Does my puppy have a bladder infection?

Veterinary Medicine: What is the Standard of Care for Urinary Tract Infection Diagnosis?

• First off, let me say, that I am somewhat of an expert in this area with regards to human beings, but my question pertains specifically to the standard of care for dogs. I am interested in hearing from licensed veterinarians and veterinary technicians. Thank you. I suspected my dog had a UTI due to her housesoiling and collected a urine sample the way I had been directed by veterinarians in the past and called my vet's office to ask if I could bring it in. They refused to let me bring in my own sample and insisted I needed to bring my dog in so they could perform a cystocentesis. Again, I am somewhat of an expert in this area as an experienced registered nurse (35 years) and as a consumer of medical services related to this condition (about 50 years). I instructed the office that I did not want a cystocentesis performed on my dog unless it was necessary. The office staff told me it was the doctor's choice what they did. I corrected her that it is the doctor's role to assess my pet, diagnose her and make recommendations for treatment, but that I as the owner make all choices regarding treatment options for my pets. The veterinary technician also told me that if my dog did not urinate soon enough they would force fluids down her using a syringe. I wrote on the consent form I did not want that done and I also instructed them not to force fluids into my dog using a syringe. My dog is a young, healthy, highly trained Golden Retriever. They did collect a urine sample, I hope without doing the bladder puncture and she was treated for a mild infection with a course of antibiotics. When I took my dog back for a follow up appointment with repeat urinalysis, they had a hard time collecting urine they said because I did not want a cystocentesis, which made collection more difficult. They told they had to try 3or 4 times to collect the urine because my dog stepped in the urine sample, knocked it over, etc. This alarmed me, because it they cannot catch a clean sample of urine, how could I trust them to collect a sterile sample with a needle? I am not a veterinary professional and I had no trouble at all collecting a sample. Recently I had a dog training client with a puppy that was having frequent urination in the house, even after voiding outside. I suggested they call their vet to make an appt. The vet, rather than see the puppy to evaluate and make a diagnosis, just prescribed a course of antibiotics over the phone and told my clients to come pick up the prescription! So what is the standard of care in veterinary practice? Is is considered necessary to collect a sterile sample by cystocentesis for every urinary tract infection, or is that just a time-saving measure? Does the standard of care permit diagnosis of an infection over the phone without seeing the dog if the dog has never had a urinary tract infection before?

• Answer:

  Only a cystocentesis provides an uncontaminated sample- even a 'clean' mid stream sample will be contaminated by bacteria from the outside of the animal, so it's of less diagnostic value, and cystocentesis is a pretty safe procedure when performed by someone who is well trained and experienced. That said, a free-catch sample is better than no sample; red or white blood cells, crystals, or casts seen in it are diagnostically useful, but it wouldn't be useful at all for performing a bacterial culture and antibiotic sensitivity screening, and you don't know whether any bacteria seen in the sediment from that sample are really from inside the bladder, or just contaminants from the outside of the dog.