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Chronic bladder infection in Rottweiller
Bladder mass in Wire Haired Fox Terrier
Persistent bladder infections in older dogs
Bladder stones in Kerry Blue
Bladder stones and urinary crystals in Corgi
Antibiotic failure in treating bladder infection
Persistent bladder infection
Bladder infection
also see Kidney problems
also see Urinary problems
also see Dog cancer
Chronic Bladder infection in RottweillerQuestion: Hi Dr. Mike, I'm a new subscriber and I have two questions regarding "Onyx"
my 12 year old female, spayed Rottweiller. She's basically in good health,
some arthritis pain for which she takes Rimadyl 100mg. once a day, but
otherwise healthy. Anyway, she's had a stubborn urinary tract infection
off and on for about two months. First she was on Clavimox, then Cephalexin,
now Baytril. It cultured out to be E.Coli bacteria. Each time, she's better
for a week or so, then it returns. She had a bladder cancer test that came back
negative, x-rays and ultrasound also showed nothing, and a blood test was
normal. Anyway, our vet seems to think it returns due to Onyx licking
herself, but I'm a little skeptical of this; because of her arthritis, she
doesn't usually stretch that far, you know. Are there other ways to become
reinfected, possibly from eating something or from some kidney abnormality?
My second question is this, I check Onyx's urine occasionally with a
multi-stick and the PH is usually 7.5. I've read where around 6 is
better to prevent bacteria from growing so I've been giving her cranberry extract
and a little methionine to try and accomplish this.
I thought maybe these were a little hard on her stomach so I give her about
1/8th of a Maalox tablet at the same time. So, since Maalox is supposed to
reduce stomach acid, is it defeating the purpose of the methionine and
cranberry or are stomach acid and urine PH two different things? Well,
thanks for your advice, I really like your website and I'm glad to be a
subscriber. VelvetAnswer: Velvet-
When bladder infections keep coming back over and over again, there is
usually a problem that is interfering with the bladder's ability to fight
off infection. The most common contributing problems are bladder stones,
anatomic defects allowing urine pooling, hyperadrenocorticism, diabetes
mellitus, kidney infection and bladder cancer. In some cases, antibiotics
are not used long enough to eliminate the infection and it never really
goes away but this is probably not an especially common cause of bladder
infections that appear to be recurring over and over. We think that
obesity is a factor in some cases of recurrent bladder infections. If Onyx
is overweight, weight reduction might help the bladder infection and the
arthritis problems but it helps with the arthritis more consistently than
the bladder infections. Once in a while we see dogs with skin disease and
recurrent cystitis, so I don't think your vet's theory about licking the
vaginal area leading to some cases of chronic cystitis is off base but you
may be correct that it is not a factor in Onyx's case.Diabetes is usually easy to detect through urinalysis or blood work and is
probably unlikely since those tests have been done. Hyperadrenocorticism
often causes mild rises in blood sugar and elevations in serum alkaline
phosphatase, which can be hints it is present from normal blood work. It
takes specific tests for this condition to rule it out, though. It is
probably worth trying to rule out this condition when bladder infections
are frequent in a patient over 9 years of age. You might want to ask your
vet about this. If there are no other symptoms of the disorder, such as
increased drinking and urination, loss of hair (especially if it is
symmetrical on both sides), a pendulous appearing abdomen or increased
appetite. Checking for vaginal tumors or changes in the anatomy of the
vaginal area would be a good idea. Dogs may have vaginal tumors that do
not change the external appearance at all. It is possible for dogs to have
bladder stones that do not show up on X-rays but it would probably be
unusual to have stone formation that was not visible with X-rays and
ultrasound. Kidney infections can be difficult to detect but may be
detectable with ultrasound examination in some patients. In some dogs
there are defects that are visible when contrast dyes are used to enhance
the ability to see the urinary tract through X-rays. Exploratory surgery
is an option for evaluation of the bladder, if nothing can be found with
other test procedures. The bladder cancer test is pretty good for ruling
out bladder cancer but is not absolutely accurate.There are some dogs who have normal urinary tracts, no sign of kidney
infection, no detectable underlying diseases and no observable anatomic
defects that might lead to urine pooling. In these patients it is
sometimes necessary just to use continuous antibiotic therapy to control
the problems. It is often possible to use antibiotics at a reduced dosage
(like once a day for an antibiotic that is usually used twice daily) when
using them chronically. It can be helpful to acidify the urine. The most
consistently successful way to do that is with the special diets made for
that purpose, such as Hill's c/d (tm) or Purina's UR (tm). I do not know
if there is an interference between Maalox (tm) and cranberry juice or d-l
methionine but I suspect that this isn't a major problem.You and your vet have been working through the possible causes of this
problem in a logical manner so I hope that you are rewarded with an answer
soon.Mike Richards, DVM
3/10/2001
Bladder mass in Wire Haired Fox Terrier
Question: I have a 12 1/2 year old female wire fox terrier. The following is an imaging consultant report:
History. chronic hematuria. Oxalate crystalluria. Culture negative. Treated with urinary acidifiers
and diet change.
