskande (2015) reported that the calculi were dissolved within period of one to two months interval after using same medicinal dissolution protocols. While,
Sran (2010) reported that the dogs given Ammonium Chloride@ 50 mg/kg and Alkasol@ tsf showed considerable improvement by day 14
th of treatment and complete dissolution of calculi was reported in one month in dogs.
The dogs having cystitis (Group 1C) were treated on the basis of antibiotic sensitivity test with Inj. Ceftriaxone @ 15 mg/kg body weight (n=13) or Inj. Cefotaxime @ 25 mg/kg body weight (n=3) or Inj. Chloramphanicol @ 25 mg/kg (n=1), intravenous, for five to seven days according to severity. All the dogs positive for bacterial isolates were treated with respective antibiotic found sensitive had recovered uneventfully. The dogs having cystitis but yielding no organisms were subjected to treatment with Inj. Ceftriaxone @ 15 mg/kg body weight intravenous to prevent secondary bacterial infections.
The dogs having transitional cell carcinoma (Group 1C) treated with immunotherapy from which five dogs (71.43%) dogs recovered with medications of three cycles weekly, whereas two (28.57%) dogs required repetition of immunotherapy for one more additional cycle. The results of the present findings are indicative of efficacy of immunotherapy using BCG vaccine for transitional cell carcinoma in canines as opined by
Kawai et al., (2013) in human patients and can be recommended as a choice of management strategy for neoplasia of bladder.
The dogs (Group 2), having large sized, one to multiple calculi and failing to urohydropulsion were subjected to surgical removal according to location of urinary calculi, comprising eight cases treated with cystotomy (Fig 15A to C), one case each treated with pre-scrotal and post-scrotal urethrotomy (Fig 16), while a Saint Bernard dog having lodged catheter in urinary bladder was managed by cystotomy (Fig 17).
The dogs (Group 3) having a calculi lodged posterior to os penis was attempted for a push to the bladder by retrohydropulsion but failed and was managed surgically with pre-scrotal urethrotomy. Out of remaining five cases, in one case calculi was lodged in urethra posterior to scrotum which was pushed in bladder by urohydropulsion and in remaining four cases were treated with cystotomy. Recovered uroliths having different sizes, shapes and numbers. The findings of the present study are supported by the comparable observations reported by earlier reports of
Madhu et al., (2013), Ravikumar et al., (2016) and
Sahoo et al., (2016). The leiomyosarcoma of bladder in a Labrador male covered under Group 1C managed successfully through cystotomy (Fig 18A and B). Similar observations reported by
Nandini et al., (2016) and
Saharan et al., (2019) in a bitch.The dogs underwent the surgical procedures were recovered without any complications.
Analysis of calculi
The gross examination of recovered either single or multiple variable sized calculi revealed the colour to be brown in seven (29.16%) dogs, white colour 16.67% (n=4), admixture of light brown and white, light brown colour (12.50%, each), green, light brown and white (8.33%) and dark brown, blackish, admixture of brown and grey, greenish brown and green surface (4.17%, each). The mineral analysis revealed the highest type of calculi having combination of calcium oxalate monohydrate and calcium oxalate dihydrate (50.0%) followed by struvite (33.33%) and urate, combination of struvite and calcium oxalate dihydrate, combination of struvite carbonate appetite, combination of calcium oxalate monohydrate with calcium oxalate dihydrate and carbonate (each 4.16%). These findings were supported by the observation reported by
Singh et al., (2005) and
Konwar et al., (2017). The Pomeranian (33.33%) breed of the dog had the maximum rate of occurrence of calcium oxalates calculi, followed by Labrador, Pug and German Shepherd (16.67%, each) and Non-descript and Himalayan Mastiff (8.33%, each). Struvite type of urinary calculi was found to be maximum in Labrador dogs (50.0%), followed by Pug (37.50%) and Lhasa Apso (12.50%) (Table 3). The findings of the present study were in agreement with the findings of
Hunprasit et al., (2017).
Among the dogs having calculi of calcium oxalate type, the highest occurrence was found to be 41.67% in dogs fed with a combination of vegetarian and commercial feed, followed by vegetarian diet 33.33, commercial diet 16.66 and combination of vegetarian and non-vegetarian diets 8.33. Among the dogs having struvite type of calculi, the highest occurrence was in dogs fed with commercial diet (50.0%) followed by vegetarian diet, combinations of vegetarian and non-vegetarian diets and combination of vegetarian and commercial available diets (12.50%, each) (Table 4). Sran (2010) reported the higher incidence of urolithiasis in dogs fed both type of vegetarian and non-vegetarian diet.
