1
Q
Topic outline
A
- Bladder, urethra, urachus, ureters
- Urolithiasis: obstruction with calculi/stones: all species
- patent urachus/infected umbilical remnant: equine
- Ruptured bladder: equine
2
Q
Urolithiasis
Bovine
A
- More common in steers than bulls
- Feedlot steers-multiple lesions
- Range steers-single lesion
- usually found at sigmoid flexure
3
Q
Urethral obstruction
CS
A
- abdominal pain
- stretching
- treading
- tail switching
- rectal
- distended bladder
- diagnostic
- distended bladder
4
Q
Ruptured Urethra
CS
A
- ventral swelling
- sheath
- abdomen
- Rectal exam
- distended bladder, but not tight
- Cellulitis
- uremic smell
5
Q
Ruptured bladder
A
- No adbominal pain
- abdominal distention
- symmetric
- Rectal
- bladder can be full
- bladder usually not empty
- Elevated BUN
- Acidotic
- Toxemia
- depression
6
Q
Goals of TX for stones (I think)
A
- steers
- salvage for market
- perineal urethrostomy
- salvage of steers
- epidural anesthesia
- dissect to penis and transect
- salvage of steers
7
Q
Urolithiasis
Pet Goats/Pigs
A
- Typically sporadic metabolic dz
- can be caused by
- environmental, dietary, metabolic, improper husbancry
- importance of anatomy
- treated with sx
- can reobstruct
8
Q
Urolithiasis
diet problems
A
- Concentrate diets
- excess phospherous
- magnesium
- Imbalance in Ca:P ratio
- Lack of water
- inadequate flushing of sediment
- High urine pH
- alkaline urine = struvite, apatite and calcium carbonate uroliths form
9
Q
Forage based diets in urolithiasis
A
- allows increased salivation and subsequent excretion in feces instead of urine
10
Q
High grain diet
urolithiasis
A
- low roughage diets decrease formation of saliva
- increases amount of phosphorus in urine
11
Q
Anatomy of males predisposing to stones
Goats
A
- sigmoid flexure
- urethral process/vermiform appendage
- narrow urethra
- early castration (<10 weeks)
- testosterone responsible for urethral enlargement
- castration by banding inc necrosis
12
Q
Goat CS urolithiasis
A
- early
- restlessness or anxiety
- tail twitching
- progressive
- excessive vocalization
- stretching/arched back
- forceful urination
- reduced urinary flow
- bloody urine
- crystals on preputial hairs
13
Q
Goats
advanced clinical signs urolithiasis
A
- swelling/pain in urethra
- ventral edema
14
Q
Goats
Ruptured bladder
A
- sudden cessation of clinical signs
- abdominal distention
- anorexic
- depression
- weakness
- death
15
Q
Owners may confuse urinary tract obstruction with
A
GI disease
*or sudden improvement with resolution
16
Q
Diagnosis urolithiasis in goats
A
- presentation
- hx
- PE
- Blood chem
- inc BUN
- inc creatinine
- inc potassium
- Rads
- plain
- contrast
- U/S
17
Q
Initial therapy
Goat urolithiasis
A
- massage/manipulatio of urethral process
- exteriorization of penis
- 0.1-0.5 mg/kg of diazepam
- removal of urethral process
- sedation, lidocaine
- temp fix
- Passage of catheter
- urohydropulsion
- difficult to catheterize
- urethral diverticulum
- traumatic
18
Q
Medical management
goat urolithiasis
A
- promotion of urethral relaxation
- ammonium chloride
- walpoles solution
19
Q
Promotion of urethral relaxation
A
- diazepam (0.1-0.5 mg/kg IV)
- Acepromazine (0.1 mg/kg IV)
- Avoid xylazine
- promotes diuresis
20
Q
Ammonium chloride
A
- Urinary acidifier
- 0.5-2% of dry matter intake
- 200-300 mg/kg - inconsistent results
- 450 mg/kg - pH < 6.5 > 24 hrs
- unpalatable
21
Q
Walpoles solution
A
- acidifying solution
- supposed to dissolve stones
- appears to work better in TX….?