Ultrasound: abdomen: there was a polypoid mural mass of the urinary bladder at the vertex. This
mass contained mineralized area and extended into the bladder lumen. Several small calculi were
also seen with the bladder. Both kidneys were small in size (4.2 cm in length) and had
mineralization at the corticomedullary junction. There was a small mass in the tail of the spleen.
This mass measured approximately 1.7 cm in diameter. The remainder of the examination was
unremarkable. Conclusions: urinary bladder mural mass. Urinary calculi. Renal mineralization.
Small splenic mass. Differentials for the urinary bladder mass include neoplasia and polypoid
cystitis. The splenic mass is either neoplasia or hyperplasia. Biopsy of either lesion would be
needed for definitive diagnosis.Question: in your opinion, what is the most likely outcome if we choose surgery; meaning do you
have statistics on how many of these operations are successful and what is the quality of life for
the dog which is our primary concern.
How long does this breed of dog usually live without medical concerns. She has vision problems
plus severe arthritis of the spine but judging by her behavior is not currently in pain.
I know this is long but we are desperate to reach a decision on what to do. We have seen our
local vet plus we took her to UC Davis. Also, we have spent $800 so far and the operation will
be approximately $2000 plus costs of chemo or radiation, whatever is called for. So what it boils
down to is what quality of life and for how long can we expect if we go ahead with the surgery.
Would really appreciate your thoughts on this. Thanks in advance. I promise I'll never send such
a long message again.
PatAnswer: Patricia-
I think that the success of surgery has to be looked at in two ways. The first is from a diagnostic
standpoint. Identifying whether the mass in the trigone area of the bladder is a tumor or a polypoid
may require surgery. It is possible, in many instances, to differentiate between these conditions using
a suction biopsy technique, in which a large bore urinary catheter (regular polypropylene urinary
catheters are usually used) is passed to the level of the tumor and then suction applied to it using a 10
to 12cc syringe. Whatever is sucked into the catheter is sent to the pathologist for review. If a
transitional cell carcinoma is identified from the suctioned biopsy it is considered to be diagnostic. It
is harder to diagnose other bladder conditions using this method. That is OK, though, because TCCs
of the trigone are very difficult to successfully remove, so knowing that was the problem would make
it easier to decide for or against surgery.Polypoid cystitis can regress without surgery if the primary cause can be identified and treated
(bladder infection, bladder stones, etc.). Since there are bladder stones (uroliths) present, surgery
would potentially provide both immediate comfort and long term resolution of the problem, though. I
do not know of any successful medical treatment for calcium oxalate stones, which it is reasonable to
presume are present until a stone can be obtained for analysis. Sometimes it is even possible to
suction out a stone to analyze using the suction biopsy technique, so that would be another potential
benefit of that procedure, although it can't be counted on.I think that you have an estimate for a worst case scenario, involving the surgery and follow-up care.
There is at least a reasonable chance that this is not a bladder cancer, in which case the cost of
surgery and subsequent treatment would be less.You do have to figure in over-all health in decision making. Twelve years of age is about the
beginning of the time that we see dogs of this size dying of natural causes, but many smaller breed
dogs will live to be fifteen years or more in age and often have good quality lives the majority of that
time. Surgery won't make her young again, but it could relieve a lot of current discomfort and that is
a worthwhile goal, unless her other problems are severe enough that you were considering euthanasia
prior to this latest problem.Hope that helps some. I am sorry for the delay in responding. There is no problem with long
questions, especially when they present important data, as you did.Mike Richards, DVM
11/4/2000
Persistent bladder infections in older dogs
Question: Hi, again, Dr. Richards,
This is in regard to earlier e-mails re: my 11-1/2 lab with the persistent
UTI. Fortunately, she came through her amikacin/gentamicin treatment
unscathed. The bleeding in her urinary tract stopped, but the most recent
culture shows she now has a drug-resistant (except for tetracycline) staph
infection in her bladder. So she's now on oral tetracycline; we are going
to the internal medicine specialist tomorrow for a follow-up ultrasound to
rule out stones and bladder cancer (again). I have two questions:1. Why is it that every time we culture her urine a new bacteria shows up?
