Species: dog
Breed: Crossbreed
Sex: f, neutered
Weight: 5.25 kg
Birth date: 2027-06-21 00:00:00
Primary diagnosis: Cystitis with mineral sediment/crystallueria, bilateral nephrolithiasis and nephropathy
Situation: emergency follow-up
Medical history: Cookie was presented to the emergency department on the 04.10.2024. She has had frequent recurrent cystitis with and without uroliths since 2022. The uroliths that were analysed were struvite and the last time also calcium oxalate stones. Bacteria were found several times (Staphylococcus intermedius, rods and cocci). She was treated with NSAIDs (Onsior, Metacam), dexamethasone, opioids, antibiotics (Betamox, Combiclav, Amoxiclav, Marbocyl, Enrofloxacin, Convenia), supplements and a special diet. She has had 3 operations for cystotomy and stone removal (7.3.22, 1.2.23, 1.5.24). After the first operation she was incontinent, especially when she woke up she was wet. It got better after a few months. After the following operations she also had incontinence but all day long. She would dribble a little. It gets worse with stress. She also leaks a little urine after micturition. In the last 2 months the incontinence has improved a little. The day before presentation Cookie needed longer to urinate. She was otherwise fit. Her owner gave her Cystopro. She is currently on a urinary diet. The day before presentation at 9pm she was unable to urinate and was seen by the private vet. She was successfully catheterised and given pain therapy and antibiotics (amoxicillin). In the morning she was referred to Bern. After presentation an abdominal ultrasound was performed. Ultrasound report (07.10.2924): Mineral sediment/ crystalluria with focal hypertrophy of the wall of the bladder neck; Bilateral nephrolithiasis and nephropathy. The dog was released the same day with a symptomatic therapy. On the 10.10 Cookie was presented again to the clinic. On the 05.10 in the morning Cookie was still able to urinate, but only a few drops of urine, and then she was completely unblocked again, she urinated a lot, it looked milky and slimy. Afterwards it was better, she had no stranguria, but severe polyuria, questionable pollakiuria (urinated up to 10-15 x urine / day, according to owner normal amount of urine). On the 9.10 Cookie again showed stranguria. In the vening she started taking urination position every few seconds without being able to pass urine. The dog was therefore presented to an emergency vet, who was unable to catheterise, the just emptied the blasser by cystocentesis. On 10.10 she still wasn't able to urinate so she came back to our clinic. She was catheterised and the day after a cystotomy was performed. Cookie went home on the 14.10.
Medication: At the private vet (04.10.2024): Meloxicam 0.2 mg/kg SC, Amoxicilline Clavulanic acid 20 mg/kg IV. No medication administered during the first stay at our clinic. Therapy at home between the two presentations: Amoxicillin clavulanic acid 100 mg PO BID (Amoxicillin 16 mg/kg, Clavulanic acid 5 mg/kg), Meloxicam 0.1 mg/kg PO SID on 04.10 & 05.10. 10.10 before observation 3: no medication. 10.10 between observation 3&4: Ondansetron 0.3 mg/kg IV, Midazolam 0.3 mg/kg IV, Methadon 0.2 mg/kg IV. 10.10 after observation 4: Pregabalin 3 mg/kg PO BID, Methadon 0.2 mg/kg IV q4h, Cefalexin 30 mg/kg PO BID. 11.10 (nothing given before observation 5): first Methadon 0.2 mg/kg IV then after surgery switch to Buprenorphin 0.015 mg/kg IV TID, Cefalexin 30 mg/kg PO BID, Pregabalin 3 mg/kg PO BID, Ondansetron 0.3 mg/kg IV TID. 11.10 directly after surgery: Methadon 0.2 mg/kg IV, Cerenia 1 mg/kg IV. (11.10 later: Cefalexin 30 mg/kg IV at 21, Ondansetron 0.3 mg/kg IV at 17 and 24, Buprenorphin 0.015 mg/kg at 17 and 24.) 13.10 --> unclear, probably: Pregabalin 3 mg/kg PO BID, Buprenorphin 0.01 mg/kg IV SID, Cefalexin 30 mg/kg PO BID. 14.10: Cefalexin 30 mg/kg PO BID, Ondanseteron 0.3 mg/kg IV TID, Metacam 0.1 mg/kg IV SID.
Anesthesia: Intervention on 10.10.2024: Cystoscopy. Sedation with Medetomidin 0.005 mg/kg IV (before the dog already had Methadon 0.2 mg/kg IV and Midazolam 0.3 mg/kg IV). Intervention on 11.10.2024: Cystotomy. Premedication at 09:10: Methadon 0.2 mg/kg IV. Induction: Ketamin 1 mg/kg IV, Midazolam 0.2 mg/kg IV, Propofol 1.5 mg/kg IV. Maintenance: FiO2, Isofluran. Analgesia: 2x Bolus Fentanyl 0.003 mg/kg IV, 1x Bolus Lidocain 1 mg/kg IV, IV Infusion Fentanyl 0.25 mg/kg/h for 55 min & 0.5 mg/kg/h for 25 min, IV Infusion Lidocain 1.8 mg/kg/h for 30 min, local anaesthesia quadratus lumborum block Ropivacain 1.5 ml and Dexmedetmidin 0.001 mg/kg. Antibiotics: Cefazolin 30 mg/kg IV. Complications: bradycardia, arrhythmia --> 1x Bolus Glycopyrrolate 0.01 mg/kg IV. Wake up phase: Bolus Methadon 0.2 mg/kg IV, Bolus Cerenia 1 mg/kg IV. Intervention duration: 95 min. Anaesthesia duration: 190.
Pain type: acute, chronic, visceral,
Pain origin: abdomen, urinary bladder
Estimated pain severity: 15