Most tortoise urinary bladder stones have been present for an extended period of time and are large. This necessitates cutting into the bottom shell (called the plastron) during surgery and removing the stone. Click here or on the picture below to see how we diagnose and treat this condition surgically.
That is one big bladder stone, and the bottom shell will need to be cut open to remove it
Sometimes the bladder stones are small, and we can use a surgical approach called pre-femoral. This is done on the inside of one of the back legs. It is far less traumatic than cutting the shell, and is the preferred method to remove a stone when it is small. That is the surgical approach that will be on this page.
Large stones can be detected when the inner leg area of the abdomen (called the coelomic cavity in birds and reptiles) is palpated. Tortoises (especially California Desert Tortoises -CDT’s), have what might be described as the shape of a Mickey Mouse ear. When the tortoise is held vertically and gently rolled sideways a stone in the bladder, if large enough, can be felt.
This is how we do it
When the stone is small it cannot be felt this way very easily. These smaller stones are diagnosed radiographically. Luckily they are radiopaque, which means they show up on a radiograph (X-ray).
You might want to brush up on your radiology by linking to our How to Read a Radiograph Page if you want to learn the principles of radiology, then come back here for more fun with radiology.
Here are some radiographs of our patient for this page on pre-femoral stone removal. In the first one you get to take a gander and make a diagnosis on your own. The second and third ones circle the areas of interest. We will make the radiographs large so you can see more detail.
Notice anything of interest?
There is a bladder stone in the pelvic canal area
Did you also notice the old egg?
The Long Beach Animal Hospital is one of the few places that anesthetizes reptiles for surgery. We have extensive experience at this and can anesthetize any reptile.
This can become especially important if we have an emergency and need to provide life-saving care. Our page on Emergency Care gives details on how we proved this care on a wide variety of animals.
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.
We gently induce anesthesia with a mask that has 100% oxygen and the anesthetic agent. We commonly give a sedative by injection prior to this for further relaxation.
In addition, a pain injection is given during the procedure so that it is in full effect when our patient awakens.
The anesthetic works rapidly, as long as they don’t hold their breath!
When fully relaxed we gently insert a breathing tube, called an endotracheal tube (ET), into the windpipe. This facilitates the administration of oxygen and anesthesia in a much more efficient manner.
Our patient intubated and being given anesthetic through the ET tube while on a warm towel
While our tortoise is being anesthetized our surgeon is scrubbing his hands. After this he caps and masks and puts on sterile gloves.
Our surgeon Dr. Ridgeway is sorting his sterile instruments just prior to starting the procedure
We will be closely monitoring this tortoise’s breathing and heart rate by using a Pulse Oximeter (Pulse Ox) to measure the oxygen concentration in the hemoglobin of the red blood cells (RBC’S). This one at 94% is good, and this patient is stable and ready for surgery.
Now that we have a bladder stone that is reasonably small we will see if we can take it out with the pre-femoral approach. The picture below helps understand this approach.
The red arrow points to where we will make our incision in the skin to find the urinary bladder and remove the stone
Our anesthetized patient on a warm towel that is also used for positioning
The leg is pulled back to expose the pre-femoral area where the surgery will occur
Making the initial incision in the pre-femoral area
Exposing the layer of tissue under the skin that lines the coelomic cavity
Going through this layer to get access to the coelomic cavity and the urinary bladder. A piece of small intestine is visible in the opening.
Getting ready to make an incision in the urinary bladder, with two stay sutures holding the bladder from falling back into the coelomic cavity
A forceps is used to start pulling the stone pieces out of the bladder
The whole stone is gently removed
The piece of stone completely removed before the bladder is flushed of smaller stone pieces
A special plication pattern is used to close the bladder before it is placed back into the coelomic cavity
Since reptiles heal slower than mammals these skin sutures will be removed in two weeks at the earliest
Final appearance of the incision site
At this point in time our patient will be given pain medication, placed in a warm towel, and monitored until breathing well on her own.
We have a short movie showing Dr. R removing the stone. The noise in the background is the oxygen generator.
Now that you have seen this way of removing a bladder stone, click here to see how we remove a larger one by cutting the shell. It is one of the more interesting surgeries we perform, and Dr. Ridgeway is an expert at it.
This is the bottom shell (called the plastron) of the tortoise while it is under anesthesia. We use a Dremel to cut into this thick shell to remove a piece of the plastron in order to get access to the urinary bladder with the stone in it. Notice the saline being dripped on the blade as it cuts? The shell is living tissue, and we do not want excess heat build up from the friction of the blade to delay healing.