So far we've had E. coli (sensitive to nitrofurantoin and amikacin),
Psuedomonas (sensitive to Cipro and amikacin) and now staph (sensitive to
tetracycline only). Is it likely that all 3 have been there all this time
(now going on 8 months)? Or does the constant treatment with antibiotics
make it easier for new species resistant to the drugs then in use to
colonize? Is there any way to keep this from happening by combining
antibiotics that are likely to kill everything?2. How many hours a day do normal elderly dogs sleep? My dogs are 13 and
11-1/2. I know that lethargy is one sign of illness, but it's hard to
figure out if that's what's going on with the older ones since they seem to
sleep so much.Thanks. Carol
Answer: Carol-
I was not able to find a reference that listed the average time that older
dogs sleep. Actually, I didn't even find a reference that lists the average
time that a dog sleeps during the day, at all. I will keep looking for
this, since I don't keep my physiology texts at home and they may have the
information. Older dogs do sleep a lot, though.E. coli, Pseudomonas and Staph are all bacteria that have a hard time
invading the bladder on their own. They usually require a breakdown in the
bladder's defensive mechanisms or the body's immune system. This can be
many things. In older dogs, it is important to rule out
hyperadrenocorticism (HAC, Cushing's disease) and diabetes mellitus as
potential underlying contributors to the recurrent bladder infections.
Diabetes is usually easily ruled out due to the repeat urinalysis testing.
HAC can be much harder to rule out. Bladder stones and bladder cancers can
be contributing factors. It is a good idea to try again to rule these out,
given the history of the problem at this time. After that, the work-ups
become more complicated.Older dogs may have neurologic problems that make it difficult to empty the
bladder and that can lead to recurrent bladder infections. These problems
include disc disease, cauda equina syndrome and spinal tumors. Older dogs
may have liver disease that makes antibody production deficient, or immune
compromise for other reasons. Kidney infections can sometimes be the source
of the bacteria that keeps causing recurrent bladder infections. Usually,
though, this will be the same bacteria, over and over again.In some dogs, it is necessary to use antibiotics long term to suppress
bladder infections that the dog can not control. The usual recommendation
is to use about half the recommended dosage and to use it at night, on the
theory that the antibiotic will be retained in the bladder longer at that
time. It is usually possible to find an antibiotic that is likely to work
to suppress most of the secondary invaders. It is easier if they have been
similar, such as all gram-negative bacteria (E. coli, Pseudomonas) or
gram-positive ( Staphylococcus), but fluoroquinolones may work for both,
the cephalosporins may work for both and there are others. When you reach
this point it is important to remember that the antibiotic is helping the
body to fight the bacteria and that even if there is partial resistance,
that may not matter. So often, an antibiotic that doesn't look like it
would work, based solely on culture and sensitivity testing, may work. It
is better to start with single antibiotics and go to combinations only when
that has been proven not to work.Hope this helps some.
Mike Richards, DVM
9/15/2000
Question: our 16 year old neutered kerry blue male developed bladder stones at 7
years, subsequently treated with a urostomy. about one month ago
developed excessive urination, including recurrrent urination in house.
does not appear to be related to a bladder stone, as the stream seems
normal. urinalysis showed sg of 1.014, culture showed 20k staph, bun
and creatinine were normal. 10 day trial of quinalone of no help. does
not appear to be incontinence as he can control his bladder when
walking, and is not wetting himself. we're currently attempting to
fluid restrict, as the vet feels it may be psychogenic polydipsia.
would appreciate any input tnx.
