Bladder stones, or uroliths, are a common condition in dogs that can lead to significant discomfort, recurrent urinary tract infections, and, in severe cases, life-threatening obstructions. If a dog is diagnosed with bladder stones, a surgical procedure known as a cystotomy may be recommended by your vet to remove them. The prospect of your furry friend undergoing surgery can be daunting, but cystotomy is a well-established and effective treatment option. When performed appropriately, it can significantly improve a dog’s comfort and overall quality of life. This article provides a comprehensive explanation of bladder stones, their diagnosis, the cystotomy procedure, and what to expect during recovery.
Understanding Bladder Stones in Dogs
Bladder stones, also called urinary stones or uroliths, are hard mineral formations that can develop inside your dog’s bladder. These stones can vary in size—some are as small as grains of sand, while others can become quite large—and they may cause discomfort or difficulty when your dog urinates. In some cases, they’re found during routine checks, but often they come to light when a dog shows signs like straining to urinate, blood in the urine, or frequent urination. Several factors contribute to the development of bladder stones, including your dog’s diet, urine pH (how acidic or alkaline the urine is), genetics, and urinary tract infections.
There are a few different types of bladder stones, each with their own cause and treatment approach:
- Struvite stones are one of the most common types, especially in female dogs. These often form as a result of urinary tract infections caused by certain bacteria. With the right antibiotics and a special diet, struvite stones can often be dissolved without surgery.
- Calcium oxalate stones are another common type, and they tend to form in dogs with a genetic tendency or those on certain diets. Unfortunately, these stones can’t be dissolved with food or medication and usually need to be removed through a cystotomy procedure. Some small stones can be flushed out under anaesthetic in a process called voiding urohydropropulsion.
- Urate stones are most commonly seen in Dalmatians and dogs with liver problems, like a condition called a portosystemic shunt. These stones form when the body doesn’t process uric acid properly. Dietary changes and medications can help reduce their formation, and in some cases, surgery might be needed if the stones cause a blockage.
- Cystine stones are less common and occur due to a rare inherited condition that affects how the kidneys process certain proteins. Breeds such as Bulldogs and Dachshunds are more likely to be affected. Managing these stones usually involves feeding a special diet and sometimes giving medication to help reduce the amount of cystine in the urine.
- Silica Stones are quite rare and thought to be linked to diets high in certain plant-based ingredients or grains. They’re most often seen in German Shepherds and may require surgical removal if they become problematic.
In many cases, your vet will need to know what type of stone they are dealing with
To find out exactly what type of stone your dog has, they may need to send it off for lab analysis after removal. This helps them understand what caused it and how to best prevent it from coming back. In the meantime, they can use X-rays or ultrasound to check for stones and monitor your dog’s bladder.
Preventing future stones usually involves keeping your dog’s urine diluted, which means encouraging plenty of water intake, and feeding a tailored diet that helps control the minerals and acidity levels in the urine. Every dog is different, so prevention and treatment plans are based on your dog’s specific needs and the type of stone they’ve developed.
How would I know if my dog has Bladder Stones?
Common signs of bladder stones in dogs include:
Frequent urination (pollakiuria)
You might notice your dog asking to go outside more often than usual or producing only small amounts of urine at a time. This frequent urge is due to irritation of the bladder lining caused by the presence of stones.
Straining or taking a long time to urinate (dysuria)
Dogs may appear to struggle or take an unusually long time during toilet breaks. They may squat or posture to urinate but pass only small dribbles, which can indicate partial obstruction or inflammation.
Blood in the urine (haematuria)
Urine may appear pink, red, or brown. This can be a result of the stones rubbing against the bladder wall and causing bleeding. It’s often one of the earliest and most noticeable signs for owners.
Pain or vocalisation during urination
Some dogs may cry out, whine, or show signs of agitation when passing urine. This discomfort is often due to inflammation, pressure from the stones, or even partial blockage.
Excessive licking of the genital area
Dogs may lick persistently due to irritation, pain, or a sensation of urgency. While occasional licking can be normal, lots of attention to the area is often a sign of underlying discomfort.
Accidents in the house or loss of toilet training
Dogs that were previously house-trained may start having accidents indoors. This usually isn’t behavioural – rather, it’s due to the urgent need to urinate caused by bladder irritation or pressure.
Complete urinary obstruction
In more serious cases, a stone can become lodged in the urethra and block urine flow completely. This is far more common in male dogs due to their narrower urethra. Signs of a blockage include:
- Attempting to urinate but producing nothing
- Signs of pain or distress
- Restlessness or pacing
- Vomiting or collapse
- Lethargy or weakness
A complete urinary blockage is a life-threatening emergency. Without immediate treatment, toxins build up in the bloodstream, and kidney function can rapidly decline. In severe cases, the dog can become critically ill within hours.
