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Official Minnesota Urolith Center Form in PDF

The Minnesota Urolith Center form is a document designed for veterinary professionals to facilitate the analysis of uroliths, or urinary stones, in pets. This form collects essential information about the pet's medical history, dietary habits, and specifics regarding the uroliths themselves. By accurately completing this form, veterinarians can help ensure that pets receive the most effective treatment and preventative care.

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The Minnesota Urolith Center form serves as a vital tool for veterinary professionals seeking to analyze uroliths—commonly known as urinary stones—in animals. This comprehensive form is designed to collect essential information, ensuring that the analysis is thorough and accurate. Key details such as the submitting veterinarian's name, clinic information, and contact details are required at the outset. Additionally, the form prompts the submission of specific patient information, including the owner's name, the patient's identification, species, and breed. It also inquires about any previous occurrences of uroliths, dietary habits prior to stone retrieval, and whether any medications, such as antibiotics or urine modifiers, were administered. For cases involving feline urethral plugs, the form offers specific instructions on preservation methods, emphasizing the importance of proper sample handling. The Minnesota Urolith Center also provides guidance on preventative measures while awaiting results, highlighting the significance of monitoring and dietary adjustments to mitigate the risk of future urolith formation. This structured approach not only facilitates effective communication between veterinary professionals and the center but also enhances the overall quality of care for animal patients.

Form Example

LAB USE ONLY

DATE REC'D

# SUBMITTED

MINNESOTA UROLITH CENTER QUANTITATIVE UROLITH ANALYSIS FORM

PLEASE SUBMIT STONES DRY IN UNBREAKABLE CONTAINER (FOR PLUGS SEE BELOW)

**Please copy this form**

Date submitted

DOCTOR NAME:

CLINIC NAME:

ADDRESS:

PHONE NUMBER:

FAX NUMBER:

Owner's Name

Patient's Name/ID#

Species

Breed

Birth Date

If yes, date of detection:

Mineral composition?

Was the urine cultured before/during stone retrieval? . . . . . . . .

. . . . .Yes		No
Bacterial growth? . . . . . . . Yes		No
Isolates:

Were antibiotics given prior to stone retrieval? . . . . . . . . . . . .

YesNo

Type/dosage:

Were urine acidifiers or alkalinizers given prior to stone

retrieval?Yes No Type/dosage:

Gender: (circle one)			M	MC		F	FS	Unk
Source: (check all areas samples obtained from)
Upper Urinary Tract				Lower Urinary Tract
(	)	Kidneys		(	)	Bladder

(	)	Ureters		(	)	Urethra
				(	)	Voided

Other

Date retrieved or voided

What brand of diet was fed prior to urolith retrieval/diagnosis?

How long was this diet fed?

Was a prescription diet fed? Yes No

If yes, which one?			(check one)
c/d(s)	dry	(		)	canned (	)
c/doxl
c/doxl	dry	(		)	canned (	)

k/d	dry	(		)	canned (	)

l/d	dry	(		)	canned (	)

s/d	dry	(		)	canned (	)

u/d	dry	(		)	canned (	)

w/d	dry	(		)	canned (	)

z/d	dry	(		)	canned (	)

Other

How long was this diet fed?

Previous Uroliths? . . . . . . . .Yes

Unk

Was allopurinol given prior to stone retrieval? . . . . . . . . . . . . .


	Yes		No
Dosage and duration:
Previous illness or injury:
Dx:		;	Date
Dx:		;	Date

FOR FELINE URETHRAL PLUGS ONLY

Preferred method for plug submission: 1/2 dry, 1/2 in formalin

How was the plug preserved? (check)
1.	No preservative	(	)

2.	10% buffered formalin	(	)
3.	Other

If sample is very small, please submit dry.

MAIL TO:

MINNESOTA UROLITH CENTER

Dr. Carl Osborne

Dept. of Small Animal Clinical Sciences

College of Veterinary Medicine

Univ. of Minnesota, 1352 Boyd Avenue

St. Paul, MN 55108

612/625-4221 FAX 612/624-0751

Supported in part by an educational gift from Hill’s Pet Nutrition, Inc

MINNESOTA UROLITH CENTER

Hasan Albasan, DVM, MS	•	UNIVERSITY OF MINNESOTA	• Carl A. Osborne, DVM, PhD
Kathleen Carpenter, CVT	•	College of Veterinary Medicine	•	Laura Pederson, BS
Thomas F. Fletcher, DVM, PhD	•	1352 Boyd Avenue	• David J. Polzin, DVM, PhD
Frédéric Jacob, DVM	•	St. Paul, MN 55108	•	Sheri Ross, DVM
Lori Koehler, CVT	•	Lab Phone (612) 625-4221	•	Laurie L. Swanson, CVT
Chalermpol Lekcharoensuk, DVM •		Fax (612) 624-0751	•	Lisa K. Ulrich, CVT
Jody P. Lulich, DVM, PhD	•		•

_______________________________________________________________________________

WHAT PREVENTATIVE MEASURES SHOULD I TAKE UNTIL I RECEIVE QUANTITATIVE MINERAL ANALYSIS RESULTS?

Urolith formation is a process that typically takes several weeks (eg. infection induced struvite), to months (eg. calcium oxalate)rather than days. The most common "cause" of rapid recurrence of uroliths is incomplete removal at the time of surgery.

Until quantitative mineral analysis on the urolith is completed, we recommend the following

steps.

-Perform post-operative radiographs of patients with multiple urocystoliths. Double contrast cystography may be necessary if the urocystoliths were not easily observed on pre- operative survey films.

-If small stones are detected on post-operative films, they may be able to be removed non- surgically either by catheter retrieval1, or voiding urohydropropulsion2 after healing takes place.

-Feed a diet unlikely to enhance urolith formation. We typically feed a diet that avoids mineral excess, and promotes a neutral urine pH. We often feed a diet designed for mild to moderate renal insufficiency. If possible, feed a canned diet to promote dilute urine. Once urolith results are received, refer to accompanying recommendation sheets.

-Obtain cystocentesis urine samples to monitor for, and prevent secondary urinary tract infections.

1Osborne CA, Lulich JP, Unger LK: Nonsurgical retrieval of uroliths for mineral analysis. In Current Veterinary Therapy XI. pp 886-889, 1992.

2Lulich JP, Osborne CA, Unger LK, et al: Nonsurgical removal of urocystoliths by voiding urohydropropulsion. In Journal of the American Veterinary Medical Association. Vol 203, pp. 660-663, 1993.

Osborne CA, et al.: Canine and Feline Urolithiases: Relationship of Etiopathogenesis to Treatment and Prevention. In Canine and Feline Nephrology and Urology, Osborne and Finco 1995, pp 798-888

➤ Minnesota Urolith Center File

Form Specifications

Fact Name	Description
Submission Requirements	Stones must be submitted dry in an unbreakable container. For plugs, a preferred method is 1/2 dry and 1/2 in formalin.
Doctor and Clinic Information	The form requires the doctor's name, clinic name, address, phone number, and fax number for proper identification and contact.
Owner and Patient Details	Owner's name, patient name/ID, species, breed, and birth date must be provided to ensure accurate analysis and record-keeping.
Governing Laws	This form is governed by veterinary medical laws in Minnesota, ensuring compliance with state regulations regarding animal health and treatment.

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