Abstract
BackgroundStruvite urolithiasis with bacterial urinary tract infection (UTI) is commonly reported in dogs; few data exist to describe successful dissolution protocols in dogs with naturally occurring disease. We hypothesized that a dry therapeutic urinary diet combined with targeted antimicrobial therapy can effectively dissolve presumptive struvite cystolithiasis in dogs with naturally occurring urease-producing bacterial UTI.ResultsTen dogs with presumed infection-induced struvite cystolithiasis based on lower urinary tract signs (LUTS), radiodense cystoliths, and urease-producing bacterial UTI were enrolled. At enrollment, antimicrobials and dry therapeutic urinary diet were dispensed. In addition to lack of radiographic resolution of urolithiasis, dogs with persistent clinical signs were considered non-responders. There was no significant difference in pH between responders and non-responders; USG was significantly higher in the responder group. Recheck visits continued until radiographic dissolution or failure was documented. Five of the 10 dogs achieved radiographic dissolution of cystolithiasis within a median of 31 days (range 19–103). In the other 5 dogs, surgical urolith removal was necessary due to persistent LUTS (3 dogs within 2 weeks) or lack of continued dissolution noted radiographically (1 dog with numerous cystoliths failed at day 91; 1 dog failed by day 57 with questionable owner compliance).ConclusionsDissolution of urinary tract infection induced struvite cystoliths can be accomplished in some dogs fed this dry therapeutic urinary diet in conjunction with antimicrobial therapy. Case selection could increase the likelihood of successful dissolution; however, if calcium phosphate is present, this could also prevent stone dissolution. If clinical signs persist despite diet and antimicrobials, stone removal is advised.
Highlights
Struvite urolithiasis with bacterial urinary tract infection (UTI) is commonly reported in dogs; few data exist to describe successful dissolution protocols in dogs with naturally occurring disease
While dietary dissolution is encouraged for struvite urolithiasis in both species [6] there is a lack of published data regarding efficacy of dietary dissolution in dogs
One study conducted in dogs with struvite urolithiasis and naturally-occurring UTI demonstrated that target urinary pH values that could allow for dissolution of struvite was achieved in all dogs fed either a therapeutic urinary diet or a similar experimental diet for up to 3 months plus antibiotic therapy given for only 1 week; it is unclear if repeated urine cultures and radiographs were performed [7]
Summary
Struvite urolithiasis with bacterial urinary tract infection (UTI) is commonly reported in dogs; few data exist to describe successful dissolution protocols in dogs with naturally occurring disease. Another study showed that a therapeutic urinary diet supplemented with sodium chloride and reduced in protein, phosphorus, and magnesium achieved dissolution of struvite uroliths within an average of 14 weeks (range 2–5 months) in 5/6 Beagle dogs with induced and persistent S. aureus UTI without the use of antimicrobials [8]. It has been suggested that if presumed struvite cystoliths do not begin to decrease in size after approximately 8 weeks of “appropriate therapy” (therapeutic urinary diet plus antimicrobial medication), alternative means of removal should be considered, but some uroliths could take longer to dissolve (up to 7 months has been reported) [9, 10]
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