Cystocentesis. Second Update, 9/22

[FiveRoooooers]

Punkin's follow-up with a first-catch urine sample showed persistent bacteria. The clinic sent me the lab results which don't seem comprehensive but Ii they were simply checking just for blood/bacteria could that explain the lack of values? Before starting Punkin on another course of abx, they want to do a cystocentesis to be sure that we are on the right track as to the specific bacteria she has. I understand that they'll use an ultrasound to guide the needle to the bladder. What else do I need to know/ask?:

How painful is it?

How often does infection occur at the site?

If Punkin is cooperative, will she need to be anesthetized?

Since her previous, first dose of abx there have not been any accidents in the house and I haven't seen any blood. I don't believe she is going more frequently nor drinking excessive amounts of water, although she drinks quite a bit and is a dog who is typically warm - are these related? I've been attributing some of her panting to pain that we are trying to address but could it also be that she is warm? Her temp is normal. 

I am on the fence about the cystocentesis but will do it if we need to. I may also ask for another full blood panel, I know that we ran something prior to her recent dental but can't recall how comprehensive it was. 

Thank you for any thoughts.

Update 9/20/23: Punkin was seen this morning for bloodwork and her cystocentesis. It took longer for us to make the appt, get ready, drive to the clinic then wait for our doc than the procedure itself took (5’ !). The culture results should be back in about a week. 

AnnIE, helpful and supportive as usual 

Our (very pregnant) tech was loving on AnnIE and asked what is her name. When I told her Ann-I-E, she looked up slowly and said “Whaaattt??” 

 

Update 9/22:  All Normal 

Edited September 22, 2023 by FiveRoooooers

[macoduck]

Jan, it's been a long while since 2 of my hounds had the procedure. The insertion was quick and painless once U/S targeted the bladder. No anesthesia is used. The needle is thin, not big like the blood drawing kind. It is the preferred way to collect urine for a culture.  You should ask how long immediately prior to the appointment you should not let Punkin pee so that she'll have a full bladder. I don't have any answers to your other questions.

In a sterile sample of cystocentesis, bacteria suggest that the bladder (cystitis) or the renal (pyelonephritis). By contrast, bacteriuria from free catch urine could be kidney, bladder, or lower genital tract infection; fecal contamination could also lead to iatrogenic bacteriuria.

 

Edited September 17, 2023 by macoduck

[GreyPoopon]

My vet much prefers to do a "cysto" than a free catch because the risk of sample contamination is much lower. So ... most of the time, that's what we do. She also often prefers a "first morning" sample so that we can run kidney values. You might want to do that, especially if you plan to do full bloodwork. 

Other than the difficulty of keeping a busting hound from peeing, a cysto is pretty much a non-event for a calm hound. None of my girls has ever been sedated and none (of the ones I watched) even seemed to flinch. None has had an infection from the poke.

[greysmom]

Do it.  It's really the best way to get an uncontaminated urine draw.  Felicity has had several and they were really no big deal for her.  She's also had several US, and again didn't seem bothered.  Since they have the US working on her already, see if they can do a quick shot of her kidneys/bladder just to see if there is anything big that jumps out at them immediately.  If they see something suspicious, you can do a more in depth US later on if warranted, or rule things out if it's normal.  The cysto is definitely easier with a full bladder, so ask about specific timing.

If she's particularly anxious for vet visits, you might suggest an anti anxiety dose prior.  And also remind them when you take her in to be super careful if they put her on her back so they don't twist her.

Flizzie is on two drugs right now for some related issues that sound a lot like Punkin's in some ways.  First, she was having urine leaking episodes all the time.  Not just little drips, but a LOT of pee.  We discovered - using US and a physical exam - that she has a weird sort of "dip" in her urethra, which creates a well where the urine pools and then exits the body when she lays down (since the defect is on the outside of the bladder sphincter that controls urine flow).  She's on the hormone DES for this issue and it's helped a lot.  It works by tightening up the urethra helping eliminate the well in the tube (if that makes sense).  Secondly, we discovered that the aforementioned sphincter has a kind of spasming that happens irregularly.  It's not particularly painful - we think - but the rapid spasms seem to cause her distress and she will have episodes of just laying there panting - like pain panting except she's not in pain and will act and respond completely normally.  She's on a drug called Prazosin for this issue, which calms the spasming down.  It's usually an issue for male dogs, but mine seems to have a-a-all the weird things!!!   

Good luck!!

[FiveRoooooers]

This is very helpful, thank you. Punkin isn't in distress, she's not leaking and hasn't had any accidents in the house, so it doesn't seem a critical emergency but obvs her issue hasn't resolved and we will get her in ASAP. The clinic is an hour away and the timing may be tricky but we'll get it done. They aren't scheduling appts until October but I can call on "the day of" [what works for us] and see if they can get us into one of their reserve appts. I missed today and I can't do it tomorrow but will try the rest of the week  Thank you!

