Caprine obstructive urolithiasis: requirement for 2nd surgical intervention and mortality after percutaneous tube cystostomy, surgical tube cystostomy, or urinary bladder marsupialization

OBJECTIVES: To determine the requirement for 2nd surgical interventions and mortality after 3 different surgical techniques (percutaneous tube cystostomy [10 goats], surgical tube cystostomy [25 goats], urinary bladder marsupialization [10 goats]) for caprine obstructive urolithiasis, and to determine whether pre- or 24-hour postoperative physical examination findings or serum chemistry results could be used as predictors of mortality. STUDY DESIGN: Retrospective study. ANIMALS: Male goats (45) with obstructive urolithiasis. METHODS: Medical records for all male goats admitted and operated for obstructive urolithiasis between 1993 and 2003 were reviewed. Data retrieved included signalment, pre- and 24-hour postoperative values for temperature, pulse, respiratory rate, packed cell volume, serum K(+), serum creatinine, and blood urea nitrogen [BUN]. The type of initial surgical procedure, time to 2nd surgical intervention, time to death, and duration and cost of hospitalization were also obtained. RESULTS: Percutaneous tube cystostomy was associated with a significantly increased requirement for (5.6-fold increased hazard) and decreased time to a 2nd intervention (P=.002). There were no differences between the 3 procedures for time to mortality. Increased BUN and respiratory rate at admission were associated with increased mortality (hazards ratio of 4.8 and 5.0, respectively). Urinary bladder marsupialization was associated with significantly decreased hospitalization time (P=.02) and cost (P=.04) compared with surgical tube cystostomy and percutaneous tube cystostomy. CONCLUSION: Surgical tube cystostomy and bladder marsupialization are both acceptable surgical methods for treatment of caprine obstructive urolithiasis. Each procedure has inherent complications that should be discussed with the owner before choosing the surgical treatment. CLINICAL RELEVANCE: There are acceptable options for treatment of caprine obstructive urolithiasis; however, percutaneous tube cystostomy should be avoided.     

Management of obstructive urolithiasis and concurrent urethral rupture in a goat

A 4-month-old, male castrated Alpine White goat presented to the University of Guelph, Veterinary Teaching Hospital, with urolithiasis and a ruptured urethra. A tube cystostomy was performed using an indwelling Foley catheter. Postoperatively, the goat remained in good health, and was discharged with the cystostomy catheter in situ. Five weeks following surgery, the goat was noted to pass urine through its urethra. Seven weeks following surgery, the catheter became dislodged and the goat was observed to urinate normally. Six months following surgery, the goat was apparently healthy and urinating normally. Tube cystostomy may be a useful therapeutic option in the management of small ruminants with obstructive urolithiasis with concurrent rupture of the urethra, especially for cases in which treatment cost is a limiting factor.     

Percutaneous tube cystostomy and vesicular irrigation for treatment of obstructive urolithiasis in a goat

Treatment of a 3-month-old male goat with obstructive urolithiasis by means of percutaneous tube cystostomy and vesicular irrigation with a chemolysis solution is described. The cystostomy tube was inserted percutaneously with ultrasonographic guidance. Patency of the urethra was reestablished with no clinical evidence of urethral stricture or recurrence of obstruction during the following 12 months. Results in this goat suggest that percutaneous tube cystostomy may be an economical alternative to surgical cystostomy tube placement. Chemical dissolution of calcium phosphate uroliths with a commercially available compound appears to be feasible in goats.     

Tube Cystostomy for Treatment of Obstructive Urolithiasis in Small Ruminants

Tube cystostomy was used to treat 13 goats and two sheep with obstructive urolithiasis. The cystostomy tube was intermittently occluded 3 to 4 days after placement to determine if urine could be voided through the urethra. If the animal showed no discomfort during urination after the cystostomy tube had been occluded for several days, the tube was removed. This procedure was successful in relieving urethral obstruction in 12 animals. The mean time until the animal could urinate freely and until the cystostomy tube was removed was 11.5 and 14.4 days respectively. Follow-up was available for 10 animals; seven were alive with no recurrence of urinary obstruction. One goat died from causes unrelated to urinary obstruction 1 year postoperatively. One goat died from unknown causes, and one goat died after urinary obstruction recurred.     

