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      Date:   20 July, 2012  

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Female dog urethral catherisation 
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
20 July, 2012
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129
I manage to find my article written in 2011.
http://www.sinpets.com/dogs/201006260catheterisation-female-urethra-dog-Singapore-ToaPayohVets.htm
In male dogs, every vet knows where to insert the urethral catheter, but in the female dog, it is very common to incorrectly insert the catheter in the clitoral fossa if the vet does not know the anatomy of the female urinary system! So, I am attaching an illustration for reference.
 

An X-ray of a Miniature Schnauzer that has urethral catherisation. Digital palpation and insertion of a soft catheter was done by Vet 1 as I had referred the owner to her. I was in Hong Kong at that time and the dog had difficulty peeing after passing out some stones. Did the dog owner agree to Vet 1 removing the urinary stones? No.

"Why?" I asked Vet 1 later when I returned to Singapore. She was willing to spay and remove the urinary stones at one surgery whereas I did not want to do two-in-one as I don't increase my anaesthetic and surgical risk by doing a prolonged surgical procedure.

She did not know the reason. "Is it the cost?" I asked her.

"No," she said. "The owners were agreeable to do the two surgeries when they consulted me."

Female Schnauzer, struvite bladder stones, catherisation, urethral, toapayohvets, singapore First X-ray shows numerous stones. Advice to remove the bladder stones not taken up as the owners wanted a spay to be included at one surgery, i.e. 2-in-one operation. I declined taking unnecessary risks as the surgery will be prolonged and may kill this dog.
Female Schnauzer, struvite bladder stones, catherisation, urethral, toapayohvets, singapore Subsequently, second X-ray with urethral catherisation. I checked out this X-ray 24 hours before the spay and discussed the case with Vet 1's boss. He said spay and urinary stone removal in one go should be OK.
Female Schnauzer, struvite bladder stones, catherisation, urethral, toapayohvets, singapore Vet 1's boss tries to send image to me via his Blackberry phone. He was unsuccessful as I have an iPhone and some application software was missing.
Female Schnauzer, struvite bladder stones, catherisation, urethral, toapayohvets, singapore Female Schnauzer, struvite bladder stones, catherisation, urethral, toapayohvets, singapore Female Schnauzer, struvite bladder stones, catherisation, urethral, toapayohvets, singapore
Owner shows me the 5 stones peed out. As at Jul 20, 2012, the dog still has the urinary stones and did not present any blood in the urine. This procrastination  is "penny wise, pound foolish" as the owner did not persevere in putting the dog on the S/D diet, in the hope that the stones be dissolved or reduced in size to be peed out. This must be given for 2 months as advised by me but he bought 3 cans after the spay.    Spayed by me but no urinary stone removal during the spay. The owner bought 6 cans of S/D diet to dissolve the stones and no more news from him for the past one month.

"How much did you quote?"

"The usual rates," she would not give me the actual figure. A fuzzy reply from the internet generation vet.

"Did you do it immediately?" I asked.

"No, it was a Saturday and the cost would be much higher. I hospitalised the dog and would have done it on Monday. The owner took back the dog back on Sunday."

"Did you follow up?" I asked.

"Yes, but there was nobody answering the phone." This is a very good vet as many vets don't do follow up at all, waiting for the owner to phone. I don't follow up in some of my cases too but owners are very glad if vets do it. This follow up is part of excellent service and will retain the loyalty of the clientele.

"I am sure it is the cost," I said to the serious sounding Vet 1 over the phone.

"No, no," she replied. "They had agreed to the surgery."

Other than cost, what could it be?

Many days later, the husband came to me to get the dog spayed. The husband would not give me the reason as to why he did not accept the combined surgery as that was what he wanted and Vet 1 said she had done such surgeries without problems. A fuzzy reply again. He said that the dog could pee after the catherisation by Vet 1.

"My dog peed out the 5 stones after consulting you and taking a can or two of the S/D diet," the man took out 5 white stones and put them on the table. I had not followed up with him since the consultation and so I did not know. Sometimes, following up could be misconstrued as trying to solicit for surgery business. 

Since the 5 stones were passed out, the couple did not want the bladder operation. The husband asked: "Vet 1 says the bladder will rupture if I don't remove the bladder stones as they will increase in size. Is it correct?"

"The bladder will rupture if the urine can't flow out for a long time," I said. "If there is no obstruction, the bladder will not rupture. You may have heard her incorrectly. The large stones will irritate the bladder causing bleeding. As to whether the stones will rupture the bladder by themselves, I don't think they will as they are not sharp."

It is a difference of opinion. Some vets will not agree with me.   

The dog still has the 3 stones and apparently had no blood in the urine. I did not advise further as this would be like high-pressure selling. The husband had associated feeding 2 cans of S/D diet with the passing out of 5 stones (see image) and got another 6 cans. I had advised 1-3 months feeding of S/D diet for struvite stone dissolution but that means more than 6 cans!

Knowing the reasons of the client is important to improve the standard of care and service. If the vet does not bother to ask, the answers will never be known and the standard of care cannot be improved.

The first report of this case is at:
http://www.sinpets.com/dogs/20120246bladder-stone-spay-packaged-deal-singapore_ToaPayohVets.htm

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