House of Duck, Canadian Oldies, Flizzie 

[GreyPoopon]

23 hours ago, greysmom said:

Since they have the US working on her already, see if they can do a quick shot of her kidneys/bladder just to see if there is anything big that jumps out at them immediately.  If they see something suspicious, you can do a more in depth US later on if warranted, or rule things out if it's normal.

Yes, this is another big benefit of a US guided cysto.

ETA: Toodles has had issues with _very_ stubborn UTIs that required long courses of abx, even when we knew we had the right one. The symptoms would go away for a while, then reappear. Sometimes the only sign was more drinking and peeing. As she ages, it becomes harder to tell whether the main culprit is food, kidneys, cognitive issues, SA, bacteria, or age. She also leaks, or rather, she did. Proin bothered her gut so she's on Stilbestrol.

Edited September 19, 2023 by GreyPoopon

[FiveRoooooers]

Update in post #1. Now awaiting results of Punkin's procedure.

[GreyPoopon]

Glad it's over and the actual procedure didn't take long. Fingers crossed for good results.

AnnIE is just keeping things calm.  

[ramonaghan]

  We'll be awaiting the report with bait on our bref! 

[MerseyGrey]

 For good results.

Those floor tiles look so much more comfortable than your average floor tile. I can see why AnnIE would want to stretch out on them.

[Jerilyn]

I'm glad it was an easy procedure and hope you get some answers for Punkin. I am also very glad to see AnnIE is maintaining her position. 

[greysmom]

I've been trying to think of what our vet called the thing that's wrong with Flizzie, and - voila! - I found it last night!  Reflex Dyssynergia

Yes, that's how all of her cystos have been!!    

[EllenEveBaz]

How nice that the floor tile colors coordinate with Punkin's brindling.  If she were the one lying down, she'd be totally camouflaged.

Fingers  Paws crossed for helpful results. 

Edited September 21, 2023 by EllenEveBaz

[GreyPoopon]

19 hours ago, MerseyGrey said:

Those floor tiles look so much more comfortable than your average floor tile. I can see why AnnIE would want to stretch out on them.

 

Even if they were knot unusually comfortable, AnnIE would stretch out.  

[FiveRoooooers]

19 hours ago, MerseyGrey said:

 For good results.

Those floor tiles look so much more comfortable than your average floor tile. I can see why AnnIE would want to stretch out on them.

Doing her best Paddy Mayhem, AnnIE wants you to know that there is nothing cushy about those tiles. Rock hard. 

Punkin (and her mom) want you to know how much your support means to us 

[FiveRoooooers]

Results:  Bacteria seen with free catch was contamination, there is no infection. Normal bladder and kidneys. Blood work all WNL. No treatment is necessary.

  Yay Punkin!

Phew. Thanks again for all the baknforfing!

[Houndtime]

On 9/17/2023 at 4:00 PM, FiveRoooooers said:

Punkin's follow-up with a first-catch urine sample showed persistent bacteria. The clinic sent me the lab results which don't seem comprehensive but Ii they were simply checking just for blood/bacteria could that explain the lack of values? Before starting Punkin on another course of abx, they want to do a cystocentesis to be sure that we are on the right track as to the specific bacteria she has. I understand that they'll use an ultrasound to guide the needle to the bladder. What else do I need to know/ask?:

How painful is it?

How often does infection occur at the site?

If Punkin is cooperative, will she need to be anesthetized?

Since her previous, first dose of abx there have not been any accidents in the house and I haven't seen any blood. I don't believe she is going more frequently nor drinking excessive amounts of water, although she drinks quite a bit and is a dog who is typically warm - are these related? I've been attributing some of her panting to pain that we are trying to address but could it also be that she is warm? Her temp is normal. 

I am on the fence about the cystocentesis but will do it if we need to. I may also ask for another full blood panel, I know that we ran something prior to her recent dental but can't recall how comprehensive it was. 

Thank you for any thoughts.

Update 9/20/23: Punkin was seen this morning for bloodwork and her cystocentesis. It took longer for us to make the appt, get ready, drive to the clinic then wait for our doc than the procedure itself took (5’ !). The culture results should be back in about a week. 

AnnIE, helpful and supportive as usual 

Our (very pregnant) tech was loving on AnnIE and asked what is her name. When I told her Ann-I-E, she looked up slowly and said “Whaaattt??” 

 

Update 9/22:  All Normal 

Good!

[LBass]

for normal!

[ramonaghan]

 You show 'em, Punkin!

[Remolacha]

 That’s what we like to hear  

[greysmom]

 

[macoduck]

Hooray for a good report! 

[EllenEveBaz]

Normal!  

 

[GreyPoopon]

Great news!

 

[MerseyGrey]

Fantastic!