Evanesco: The Magic of Vanishing Bladder Stones

By: Michael W. Miller, DVM


I love cystotomies.  If all I did for the rest of my career was cystotomy surgeries in female dogs and cats with large bladder stones, I would be happier than a niffler in Gringotts.  For me the surgery is straightforward, relatively quick, and very rewarding.  


One of my favorite parts is showing the pet owners the before and after radiographs.  To us in vet med, those radiographs tell the story of the surgical technique to remove the uroliths as well as the time and effort for anesthesia induction, monitoring, and recovery.  However, the owner’s impression may be as simple as seeing that the stones were there when the patient was dropped off and gone after surgery.  To the owner, we might as well have performed a vanishing spell.  Evanesco!  Now the stones are magically gone!  


How often are we overlooking this chance to present the magic of vet med to our clients?  If the dog with urinary bladder stones is dropped off in the morning and then sent home in the afternoon with only the minimal discussion about post-op care, we are missing a chance to showcase our magic to the owner.  It now becomes more likely that the client focuses on the dollar signs on the bill without seeing the value.


We often complain that we don’t have a “magic pill” to fix sick pets, but then why do we refuse to consider our curative treatments as vet med magic?!  What if the owner instead was told the heroic story of how their pet’s discomfort was cured, with the visual aid of the radiographs taken before and after surgery?  Suddenly the amazing magic required for this spell takes the focus instead of the price of the surgery.  


Uroliths – urinary bladder stones – are a great chance for veterinary professionals to showcase the various aspects of the magic of veterinary medicine.  Surgery is just one option.  For those medically or nutritionally minded out there, the prescription dissolution diets can sometimes be used to perform the Evanesco spell.  It’s still magic, if you describe it correctly to the owner.  The radiographs still tell the same story.  The stones have vanished.  But, the owner will only appreciate this if the vet team showcases this magic effectively.


Often we are too close to the medicine to realize the magic the clients may see.  The cystotomy surgery is a clinical series of events, a checklist to accomplish.  The prescription dissolution diets are scientifically formulated to create the correct biochemistry inside the bladder to break down the stones.  We see the before and after radiographs to ensure the treatment worked correctly and no uroliths are left behind.  


However, to a client who has never experienced an animal with bladder stones, the whole situation can be frustrating, scary, or magical – depending on how the medical staff discusses the procedure.  To ensure the client is impressed, we should use all the tools we have to display the magic.  Look how this giant stone is magically gone.  Look how your dog has recovered from anesthesia and is wagging her tail after surgery.  Look how your cat is now contently purring and using his litter box appropriately after starting a prescription diet.  Look how that red-colored urine magically changes back to the normal yellow color.  Look how your pet’s veterinary team magically cured your pet.  This impression only happens if you can help your clients discover the magic in veterinary medicine.