Image of the month

This month we are focusing on the interesting, strange and scary things we have found in the center of uroliths.

•  Suture was identified in approximately 10% of recurrent stones.  When closing the bladder after a cystotomy, minimize placing suture in the bladder lumen to reduce its contribution to stone recurrence.  Image A

• Plant awns/material are common in the western United States and sometimes enter the bladder and can become encrusted with mineral.  Image B

• Toothpick - a migrating toothpick could have been swallowed by the pet because it held a tasty Halloween treat.  In this case, the toothpick pierced the intestine, traveled to the bladder and initiated stone formation.  Image C

• Fleas, louse, and other insects may climb up the urethra and become entombed in stones. Image D

What do all of these spooky invaders have in common?
Heterogeneous nucleation: the process where crystallization is enhanced by initiating over foreign-preformed surfaces. 

What’s in the center of your uroliths?    For complete and accurate urolith analysis – please submit the entire urolith.