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.

CDT radiograph with a very large bladder stone

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.

Diagnosis

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.

Doctor palpating the femoral area of the abdomen for a bladder stone

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.

X-ray of a CDT laying on its back

Notice anything of interest?

X-ray of a CDT with pelvic area with bladder stone circled in red

There is a bladder stone in the pelvic canal area

Old egg in X-ray of a CDT

Did you also notice the old egg?

Anesthesia

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.

CBC showing elevated white blood cells

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.

CDT with anesthetic face mask over head

The anesthetic works rapidly, as long as they don’t hold their breath!

Inserting the breathing tube into the windpipe

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 on a warm towel

Our patient intubated and being given anesthetic through the ET tube  while on a warm towel

Surgeon washing his hands

While our tortoise is being anesthetized our surgeon is scrubbing his hands. After this he caps and masks and puts on sterile gloves. 

Surgeon preparing sterile instruments for surgery

Our surgeon Dr. Ridgeway is sorting his sterile instruments just prior to starting the procedure 

Pulse Oximeter showing an oxygen saturation of 94%

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.

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.

Arrow pointing to the pre-femoral area where we will do the surgery

The red arrow points to where we will make our incision in the skin to find the urinary bladder and remove the stone

Put on a towel for the right angle for surgery

Our anesthetized patient on a warm towel that is also used for positioning

View of the pre-femoral area where the surgery will occur

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

Making the initial incision in the pre-femoral area

Exposing the layer of the coelomic cavity

Exposing the layer of tissue under the skin that lines the coelomic cavity

Opening up the layer of tissue that surrounds 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.

Exteriorizing bladder and placing stay sutures

Getting ready to make an incision in the urinary bladder, with two stay sutures holding the bladder from falling back into the coelomic cavity

Forceps removing stone fragments visible in the opening of the urinary bladder

A forceps is used to start pulling the stone pieces out of the bladder

The large stone segment being removed

The whole stone is gently removed

Stone piece being held in forceps

The piece of stone completely removed before the bladder is flushed of smaller stone pieces

Appearance of the urinary bladder after it has been sutured and before placement back into the coelomic cavity

A special plication pattern is used to close the bladder before it is placed back into the coelomic cavity

Suturing the skin where the incision was

Since reptiles heal slower than mammals these skin sutures will be removed in two weeks at the earliest 

Skin completely sutured

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.

We use a Dremel to cut the shell to get access to the bladder

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. 

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