If your dog shows any of these signs, especially straining or inability to urinate, prompt veterinary evaluation is essential. Diagnosis typically involves a physical exam, urine analysis, and imaging (such as x-rays or ultrasound). Early intervention not only relieves discomfort but can also prevent serious complications and safeguard your pet’s long-term health.
Diagnosing Bladder Stones
Identifying bladder stones accurately is key to deciding the most appropriate and effective treatment plan for your dog. Here’s how we approach the diagnostic process:
Physical Examination
During your dog’s consultation, your vet will gently palpate the abdomen. In some cases – particularly with larger stones – it may be possible to feel the stones through the bladder wall. However, many stones are small or positioned in a way that makes them difficult to detect by touch alone, so additional tests are almost always needed.
Urinalysis
A urine sample gives your vet valuable information about your dog’s urinary health. Through urinalysis, they can check for:
- The presence of blood, which may indicate irritation or trauma from stones
- Crystals, which can suggest the type of stone forming
- Signs of infection, such as bacteria or white blood cells
- Urine pH, which can help us determine if the environment inside the bladder is promoting stone formation
This test is quick and painless and plays a vital role in both diagnosis and future monitoring.
Diagnostic Imaging
As bladder stones aren’t visible from the outside, imaging tools are used to take a closer look inside your dog’s bladder:
- X-rays (radiographs) – Most stones—including struvite and calcium oxalate types—are dense enough to show up clearly on standard x-rays. This allows your vet to assess their size, number, and position.
- Ultrasound scanning – For stones that don’t show up well on x-rays (like urate or cystine stones), ultrasound is a very effective tool. It uses sound waves to create images of the bladder, helping your vet spot softer or radiolucent stones.
- Contrast studies (special x-rays) – In some cases, a contrast agent (a dye-like substance) may be used to highlight the bladder and any stones inside it. This can improve visibility and provide additional detail, especially if the diagnosis is unclear.
Once your vet has confirmed that bladder stones are present, they will talk you through the treatment options. The best approach depends on the type of stone, how many there are, their size, and whether they’re causing any blockages or infections. Some stones (like struvite) can be dissolved using special diets. Others may require surgical removal, especially if they’re causing discomfort or obstruction. In some cases, medication or flushing techniques may be used.
What is a Cystotomy?
A cystotomy is a surgical procedure involving the opening of the urinary bladder to remove stones. It is indicated in cases where:
- Stones are too large to pass naturally
- Dietary dissolution is not an option for the stone type present.
- The dog experiences chronic infections or discomfort.
- There is a risk of complete urinary obstruction, which can be life-threatening.
The Cystotomy Procedure: Step by Step
1. Pre-Surgical Preparation
Before surgery, your vet will perform a thorough examination to ensure your dog is fit for the procedure. This includes preoperative blood tests to check organ function, detect underlying health conditions, and assess anaesthetic suitability. Intravenous (IV) fluids may be started before surgery to maintain hydration, and antibiotics might be given to prevent infection, especially if a urinary tract infection (UTI) is present.
2. Anaesthesia and Surgical Preparation
To ensure your dog is comfortable and pain-free, they will be placed under general anaesthesia. Once anaesthetised, the surgical team will clip the hair away from the lower abdomen area and clean the skin with an antiseptic solution to prevent infection. Throughout the surgery, your dog’s vital signs – such as heart rate, breathing, and oxygen levels – will be closely monitored to ensure their safety.
3. Bladder Access and Incision
A precise cut is made along the lower abdomen area to allow your vet to find the urinary bladder. Once the bladder is located, your vet will carefully make a small incision in the bladder wall to access and remove the stones inside.
4. Stone Removal and Bladder Flushing
Bladder stones vary in size and number – some dogs may have a single large stone, while others have multiple small ones. Each stone is carefully removed using sterile instruments. To make sure no tiny stone fragments remain, your vet will flush the bladder and urethra with a sterile saline solution. In some cases, imaging (such as X-rays or ultrasound) may be used during surgery to double-check that all stones have been successfully removed.
5. Bladder and Abdominal Closure
After all stones have been cleared, the bladder incision is closed using absorbable stitches that dissolve over time. The abdominal wall and skin are also sutured in layers to ensure proper healing. In some cases, a protective bandage may be applied over the incision site to reduce the risk of contamination and irritation.