Urethroscopy and laser lithotripsy for the diagnosis and treatment of obstructive urolithiasis in goats and pot-bellied pigs

OBJECTIVE: To explore the use of urethral endoscopy and laser lithotripsy in the diagnosis and management of urolithiasis in goats and pot-bellied pigs. DESIGN: Prospective clinical study. ANIMALS: 16 male goats and 6 male pot-bellied pigs with dysuria. PROCEDURE: Abdominal ultrasonography and urethral endoscopy were performed on all 22 animals. Endoscopic-guided holmium:yttrium-aluminum-garnet laser lithotripsy was performed in 3 goats and 2 pot-bellied pigs. RESULTS: Urolithiasis was identified in 15 goats and 5 pot-bellied pigs. Primary urinary bladder paralysis and cystitis were identified in the remaining pot-bellied pig and goat. Mean bladder diameters of obstructed small- and large-breed goats were 7 and 9.5 cm, respectively. The mean bladder diameter of obstructed pot-bellied pigs was 9.5 cm. Five of 20 animals with obstructive urolithiasis had severe urethral necrosis or stricture formation at the time of urethroscopy. All of these animals were euthanatized within 6 months because of persistent dysuria. When used, laser lithotripsy successfully fractured the distally located obstructing stones in the 3 goats and 2 pot-bellied pigs. CONCLUSIONS AND CLINICAL RELEVANCE: Urethral endoscopy is useful for evaluating urethral patency in goats and pot-bellied pigs. Examination of the urethral mucosa following relief of urethral obstructions aids in the assessment of the long-term prognosis for urethral stricture. Urethral endoscopy also expands the therapeutic options for management of urolithiasis by providing a route for conducting laser lithotripsy. Laser lithotripsy proved to be safe and effective for clearing distally located calculi refractory to removal by traditional urethral flushing. Lithotripsy application is restricted to calculi lodged in the urethra.     

CONTRAST RADIOGRAPHY OF THE LOWER URINARY TRACT IN THE MANAGEMENT OF OBSRUCTIVE UROLITHIASIS IN SMALL RUMINANTS AND SWINE

Contrast radiographic visualization of the small ruminant and porcine lower urinary tract is an infrequently used modality for the evaluation and management of obstructive urolithiasis. The administration of contrast medium through a tube cystostomy catheter used to divert urine flow until the resolution of the obstruction may provide an easy method to evaluate the status of the urethral obstruction. Contrast fluoroscopy is utilized to monitor and visualize therapeutic flushing of the urethra. A review of 26 patients seen at the Veterinary Medical Teaching Hospital suggested that among the radiographic techniques used, positive contrast normograde cystourethrography through the tube cystostomy catheter allowed the best visualization of the lower urinary tract structures and enabled assessment of the resolution of the obstructive lesion.     

Outcome of and complications associated with tube cystostomy in dogs and cats: 76 cases (1995-2006)

OBJECTIVE: To determine indications for cystostomy tube use in dogs and cats, complications associated with their use, and outcome of dogs and cats in which cystostomy tubes had been inserted. DESIGN: Retrospective case series. ANIMALS: 37 dogs and 39 cats. PROCEDURES: Information was obtained from medical records. Long-term follow-up information was obtained by use of a client questionnaire. RESULTS: Indications for cystostomy tube placement were bladder dysfunction, urinary tract rupture, obstructive urinary tract neoplasia, urinary diversion following urogenital surgery, obstructive urolithiasis, and feline lower urinary tract disease. Median time tubes were in place was 11 days, but duration of tube use was significantly longer for animals with bladder dysfunction than for animals with urinary tract trauma, urinary diversion, or urinary tract obstruction. Thirty-seven (49%) animals had tube complications. Development of complications was not significantly associated with species, age, body weight, duration of tube use, or tube type, except that animals were significantly more likely to develop complications following long-rather than short-term use. In 42 animals, the underlying condition resolved and the tube was removed; 22 animals died or were euthanatized with the tube in place. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that cystostomy tubes may be used for animals with various conditions related to problems with urine outflow. Nearly half the animals in the study developed complications related to the cystostomy tube, suggesting that potential complications should be discussed with owners prior to tube placement. However, most complications were easily resolved.     

