Dog Bladder Stones Surgery: FAQ with Our Vet Surgeon

Bladder stone surgery, also known as a cystotomy, aims to surgically remove any harmful urinary stones that may have accumulated in your dog’s bladder. To get all your questions answered about this important surgery, we have interviewed one of our veterinarians: Dr. Alex Crow, a veterinary surgeon who graduated from one of the top 5 veterinary schools in the world (the Royal Veterinary College in London, UK). Let’s get started!

What is a Bladder Stone Surgery?

Dr. Alex Crow: Performed under a general anesthetic, it involves making a skin incision on your dog’s tummy to gain access to their abdomen. The bladder is then identified and a small incision is made into it. Any bladder stones are carefully removed; a urinary catheter is also placed in your dog’s urethra and sterile saline water is injected to remove any stones that might be stuck in the urethra. Once the surgeon is sure that all the bladder stones have been extracted, they stitch up the incision they made into the bladder, followed by the incision that they made in your dog’s skin. X-rays are often taken before and after surgery to ensure that all the stones have been removed.

When is a bladder stone surgery warranted? 

Dr. Alex Crow: Bladder stone surgery is usually used as a last resort for the treatment of stones that can’t be treated medically. Bladder stones can take many different forms, and some of which may dissolve over time with the correct medical treatment and diet changes. Unfortunately, however, other forms of bladder stones cannot be dissolved once they have accumulated – these stones are referred to as being insoluble. The most common type of insoluble bladder stones in dogs are calcium oxalate. The type of stone present can be identified by analysing a urine sample from your dog.

Symptoms associated with bladder stones include:

• Urinating more frequently and often smaller amounts.
• Straining or pain when urinating.
• Blood in the urine
• Reduced appetite or lethargy

If your dog has been diagnosed with insoluble bladder stones and they are displaying symptoms of urinary tract disease then they’ll likely need surgery.

What happens if I do not do the surgery? Can dogs live with bladder stones?

Dr. Alex Crow: Leaving insoluble bladder stones untreated is not an option. More stones will accumulate with time leading to repeated urinary tract infections, extreme pain, and discomfort. Stones can also block the flow of urine out of the bladder; this can eventually result in kidney failure, bladder rupture and toxicity – all of which are fatal.

How much does the surgery cost?

Dr. Alex Crow: The cost of bladder stone surgery varies depending on the number of stones present, size of dog and time that the procedure takes. The average cost of bladder stone surgery in the US is between $1300 and $3000; this includes the cost of surgery, X-rays, and medication. Most pet insurance companies will cover the costs of surgery provided that your dog didn’t have any urinary tract disease before taking the policy out.

What is the success rate? 

Dr. Alex Crow: The success rate of bladder surgery in dogs is difficult to quantify. Although surgery is often necessary as a matter of life and death, performing the procedure creates inflammation within the bladder which can further predispose dogs to recurrent urinary tract issues. Therefore, while the procedure has a good success rate in terms of preventing a dog from dying short term, it does not prevent the issue from recurring in the future. There are many predisposing factors that can contribute to urinary tract disease in dogs and so if these are not addressed then the issue is likely to come back.

What are the risks or potential complications from the surgery?

Dr. Alex Crow: Bladder surgery, as with any other major procedure, doesn’t come without risks. The procedure is performed under a general anesthetic and so there are risks involved with this; older dogs and those with concurrent health conditions will be at higher risk. In addition to these risks, there are procedure-related risks such as:

• Recurrent bladder stones – 42% of cases
• Urinary tract infection – 29% of cases
• Diarrhea – 8% of cases
• Urine leaking into abdomen – 5% of cases
• Urethral damage – 3% of cases

What age do dogs get bladder stone surgery?

Dr. Alex Crow: Dogs of any age can suffer from bladder stones, but older dogs may be predisposed due to a weaker immune system and ability to heal. The main predisposing factors to bladder stones in dogs include genetics, too much calcium in the diet and other conditions that increase the amount of calcium found in the urine. Since these factors are largely independent of age, dogs may need this surgery at any point of their life The average age of a dog presenting with a calcium oxalate bladder stones is 8 years old.

How do dogs recover from the surgery?

Dr. Alex Crow: Recovery from bladder surgery is generally quick. For the first 24-48 hours your dog may be a little drowsy from the anaesthetic drugs and they will probably feel the sensation of needing to urinate more frequently due to the inflammation created by performing the procedure. The good news is that the bladder heals rapidly and is usually functioning normally again within 2 weeks.

You should minimise your dog’s activity for 2 weeks following the procedure, keep to short lead walks only. Try to prevent your dog from jumping or climbing the stairs as doing so can put excessive strain on the wound while it heals.

Expect your dog to feel the sensation to urinate more frequently for the first 1-2 weeks following surgery, blood tinged urine is also normal at this stage.

Depending on the type of bladder stones found in your dog’s bladder, your vet might recommend a special diet for them to be on. This aims to change the pH of the urine to prevent further stones from forming. You should also avoid dietary supplements or treats unless your vet has informed you that your dog is safe to have them

What other surgical treatments are available?

Dr. Alex Crow: Some specialist veterinary clinics may offer alternative surgical treatment options. Urohydropropulsion is one such option. If the bladder stones are small enough they may be able to be flushed out of bladder by passing a urinary catheter up your dogs’ urethra. This is usually performed under a general anaesthetic and can be a good alternative if there are no large bladder stones present.

Another option is Ultrasonic dissolution. This involves firing high frequency ultrasound waves at the stones to break them into small chunks which can then be flushed out if the bladder through the urethra.

Prevention: what can owners do to avoid this surgery?

Dr. Alex Crow: Treating urinary tract disease is all about prevention. As you can see, bladder surgery is quite invasive, comes with risks and doesn’t reduce the chances of bladder stones coming back in the future. Therefore, it’s imperative to prevent stones from forming again in the future. This is predominantly done through a change in diet and proper hydration. The diet that your dog needs will depend on the bladder stones present so be sure to ask your vet for advice on that one. Keeping your dog well hydrated will also make their urine more dilute, reducing the chances of stones forming – wet food, adding water to dry food and always making sure there’s plenty of water available will help with this.

Example dog with bladder stones surgery: Daisy

Daisy was a 7-year-old Jack Russel Terrier that presented with pain when urinating and blood-tinged urine. Daisy had suffered from urinary symptoms in the past, but the owners just put that down to the stress of moving to a new house at the time and the issue was largely ignored. However, the issue had become far more apparent and it was clear that Daisy was in a lot of discomfort when trying to go to the toilet.

They brought her to the vet and her urine was analyzed – calcium oxalate crystals were identified. This prompted X-rays and an ultrasound scan of her bladder to try and gain more information into whether she might be suffering from bladder stones.

Sure enough, multiple stones were identified, some quite large which suggested that the issue had been going on for a while. Unfortunately, her only real option at this stage was to go the surgery – Daisy needed a cystotomy to remove these stones. $2500 later, nine calcium oxalate stones of varying sizes were removed and the surgery was a success, but because the stones had been there for some time there was a lot of inflammation present within the bladder; the owners were warned that this was a problem that could easily come back.

From that point on, Daisy was put on a special urinary diet to try and prevent any further stones from developing. They also stopped giving her a multivitamin supplement that contained calcium in case this was contributing to things. Daisy seemed to recover well from the surgery and started to urinate pain-free again. She stayed on the special diet long-term and remains symptom-free, largely because of her hypervigilant owners.