Answer: TNX-
It sounds more like there is a cause of increased production of urine,
rather than an increased need to urinate with normal urine production. The
most common causes of increased urine production in older dogs are kidney
insufficiency, diabetes mellitus, and hyperadrenocorticism (Cushing's
disease). There are other possible causes of increased drinking and
urinating, including diabetes insipidus, hypothyroidism, hypercalcemia, and
liver disease. The urine specific gravity is not too helpful in this case,
since several of these conditions would be expected to have a specific
gravity in this range. A general blood chemistry examination might be
helpful in differentiating between them. If that didn't help, specific
testing for the conditions that require it, such as hyperadrenocorticism
and hypothyroidism might be necessary.I would be really hesitant to restrict fluids without having ruled out most
of the above conditions, since it could cause problems with some of them.I hope that you already have a better idea of what is going on by now, but
if not, it would be a good idea to keep looking for a cause of this problem.Mike Richards, DVM
8/29/2000
Urinary crystals and bladder stones in Corgi
Question: Doctor, Our little corgi had some bladder stones taken out about six months
ago. You may remember the case she was bleeding excessively for 10 days
after surgery. Well anyway we have her urine checked every month for
crystals and this time when we took her in , she didn't have crystals in her
urine but the white cell count was up and they think she has some irritation
or a bladder infection. We have tried her on Baytril, Calvomox, and a few
others but she always gets diarrhea from them. They said to let her rest a
few days to clear up the diarrhea, while they pick their brains as to what
we could use to help her without so many problems. Do you have any ideas as
to what may help clear up this bladder infection or irritation without
giving her diarrhea. Any advice would be much appreciated. She seems a
little uncomfortable this last week and a little jumpy.Connie
Answer: Connie-
If increased white blood cells are the only abnormality on a urinalysis
using a dipstick testing technique, I have some suspicions about the value
of this particular test. On the other hand, since there is a history of
bladder stones and signs of discomfort, it does seem like a good idea to
try to figure out if there is a problem and to treat it, if necessary.The best test to perform at this point would probably be a urine culture
and sensitivity, withdrawing the urine from the bladder by cystocentesis.
This is the process of inserting a needle into the bladder by passing it
through the skin and muscles layer and then into the bladder. This is the
best way to obtain a sample for urine culture. If it is possible to get a
culture of a bacterial agent, this will help in selecting an antibiotic
that would work but perhaps cause less problems with diarrhea. This test
sounds scary, but it is usually easy to obtain urine in this manner and
there is very little risk associated with it. Most dogs will allow us to
withdraw urine without struggle and without sedation.It is also a good idea to examine the urine from the bladder using the same
testing techniques as are used for free catch urine samples. If there are
crystals in urine that is voided but not in urine that is withdrawn
directly from the bladder, the crystals may be forming after the urine is
voided. If there is no blood in the urine withdrawn from the bladder but
blood in voided urine, the problem may be lower in the urinary tract. This
is also true for increased white blood cells.If diarrhea occurs when any antibiotic is given it may be necessary just to
treat the diarrhea. This is usually possible using diphenoxylate and
atropine (Lomotil Rx) or loperamide (Immodium AD Rx). We do not have too
much problem with diarrhea when using Baytril (Rx), so I am wondering if
you will be able to find an antibiotic that doesn't lead to this problem.Good luck with this.
Mike Richards, DVM
4/15/2000Antibiotic failure in treating bladder infection in Boxer
Q: Dear VetInfo, I'm writing to you from Buenos Aires, Argentina. I read your
page and I understand that in order to ask a question I have to be a
subscriber. I'm planning to be in the Miami this month, and call you to
subscribe. I would like to know if you could please provide the following inquiry
to Dr Michael Richards. I don't expect an answer until after my subscription is in,
but he might be able to have something ready by the time I become a subscriber.I have a situation with one of the five Boxers I have which is driving my
husband, my vet and I absolutely crazy.Pericles, a 1.5 year old male Boxer, has been found to have the bacteria
"Escherichiacoli". We have made several cultures of urine, isolating the
bug and running antibiotic sensitivity testings. We are running out of
antibiotics, and the bacteria still there. We have given Pericles
antibiotics for different periods of time, anything from 7 to 20 days
period. After 5 to 7 days of the last intake of antibiotics, the blood
shows up again. The results indicate the bacteria still there. By the way,
when running each culture we have taken into consideration the fact of not
having Pericles taking any medicine, and allowing the sufficient time after the
