Hematuria due to bladder cystolith and something else…

By Dr. Veronica Damian, Soundiagnosis June 2025

History:

5 year old Male entire American Staffordshire terrier, presented for history of haematuria for 2 days, urinating normal, hyporexia. On physical exam  presented tense abdomen (difficult to palpate) and did not tolerate rectal palpation.

Urinalysis: free catch urine, urinating fresh blood, USG 1.034, Red blood cells rbcs +++, cocci

Treated with NSAID and enrofloxacin for 14 days. But recurring a month after.

Abdominal ultrasound revealed:

•       2 large anechoic cystic-like cavitations with echogenic striations, right cranial to the prostate and right lateral to the urinary bladder. Consistent with paraprostastick cyst

•       Prostatic cysts of smaller size

•       Large cystolith in the bladder lumen (3.18cm)

•       Hypoechoic nodule in the head of the spleen 1.3 x 1.4cm

Images:

Figure 1. Urinary bladder with large cystolith in the lumen casting distal acoustic shadowing.

Figure 2. Large paraprostatic cyst with anechoic fluid and striations

Video 1. Large anechoic fluid filled paraprostatic cyst with multiple striations in the lumen.

Figure 3. Smaller prostatic cysts in the parenchyma

Figure 4.  Small incidental hypoechoic nodule in the splenic parenchyma

Comments:

Paraprostatic cysts are usually diagnosed in older dogs. They have no contact with the prostate and arise from a uterus masculinus (remanent of the Müllerian tube, haematoma or a serosal cyst.

The incidence is reported to be 1.1–5.3% in dogs with prostatic disease. 

Clinical signs might include abdominal distension associated with pain, tenesmus, in progressed cases strangura. They can herniate through the inguinal ring.

Treatment of paraprostatic cyst in dogs may involve drainage, resection or marsupialization. It is important to note that castration alone is unlikely to be of benefit, however, it does present benefits if its performed after the cyst has been removed.