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What is lithotripsy?
Lithotripsy is an endoscopic procedure to fragment and remove stones from the bladder and urethra. A special laser, called a holmium laser, is used to break up the stone and endoscopy is needed to get the laser right up to the stone where the patient’s tissues are not in the way.

The cystoscope is used in the urinary tract to penetrate the very narrow urethral opening of a small animal. Once the cystoscope is in position, the laser uses heat to create water vapor bubbles, which rapidly expand and collapse. If these bubbles are in contact with the stone, the crystal structure of the stone is disrupted and the stone fragments. The fragments are either allowed to pass or are removed via basket with the guidance of the cystoscope.

This differs from extracorporeal shock wave lithotripsy in which sound wave energy is directed toward stones while animals lie in a water bath.

If the stone is in the urethra, disruption of the stone is easiest. Despite potential problems, studies have reported 83-96% success (i.e. complete stone removal) in female dogs and 68-81% success in male dogs. Laser lithotripsy is an excellent option for dogs with urethroliths or a few small cystic uroliths than can be repositioned into the urethra prior to laser fragmentation.

Why consider laser lithotripsy?
Laser lithotripsy offers an alternative to traditional surgery or medical dissolution (when possible) as treatment for removal of urinary stones (bladder and urethra). It is considered minimally invasive when compared to surgery.
Laser lithotripsy is thought to be as effective surgery in removing stones. It is estimated that incomplete stone removal occurs in approximately 20% of surgical stone removal cases2 versus
8% via lithotripsy.1

Which patients are good candidates for laser lithotripsy?
Patients with urethral or bladder stones that:
Female dogs or cats that weigh a minimum of 7 lb.
Male dogs that weigh a minimum of 20 lb (or if a 10 Fr red rubber catheter is able to be passed through the urethra).

Which patients are not good candidates for laser lithotripsy?
Female dogs with multiple large bladder stones.
Male dogs with multiple urethral and bladder stones.
Male cats - Not possible to perform in any male cats.
Ureteral or kidney stones - Not possible to perform in any of these stone types.

Will my pet be anesthetized for the procedure?
General anesthesia is required for cystoscopy and lithotripsy as this will provide comfort, pain control, and prevent any movement during the procedure.

Is it painful?
The procedure is minimally invasive and nonpainful. However, the manipulation of the cystoscopy to remove the stones triggers more inflammation and possibly leading to difficulty urinating after the procedure.

What are the benefits?
Minimally invasive
Less pain
Shorter recovery time
Minimal scarring

Are there alternative procedures?
Alternative procedures include surgical removal and possibly urohydropulsion (in large female dogs with very small stones).

How can we measure results? Will the stones come back?
Radiographs or fluoroscopic images will be obtained prior, during and, after the procedure to ensure that all stones have been removed. Recurrence rate will depend on primary cause of stone formation and individual predisposition to more stone formation.

How long is the recovery?
Recovery typically occurs over 1-7 days depending on the size of the stones, prior inflammation, and size of the patient. Some hematuria and dysuria may be noted within the first week. Depending on the severity of the changes seen during cystoscopy, pre-emptive urinary cauterization may be recommended to help the urethra heal.
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Surgery

We believe that our patients deserve the best care we can deliver. This is why our highly trained and technically-advanced surgeons collaborate as a team with other CVS specialists to determine the most efficient and minimally invasive surgery option for each patient.

Our surgical services include comprehensive abilities to treat all soft tissue, orthopedic and neurologic conditions. Our team also performs specialized advanced diagnostic procedures such as myelography, CT, and MRI. While we provide all the traditional surgical services, we place a significant emphasis on cancer surgery. Our dedicated and compassionate cancer surgeons use the very latest surgical techniques and have pioneered the development of new approaches to benefit pets and their families.

Why Does My Pet Need A Veterinary Surgeon?

Just as your own primary care physician may feel the need to refer you to the care of a specialist from time to time, your general practitioner veterinarian may feel your pet needs the additional expertise of a board certified surgeon for certain surgeries. In fact, many general practitioner veterinarians refer all but the most routine of surgeries to specialists, orthopedic and neurology cases, reconstructive surgeries, tumor removals, etc. Board certified veterinary surgeons also are often affiliated with referral hospitals where they may have access to specialized diagnostic or surgical equipment, the latest and safest anesthesia monitoring equipment, physical therapy or rehabilitation capabilities, and other critical care services that a general practitioner may not have access to. All of these specialized services may be necessary for the optimal care and recovery of your pet. You can be assured that a veterinarian who knows when to refer you and your pet to a veterinary surgeon is one that is caring and committed to ensuring that your pet receives the highest standard of care for his or her problem.

What Kinds of Problems Require the Expertise of a Veterinary Surgeon?

Board certified veterinary surgeons can repair complex fractures, perform total hip replacements, and use advanced techniques to repair torn ligaments (ruptured cruciate ligaments) within the knee. They can also remove cancerous growths, manage extensive or non-healing wounds, and perform reconstructive surgery, such as grafting skin over large injuries. Veterinary surgeons can perform intricate surgeries in the chest or abdomen, such as kidney transplants in cats or repairing heart defects in dogs. Spinal injuries and herniated discs are problems that are also commonly referred to board certified surgeons. Veterinary surgery is also expanding into minimally invasive surgery, such as arthroscopy, thorascopy, and laparoscopy.

Will My Regular Veterinarian Still Be Involved?

In many if not most surgical cases, your regular veterinarian will still supervise your pet's veterinary care, especially if your pet is continuing to cope with a disease or chronic condition. It depends on your pet's particular disease and health problem, however. Typically, though, your general practitioner veterinarian will oversee many aspects of your pet's pre-op and post-op care, just as in human medicine. Recovery periods are often prolonged in many surgical cases, particularly in orthopedic surgery, and it is very important to follow your veterinary team's recommendations concerning at-home recovery guidelines for your pet, follow up care and appointments, as well as any rehabilitation that has been prescribed.

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Advanced Anesthetic Monitoring
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