You know what? I am going to talk about one of my main soapbox topics: the mismanagement of urinary stones by surgery. What? You are a surgeon, how can you say that? Isn’t surgery the fastest and quickest way to get rid of them? Don’t stones get stuck when you try to dissolve them? No, no, no, no, noooooooo!
50% of all stones submitted to the Minnesota Urolith Center are struvite stones. 50%!!! What-the-feline-and-canine-f….? Correct, although we have advocated using diets for struvite stones for years and years, this number has not changed. Just to put it in perspective this is 50.000+ struvite cases a year and that covers only the ones that are submitted. Are we totally out of our minds?
Struvite stones can be dissolved safely in dogs and cats within a couple of weeks using the appropriate diet according to every urinary specialist. Yes, it is a bit more complicated in dogs than in cats (as they are almost always infected; ie the dogs NOT the cats). But still, 50% of stones all over the world are cut out for NOTHING. And no, I am a surgeon and I do love surgery, but I also am convinced that DO NO HARM is more important than me cutting out things, just because.
So what are we doing about it? Dr. Jody Lulich (Urology professor at the MUC), Dr. Susan Little, famous catvet, and I have decided to start a movement to stop struvite submissions by 2020. We have a FB page (do the plegde), we do lectures all over the world and we will carry the cone of shame everywhere we go for people that still want to cut out struvite stones.
We also realise we need to make this message simple, we listened to you and came up with a very simple and logical plan of attack.
This is it:
Cats: Urinary signs – take a radiograph (all you need) – check the MN urolith app for most likely stones – put them on a diet for 2-3 weeks (be strict) – recheck with radiograph:
Option A Stone is smaller – keep on trucking and keep them on the diet!
Option B Stone is as big as before – Check for compliance (Awwww I felt so bad for my cat so I just sprinkled a bit of over the counter beef jerky over its food) and if ok take the stone out by any means you like (we like minimally invasive btw).
In dogs, the only addition is to check for urinary infection and use appropriate antibiotics with the diet. Sometimes it can take a bit longer for the stones to dissolve, but still.
What about surgery being faster? BS, you do not prevent the stones from coming back after surgery, induce more stones by implanting foreign bodies and you should know how many people leave in undetected stones. And, additionally, you torture the animal for nothing.
What about stones getting stuck? Are you serious? It really does not happen with struvite dissolution. And if it happens, it is most likely not a struvite stone anyway.
What about compound stones? If they were not that rare (only 10% of all stones submitted), it would be a good excuse, but most stones are struvite or Ca-oxalate.
Check out the awesome MN Urolith app in your favorite app store. The CALCulator is an amazing tool that will check more than 500k animals to predict what stone it may be in a specific breed, sex, and age of an animal. So if you have a 4-year-old DSH F cat you have a 69% change of a struvite stone!
And although my mantra is keep on cutting, we do need a mindset change for struvites. Keep on dieting!
For more info:
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