Rabbit Medicine and Surgery: Self-Assessment Color Review, Second Edition, Q&A 21

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Student tip: This case is beyond teaching at vet school but interesting to know.

A 2-year-old male neutered rabbit presents with weight loss, urine scalding and anorexia. On clinical examination abdominal palpation is resented and the rabbit exhibits bruxism (teeth grinding). A radiograph is taken (see image).

Question	Answer		Article
What is your diagnosis?	Hypercalciuria and cystic calculi present as radiodense material in the bladder on radiography, and it may be difficult to distinguish between the two.		Link to Article
What further diagnostic tests would you perform?	Ultrasonographic examination will differentiate between discrete calculi and ‘sludge’ material. Urinalysis should be performed on a sterile sample obtained by cystocentesis or catheterization to rule out underlying bacterial or fungal infections. A complete blood count and serum biochemical assay should also be performed to assess renal function.		Link to Article
What treatment is indicated?	Cystotomy and removal of thick sludge or a bladder stone is indicated in cases of cystic calculus. This is the treatment of choice for large cystic calculi in the rabbit. Smaller calculi and crystalluria may sometimes be treated by catheterization of the bladder under sedation and careful flushing with saline. The rabbit should be thoroughly hydrated prior to surgical removal. Analgesics and anti-inflammatory drugs are indicated and should be continued until the rabbit urinates normally. Intravenous fluid therapy should be continued postoperatively and the rabbit should be hospitalized until urination returns to normal. Antibiotics should be given for 4–6 weeks in cases with concurrent bacterial cystitis.		Link to Article
What preventive measures would you instigate?	Preventive measures include increasing exercise, increasing water intake and reducing dietary calcium intake. Treatment is aimed at reducing calcium levels and increasing urine output. Alfalfa hay and rabbit pellets contain high levels of calcium and should be avoided. Water intake should be carefully monitored to ensure that the water source is being used. Water intake can be promoted with the provision of both a bowl and a bottle, with rabbits showing a natural preference for bowl drinking. Analgesics and antibiotics are indicated, but urinary acidifiers are not effective in rabbits. The rabbit should be encouraged to exercise to ensure normal urination patterns and, if obese, lose weight.		Link to Article

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