22
Q
Surgical managment
goat urolithiasis
A
- urethral process amputation
- percutaneous catheter placement
- tube cystostomy
- bladder marsupialization
- perineal urethrostomy
23
Q
Removal of urethral process
A
- always done despite little success
- sedation
- 0.1-0.5 mg/kg diazepam
- be careful in compromised patients
- put in sitting position
- Allis tissue forceps
- Topical lidocaine
- cut with scalpel
24
Q
Percutaneous cather
A
- minimally invasive stabilization overnight
- pigtail catheters
- sedate
- local anesthesia
- U/S guided
- suture in place
- abx
- NSAIDS
25
Tube cystotomy
* Most common procedure
* allows urethra to rest
* complete recovery and tube removal may be possible in a few months
* Allows admin of acidifiers to urine
* temp diversion
* **must change diet also**
26
tube cystotomy
complications
* blockage of tube
* failure of balloon
* continued straining
* premature removal of tube
27
Bladder marsupialization
* permanent solution after failed tube cystotomy
* minimally invasive technique
* two incision technique
* 4 cm stoma created
* not recommended for young or breeding goats
28
Bladder marsupialization
complications
* cystitis
* pyelonephritis
* premature closure
* bladder prolapse
* urine scalding
29
Perineal urethrostomy
* generally salvage procedure in ruminants
* high rate of stricture
* newer technice described
* incision ventral to anus
* penile body freed from ishium
* urethral mucosa spatulated
* **inc success rate**
30
Prevention urolithiasis
* avoid grain
* feed diets Ca:P ratio 2:1 not below 1:1
* high Ca reduces P absorption
* don't add magnesium or phosporous
* Legume hays: alfalfa
* add 4% salt to ration in inc water intake
* Urinary acidifiers
* Walpoles
* ammonium chloride
* ammonium sulfide
* Bio Chlor
* dietary cation anion difference (DCAD)
* palatability
31
Urolithiasis in horses
* Males: neck of bladder
* chronic cystitis, incontinence, dysuria, pollakuria, polyuria, hematuria, stranguria
* staining and scalding
* colic
* stiif, stilted hindquarter gate
* **usually calcium carbonate**
* weight loss
* **rectal - diagnostic**
32
Subischial urethrotomy
* epidural anesthesia
* crush/remove stone
* second intention healing
33
Lithotripsy
* long regular slotted scre driver
* grind tip into stone that crushes it
34
Perirectal approach
* another option for stone removal
* Dr. Freeman doesn't do
35
Laparocystotomy
* cystotomy under general anesthesia
* equine bladder far back in pelvis
* difficult to assess
36
Hematuria
* cystic calculi
* neck of bladder
* easy recalt DX
* urethral defects
* ulcerated mucosa in proximal urethra
* responds to subischial urethrostomy
37
Patent Urachus
about
* urachus persists in foals for weeks postpartum
* normally closes after birth
* can resolve without treatment
* not life-threatening
* can uncommonly be caused by infection
* medical tx
* silver nitrate cautery
* avoid aggressive use
* Sx
* umbilical resection
38
Urachus def
* urine from fetal bladder to allantoic cavity
* scar at apex of bladder
39
umbilical arteries
* on each side of bladder
* drains blood from fetus
* round ligaments of bladder
40
umbilical vein
* carries oxygenated blood to fetus
* falciform ligament
41
Omphalophlebitis
* Infected umbilical remnants
* CS in first 4 weeks
* septicemia
* fever
* swollen/septic joints (life threatening)
* cause
* can be overzealous iodine application
* If umbilicus is not hot, swollen and draining, U/S is critical
* tells you what structures are infected
42
umbilical vein
* usually the size of a pencil or less
* goes all the way to the liver
* unable to access that far up
* marsupialize infected end
43
Uroperitoneum
* Ruptured bladder
* Ruptured urachus (internal)
* Ruptured ureter
\*fairly common issue in foals
44
Signs uroperitoneum
* depression
* abdominal distention
* abnormal urination
45
Uroperitoneum
DX
* History and age (= 6 days)
* Males more common, but slightly
* abdominocentesis
* electrolytes
* blood and peritoneal fluid
* U/S
\*rarely used: dye studies, contrast studies
46
Electrolytes with uroperitoneum
* Sodium will leak into peritoneal cavity
* hyponatremia
* Potassium will leak into blood
* hyperkalemia
* Creatinine in peritoneal cavity and blood
\*treat electrolyte abnormalities before sx
47
TX uroperitoneum
* treat hyperkalemia
* repair defect
* bladder (**dorsal**, ventral), urachus, ureter (rare)
\*ureter rupture: accumulation urine in retroperitoneum
Surgery final
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