Common Green Iguana’s occasionally have a problem with bladder stones (the medical term for bladder stone is urolithiasis or cystic calculi). It is difficult to determine exactly why they have this problem. Just like in tortoises, the bladder stone can be very large.
In addition to learning about the surgical removal of a bladder stone in an Iguana in this page, we also have pages that show a bladder stone removal in a dog and a tortoise. The tortoise page on removing a bladder stone is particularly interesting. Check it out and you will see why. The page on removing a bladder stone in a dog shows how we use the surgical laser.
Radiographs are important in the diagnosis of bladder stones. You might want to brush up on your radiology prior to reading this page by going to our How to Read a Radiograph page.
Graphic surgical photos on this page.
In dogs and cats there are several clues as to when a pet has a bladder stone. These include straining to urinate, blood in the urine, and lethargy. In reptiles the symptoms are not so clear cut since they don’t have the same habits as mammals and they easily hide symptoms of disease.
Sometimes they don’t have any symptoms, in which case the diagnosis is made accidentally while looking for other problems. In general, the symptoms of a bladder stone in an Iguana might include lethargy and a poor appetite.
A diagnosis of a bladder stone in reptiles is usually made by taking a radiograph. Most of these stone are radiopaque, which means they show up vividly on a radiograph. Stones that do not appear on a radiograph are called radiolucent.
This is the radiograph of Elvis, an Iguana with a very large bladder stone that is easily visualized as the large and circular white object
Another view gives some additional perspective as to the size. It has probably been there for years in order to progress to this size.
The treatment of choice for this bladder stone is surgery. It takes about an 90 minutes from start to finish. It’s a meticulous surgery that requires a very gentle touch to an inflamed and sensitive bladder. It is performed under sterile conditions to minimize any chance of infection.
The Long Beach Animal Hospital is one of the few places that attempts to anesthetize reptiles for surgery. We have extensive experience at this and can anesthetize any reptile. This can become especially important if we have an emergency.
We start with pre-anesthetic preparation long before the surgery. This preparation begins with an exam. After the exam we run a blood panel to check for any internal problems or infections in regards to anesthesia.
The blood panel on this animal shows an elevated wbc count of 18,500. The normal range is up to 12,200.
Anesthesia is initially induced with a face mask. Sometimes Iguana’s are given a tranquilizer before we given them anesthetic via the face mask. The anesthetic works rapidly, as long as they don’t hold their breath!
They can hold their breath, so we watch carefully as they are relaxing
When she has relaxed enough, a special tube (called an endotracheal tube or ET) is placed in the windpipe. This tube allows us to inflate the lungs and supply adequate amounts of oxygen and anesthetic.
Placing the ET is a gentle and precise process. The endotracheal tube is gently passed into the opening to the windpipe. This opening is at the back of the tongue, and can be difficult to visualize due to the fleshy tongue.
There is much more to anesthesia than this. If you click here you can learn plenty on how we anesthetize a wide variety of animals.
Once our patient is properly anesthetized it is prepared for surgery. The first step in the process is scrubbing the skin in an aseptic manner to prevent infection.
We use a special surgical antiseptic that removes and kills bacteria. We do many scrubs until the cotton is clean.
While our nurse prepares our patient our doctor is doing the same cleansing of his hands
While all of this preparation is transpiring our surgeon, Dr. Ridgeway, is preparing his sterile instruments
This is a major abdominal surgery, so our surgeon is fully gowned and masked
Once he is happy everything is in order Dr. R makes an incision in the scales. The incision is around 6 inches long in order to have an opening large enough to remove this large stone from the coelomic (the reptile version of abdominal) cavity.
A scalpel blade is used to nick the skin enabling us to use a special scissors to extend the incision.
Great care must be taken when extending the incision with the scissors. Immediately below the skin is a large vein that must be avoided. You can see it here as the dark blue object running horizontally.
The bladder is then localized and brought out through the incision. It is carefully assessed to determine the correct location to place sutures and to make an incision. Notice the large number of blood vessels that cover the surface of the bladder. The bladders wall is quite thin and can easily tear, especially when inflamed because of the large stone.
The opening is draped with moistened sterile gauze to minimize contamination and keep the bladder moist. A small suture (called a stay suture) is placed at each end of the bladder to keep the bladder in position and to minimize handling during manipulation of the stone. The arrow is pointing to the suture as it is being placed at one end.
When the bladder has been properly stabilized an incision is made at an area where there is minimal blood supply. The incision is made just large enough to squeeze out the stone.
The stone is carefully squeezed out of the bladder. You can get an idea of its size in relation to Dr. Ridgeway’s hands. It is hard to imagine what type of pain this must be causing.
Internal organs like the bladder have to be kept continually moist when they are not in their usual position inside the body cavity. Here we are moistening the bladder with sterile saline just prior to suturing.
The bladder is sutured with a special suture material that will slowly dissolve over several months. This suture is very strong and will hold the cut edges together during the time the healing is progressing.
When Dr. R is happy that the urinary bladder has been securely sutured and there is no bleeding the process of suturing the scales begins.
Reptile skin is sutured differently than mammalian and avian skin. For reptile skin to heal properly the edges must be “everted”. Within a month these sutures are taken out and within three months the scales are back to normal.
Here is Elvis immediately after surgery and just prior to her pain injection. She is being kept warm to aid in her recovery. She went home the next day and is healing fine. We will be monitoring her condition to help prevent the recurrence of this stone.
In many species we use the laser to make the incision in the urinary bladder. This gives us good control of bleeding when the bladder is inflamed and our patients appreciate the pain reduction that is achieved when using the laser. You can learn more about the laser here.
Reptiles like this iggie are highly prone to a serious metabolic problem called Metabolic Bone Disease. Please follow this link to learn more and prevent this from happening to your iguana.
Iguana’s are one of the more common reptiles we care for. If you take the effort to read our page on MBD and care for your iggie properly yours might live long enough to be this size.