Emergency management of urethral urolithiasis with concurrent cystitis in a cocker spaniel: A diagnostic imaging-guided approach

Introduction

Diseases of the lower urinary tract are commonly encountered in canine clinical practice, with cystitis and urolithiasis representing two of the most frequently diagnosed conditions. Urinary tract infections (UTIs) are one of the major causes of cystitis in dogs and are often associated with predisposing factors such as urinary stasis, anatomical abnormalities, and the presence of uroliths, which can act as a nidus for bacterial colonization and persistent inflammation (Ling et al., 2001) [3] . Urolithiasis in dogs is a multifactorial condition influenced by breed predisposition, age, sex, urine pH, diet, and urinary tract infections. Certain breeds, including Cocker Spaniels, have been reported to have an increased susceptibility to lower urinary tract disorders and urolith formation, particularly calcium oxalate and struvite uroliths (Houston et al., 2004; Palm et al., 2017) [2,6] . In male dogs, uroliths are more likely to lodge within the urethra due to its narrower diameter, leading to partial or complete urinary obstruction, which constitutes a life-threatening emergency (Berent et al., 2011) [1] . Urethral obstruction results in rapid bladder distension, pain, post-renal azotemia, and electrolyte imbalances if not promptly relieved. Survey radiography and ultrasonography play a complementary role in the diagnosis and localization of uroliths, as some calculi may not be detected on ultrasonography alone but are readily identified on radiographs (Weese et al., 2019) [8] . Hematological changes such as neutrophilic leukocytosis, together with urinalysis findings, are commonly observed in dogs with bacterial cystitis and support the diagnosis of UTI (Smee et al., 2013) [7] . Immediate relief of obstruction through urethral catheterization and retrograde Urohydropulsion is considered the treatment of choice for urethral urolithiasis, followed by appropriate medical management aimed at resolving infection, reducing inflammation, and preventing recurrence (Lulich et al., 2016) [4] . This case report documents the diagnostic approach, emergency management, and therapeutic outcome of cystitis associated with urethral urolithiasis in an intact male Cocker Spaniel, highlighting the importance of timely intervention and multimodal diagnostics.

Interna tional

Case report

A 4-year-old intact male Cocker Spaniel was presented to the clinic with a 24-hour history of dysuria and stranguria, suggestive of an acute urinary obstruction. The owner reported that the dog was straining to void frequently, producing only small amounts of urine, and appeared visibly uncomfortable during attempts. On physical examination, the patient exhibited a distended urinary bladder, abdominal discomfort on palpation, and vocalization during urination attempts, confirming signs consistent with lower urinary tract obstruction. A comprehensive diagnostic evaluation was performed to assess the patient's systemic and urinary status.

Hematological analysis revealed neutrophilic leukocytosis, indicating an underlying inflammatory or infectious process. Serum biochemical analysis, including liver function tests

(LFT) and renal function tests (RFT), were within normal limits, suggesting preserved hepatic and renal function despite urinary obstruction. Urinalysis (catheterization & collection) demonstrated hematuria and crystalluria, along with slightly acidic urine pH, which is a predisposing factor for calcium oxalate crystalluria. Bacteriuria was also observed, supporting the diagnosis of urinary tract infection (UTI). Urine culture and sensitivity was not performed in this case due to financial constraints from pet owner side. Imaging studies were performed to localize any uroliths and evaluate structural changes in the urinary tract. Abdominal ultrasonography revealed diffuse bladder (Fig. 1) wall thickening consistent with cystitis. No uroliths were detected within the bladder lumen, although intraluminal urinary sediment was observed. In contrast, survey radiographs identified multiple radiopaque urethroliths lodged within the penile urethra (Fig. 2), confirming the site of obstruction. This combination of findings explained the acute urinary obstruction and associated clinical signs. The results of hematological and biochemical investigations are summarized in Table 1. The complete blood count showed neutrophilic leukocytosis, while red blood cell count, hemoglobin, and hematocrit were within normal limits. Liver and renal function parameters, including ALT, AST, ALP, BUN, and creatinine, were also within normal reference ranges. Based on the diagnostic findings, the patient was diagnosed with cystitis associated with urinary tract infection and urethral urolithiasis causing obstruction. The combination of neutrophilic leukocytosis, urinalysis results, and imaging studies provided a clear clinical picture, confirming the need for urgent intervention to relieve urethral obstruction while addressing the underlying infection and inflammation.

Therapeutic management

The urethral obstruction constituted a medical emergency and necessitated immediate intervention to relieve urinary retention and prevent secondary complications such as postrenal azotemia and electrolyte disturbances. Following confirmation of a urethral urolith on survey radiography, urethral catheterization was performed under strict aseptic conditions, resulting in partial alleviation of the obstruction. This was promptly followed by retrograde urohydropulsion, which successfully displaced the radiopaque urolith into the urinary bladder, thereby restoring normal urine flow. After resolution of the obstruction, the patient was stabilized and initiated on medical management aimed at controlling cystitis and suspected urinary tract infection. Surgical intervention by cystotomy for definitive urolith removal was recommended; however, the owners declined the procedure. Medical therapy was instituted immediately after relief of the obstruction. Amoxicillin-sulbactam was administered at a dose of 20 mg/kg intravenously twice daily for two days to address the suspected urinary tract infection. Analgesia was provided with buprenorphine at 0.02 mg/kg intravenously twice daily for two days to ensure patient comfort and minimize stress associated with lower urinary tract inflammation.