last antibiotics were given (at least 10 to 15 days).We have done x-rays of the bladder and everything shows to be fine. We
have also done an echography which doesn't show us anything abnormal either.We would greatly appreciate any information you could prepare for us in
relation to the above mentioned matter.Best regards, Lorena
A: Dear Lorena-
There are several possible problems that might lead to repeated failure of
antibiotic therapy for cystitis or lower urinary tract infection (since it
is necessary to consider prostatitis and urethritis as well).The most common reasons are probably bladder stones and anatomical defects
in the bladder. Sometimes bladder stones don't show up well on X-rays. We
have been surprised to find them on exploratory surgeries for persistent
bladder problems on a couple of occasions after having failed to see them
X-rays. Anatomical problems, such as diverticuli in the bladder, provide a
safe haven for bacteria to escape the effects of antibiotics, in some dogs,
and the result is a recurrent infection that appears not to respond to
antibiotic therapy. It is probably possible to diagnose many of the
anatomical defects using contrast X-rays (dye studies) but it sometimes
takes a specialist's help in reading the films. Visualization of the
bladder using endoscopy is a possibility in some practices in the U.S., but
not many. That would be a good choice if it was an option, though.Sometimes the signs of cystitis are occurring because of infections or
problems in the kidneys. In this case, it can take longer for antibiotics
to work and in some cases they simply won't -- such as pyelonephritis (sort
of an abscess of the kidney).I have read of a couple of cases in which male dogs had a rudimentary
uterus that became infected and led to signs of recurrent urinary tract
infection. These are very resistant to antibiotic therapy, too.Sometimes the problem really is antibiotic resistance. There was a paper in
the Journal of Small Animal Practice (1997) by Farca, et. al., on the use
of Tris EDTA in combination with antibiotics to treat resistant cystitis.
The authors used local irrigation with tris-EDTA and various antibiotics.If you try the tris-EDTA and it doesn't work then the next best options are
special X-ray studies or exploratory surgery, which allows visualization of
the bladder and the opportunity to take biopsy samples if nothing is seen
on exam.Good luck with this problem.
Mike Richards, DVM
8/7/99Q: Dr. Mike,
A friend has a female (spayed) 7 year old mixed breed dog that can't seem
to get rid of a bladder infection. She's had 20 days of antibiotic treatment and
seemed much better, but is again experiencing frequent urination with blood
present. She doesn't seem to feel bad, but there is obviously a problem.
Could this be something other than an infection, like bladder stones. My friend
also mentioned that the dog's (Tinsel) urine is killing the grass, which is a new
development.A: Melissa
Your friend's dog should be checked for other problems. Bladder stones are
most likely but bladder cancer, Cushing's disease and several other
problems can lead to persistent urinary tract infections. Sometimes, but
not often, there are just highly resistant bacteria and in those cases it
helps to have a urine culture and sensitivity done to be sure that an
antibiotic is being used that will kill the infection. Sensitivity testing
is a way of checking to see if different antibiotics have the ability to
kill the specific bacteria that grows on culture.Mike Richards, DVM
7/31/99Q: Our five-year-old Shih-Tzu had a bladder infection several months ago and was treated
successfully with an antibiotic. We also changed her food to more accurately meet her acid
content needs. Five days ago, she developed another bladder infection and our vet performed
x-rays but found no stones in her bladder. He put her on a more potent antibiotic but her
condition has not changed. There is still blood in her urine, she is very lethargic, eating little
and drinking water. Our vet thought we would see a change in her by the second day into
the antibiotic but she appears to be on the decline and I fear we may lose her. Do you have
any idea as to what this may be? Our vet is very capable and caring but he's not an
expert on Shih-Tzus. Please help. Sincerely, ShelleyA: Shelly, Anytime that I have a dog with signs of cystitis that is not responsive to antibiotics
the first thing I think of is bladder stones. There are occasional bacterial infections that are
resistant to antibiotic treatment but most of the time there is another problem when a dog is
on antibiotics and blood continues to show in the urine. Cancer is another possible problem
and there can be blood in the urine from non-bladder sources, such as kidney damage or a
systemic bleeding disorder. I'm sure your vet has or will consider all of these possibilities
but it is important to keep communicating and letting him know if treatment is working. Not
all bladder stones show up on X-rays and bladder tumors are very hard to see on X-rays, too.
Sometimes it is necessary to do exploratory surgery to rule out these problems.I hope you are seeing improvement by now, but if not, keep working with your vet to sort
through the possible problems.
Mike Richards, DVM
Last edited 08/30/02
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