6. Post-Surgical Recovery
Once the operation is finished, your dog will be monitored as they wake from the anaesthetic. Pain relief and antibiotics will be given as needed to keep them comfortable and prevent infection. They may be kept on IV fluids for a little while longer to support hydration and kidney function. Most dogs are ready to go home the same day but your vet will determine the best time for discharge based on your dog’s recovery progress.
Post-Operative Care and Recovery
Looking after your dog after bladder stone removal is just as important as the surgery itself. Good post-operative care supports healing, reduces discomfort, and lowers the risk of complications or recurrence. Here’s what to expect and how you can help at home:
Pain Management
After surgery, your dog may experience some discomfort. Your vet may prescribe:
- NSAIDs (non-steroidal anti-inflammatory drugs) to reduce inflammation and ease mild to moderate pain
- Opioid medications can be used in more severe cases to ensure your dog remains comfortable during the healing process
It’s important to give these exactly as directed and never use human painkillers unless specifically advised by your vet.
Antibiotic Therapy
If there are any infections present your dog will continue a course of antibiotics to clear up any remaining bacteria. Always complete the full course, even if your dog seems better, to prevent recurrence of the infection or resistance to the antibiotics.
Activity Restriction
Rest is essential to promote healing. Your dog’s physical activity should be kept to a minimum for about 10 to 14 days:
- Avoid running, jumping, or rough playing
- Keep them on a lead when taking them out to the toilet
- No off-lead walks until your vet gives the all-clear.
Too much movement can put pressure on the surgical site or disrupt internal healing.
Buster Collar/ Elizabethan Collar (E-Collar)
While not always a favourite accessory, the buster collar, affectionately nicknamed the cone of shame, is very important for preventing your dog from licking or biting at the surgical incision. This helps reduce the risk of infection and ensures the wound heals properly without irritation.
Dietary Changes
Depending on the type of stone removed, your vet may recommend a special prescription urinary diet. These diets are formulated to:
- Alter the pH of urine
- Reduce certain minerals that contribute to stone formation
- Help prevent new stones from developing
Long-term dietary management is often key to preventing recurrence.
Monitoring Urine and Behaviour
Keep a close eye on your dog’s urination habits at home. Contact your vet if you notice:
- Straining to urinate
- Blood in the urine (pink, red, or brown colouring)
- Urinary accidents or unusual urgency
- Lethargy, restlessness, or signs of discomfort
Early detection of issues can prevent more serious complications and help your dog recover more comfortably.
Potential Complications
While cystotomy is generally a safe and effective procedure for removing bladder stones, it’s important to be aware of some potential risks. Fortunately, most dogs recover very well with the proper care and monitoring, but here are a few things to keep in mind:
Bladder or Incision Site Infection
Although every precaution will always be taken to maintain a sterile environment during surgery, there is still a small risk of infection post-operatively. Signs of infection may include:
- Increased redness, swelling, or discharge around the incision site
- Frequent urination or straining
- Fever or general lethargy
Prompt treatment with antibiotics typically resolves infections if they occur.
Recurrence of Bladder Stones
Some dogs are prone to forming stones again in the future, especially if the underlying cause (such as diet, urinary pH, or a medical condition) isn’t fully addressed.
Temporary Urinary Incontinence
In rare cases, dogs may experience a short period of urinary leakage or difficulty controlling their urination after surgery. This is usually temporary and resolves as healing progresses. If it persists, your vet may recommend additional tests to investigate further.
Anaesthetic-Related Complications
Modern anaesthetic protocols are very safe, especially with thorough pre-operative screening and continuous monitoring. However, there is always a small risk involved. These risks are greater in older pets or those with other medical conditions. Your vet practice will take every measure possible to minimise the risk.
Prevention of Bladder Stones
To reduce the risk of recurrence, your vet may recommend the following:
- Encouraging water intake: Increasing water consumption helps dilute urine and reduce stone formation risk.
- Prescription diets: Specialised diets can prevent the recurrence of certain stone types.
- Routine vet check-ups: Regular urinalysis, including checking the pH of the urine and imaging may help detect early stone formation.
Final Thoughts
While the thought of bladder surgery can be overwhelming, a cystotomy is a highly effective treatment for bladder stones. With proper care and long-term management, most dogs recover well and go on to lead happy, comfortable lives. If your dog has been diagnosed with bladder stones, your vet will support you every step of the way to ensure the best possible outcome for your furry friend. If you have any concerns about bladder stones or cystotomy surgery, get in contact with your vet, they will be more than happy to help!
Sources
Urolithiasis in small animals – MSD Vet Manual
Management of struvite uroliths in dogs
Bladder Stones in Dogs and Cats – VIN
Discussion