In addition to these medications, supportive care included fluid therapy to maintain hydration, optimize renal perfusion, and facilitate urinary clearance. Given the slightly acidic urine and the presence of calcium oxalate stones, urinary alkalinizes were provided to correct urine pH and help prevent further stone formation. The importance of urine pH modulation and dietary management was emphasized, including strategies such as increased water intake. Environmental factors and hygiene were also addressed, as bacterial contamination can perpetuate cystitis and contribute to urolith formation. Overall, the combination of targeted antibiotics, pain management, supportive therapy, urine pH correction, and preventive measures resulted in progressive clinical improvement, with resolution of urinary signs and stabilization of the patient's condition.

The dog showed clinical improvement by day two, was treated for urinary tract infection for 10 days, and remained free of recurrent urinary obstruction during the 6-month follow-up. Mild hematuria occurred only occasionally, and no treatment-related adverse effects were observed. This case underscores the importance of prompt diagnosis, multimodal imaging, and timely emergency intervention, along with appropriate medical and supportive care, in achieving favorable outcomes in dogs with urethral urolithiasis complicated by cystitis.

Discussion

Cystitis and urolithiasis are commonly encountered disorders in dogs, and their concurrent occurrence poses significant diagnostic and therapeutic challenges, particularly in breed-predisposed dogs such as Cocker Spaniels (Palm et al., 2017) [6] . In this case, the patient presented with acute dysuria, stranguria, hematuria, and urethral obstruction, highlighting the urgent nature of urethral urolithiasis as a potentially life-threatening condition (Berent et al., 2011) [1] . The hematological findings of neutrophilic leukocytosis, together with urinalysis revealing hematuria and bacteriuria, were consistent with a urinary tract infection, which is a common predisposing factor for cystitis and may also contribute to urolith formation (Ling et al., 2001; Smee et al., 2013) [3,7] . While abdominal ultrasonography detected bladder wall thickening indicative of cystitis, no bladder stones were observed, emphasizing the importance of multimodal imaging, as the urethral stone was only visible on survey radiographs. This aligns with previous reports highlighting that certain uroliths, particularly in the urethra, may be missed on ultrasonography alone and require radiographic confirmation (Weese et al., 2019) [8] . Immediate relief of the urethral obstruction was achieved using urethral catheterization and retrograde urohydropulsion, consistent with established emergency management protocols for obstructive urolithiasis in male dogs (Lulich et al., 2016) [4] . Prompt intervention not only alleviated clinical signs but also prevented potential complications such as post-renal azotemia, electrolyte disturbances, and further urinary tract injury. The presence of slightly acidic urine and crystalluria suggested a predisposition to calcium oxalate stone formation, which is consistent with breed-specific metabolic tendencies in Cocker Spaniels (Houston et al., 2004) [2] . Medical management included broad-spectrum antibiotics, analgesics, supportive fluid therapy, and urine alkalinization, which together addressed both the infection and the risk of recurrence. Additionally, dietary modifications, increased water intake, and environmental hygiene were emphasized to reduce the likelihood of future stone formation and cystitis, in line with current preventive recommendations (Palm et al., 2017) [6] . This case highlights the interrelationship between urinary tract infection, cystitis, and urethral urolithiasis, demonstrating how systemic inflammation, urine pH, and anatomical factors converge to influence stone formation and obstruction risk. Early recognition, prompt emergency intervention, and comprehensive post-obstructive management were critical to achieving a favorable clinical outcome. The findings of this case are consistent with previously published studies emphasizing the importance of breed predisposition, urine pH modulation, and multimodal diagnostics in the management of canine lower urinary tract disorders (Berent et al., 2011; Lulich et al., 2016) [1,4] .

Conclusion

This case highlights the importance of early diagnosis, emergency intervention, and comprehensive supportive care in dogs with cystitis complicated by urethral urolithiasis. Prompt recognition using ultrasonography and radiography enabled timely urethral catheterization and retrograde urohydropulsion, preventing severe complications and facilitating rapid recovery. Concurrent management of urinary tract infection, cystitis, and urinary pH, along with attention to breed predisposition, diet, and environment, was essential in achieving full recovery and minimizing the risk of recurrence.

Acknowledgement

AcknowledgementThe authors would like to express sincere gratitude to the owner of the patient for cooperation and consent in the diagnosis and treatment of the pet. In addition, they appreciate the assistance of the veterinary diagnostic laboratory staff in performing and analyzing various hematological, blood chemical, urinalysis, and imaging studies, which played a key part in the diagnosis and subsequent treatment of this patient.

References

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