Buccal mucosal graft urethroplasty for reversal of a perineal urethrostomy in a goat wether

OBJECTIVE: To describe the use of buccal mucosa as a urethral graft for reversal of perineal urethrostomy (PU) in a castrated male goat. STUDY DESIGN: Clinical case report. SAMPLE POPULATION: One client-owned castrated male goat. RESULTS: An 8-month-old Pygmy cross wether was admitted for urolithiasis and PU stricture. After repeated unsuccessful attempts at urethrostomy reversal and urethral reconstruction, a buccal mucosal graft was used for urethroplasty. Buccal mucosa proved to be an excellent graft for urethral repair. Normal urination has occurred through the reconstructed region for at least 24 months. CONCLUSIONS: Buccal mucosa worked well as a graft for urethroplasty and PU reversal. CLINICAL RELEVANCE: Grafting with buccal mucosa may also prove useful in other urethral repair techniques in small ruminants.     

Serum biochemical abnormalities in goats with uroliths: 107 cases (1992-2003)

OBJECTIVE: To characterize serum biochemical abnormalities in goats with uroliths. DESIGN: Retrospective case-control series. ANIMALS: 107 male goats with uroliths and 94 male goats with various nonrenal diseases (controls). PROCEDURES: For male goats, results of serum biochemical analyses collected from 1992 through 2003 were retrieved from computerized records, as were signalment, clinical diagnoses, and discharge status. Results of analyses for BUN, creatinine, phosphorus, calcium, Na, K, Cl, total CO2, anion gap, and glucose were compared between goats with uroliths and control goats. RESULTS: Goats with uroliths had higher mean BUN, creatinine, total CO2, K, and glucose concentrations and lower mean phosphorus, Na, and Cl concentrations than control goats, with no difference in mean calcium concentration and anion gap. Goats with uroliths had higher frequency of azotemia, hypophosphatemia, hypochloridemia, and increased total CO2 and lower frequency of decreased total CO2 than control goats. Urolithiasis occurred more frequently in castrated males than in sexually intact males and in dwarf African breeds than in other breeds. CONCLUSIONS AND CLINICAL RELEVANCE: Goats with uroliths often had hypophosphatemia at admission. Hypochloridemic metabolic alkalosis was the most common acid-base disorder. Rupture in the urinary tract system was associated with increased prevalence of hyponatremia and hyperkalemia. Clinicians should be aware of these abnormalities when determining fluid therapy.     

Urolithiasis in small ruminants. II. Cysto-urethrography as a new aid in diagnosis

A technique for catheterizing male small ruminants is described. The barrier formed by the presence of the urethral diverticulum is avoided by the use of a pre-curved catheter. The technique enables application of contrast studies of bladder and urethra in animals suspected of urolithiasis. Differentiation between cystitis and obstructive urolithiasis is possible and the indications for urethrostomy can be reduced.     

Vaginourethroplasty as a salvage procedure for management of traumatic urethral rupture in a cat

This report describes a cat that suffered pelvic urethral rupture associated with multiple pelvic fractures. A vaginourethroplasty was performed as a salvage procedure, via intrapelvic anastomosis of the proximal urethra to the caudal vagina, following failure of a primary urethral anastomosis. Urinary diversion was achieved via tube cystostomy and a vagino-urethral catheter was maintained for 3 days postoperatively. Anterograde cystourethrography was performed at 7 days and 14 days postoperatively. Absence of contrast leakage from the vagino-urethral anastomosis was documented at 14 days postoperatively and the tube cystostomy was removed. An Escherichia coli urinary tract infection was treated following removal of the tube cystostomy and subsequent urine culture revealed no evidence of urinary tract infection. The cat retained normal urinary continence and elimination behaviour during the 7-month follow-up period. Vaginourethroplasty could be considered as a salvage option for management of traumatic pelvic urethral rupture in the neutered female cat.     

Minimally Invasive Inguinal Approach for Tube Cystostomy

Objective— To report a technique for tube cystostomy placement via a minimally invasive inguinal approach and outcome in 9 dogs and 6 cats with urinary tract obstruction or detrusor atony.
Study Design— Case series.
Animals— Dogs (n=9) and cats (6).
Methods— Medical records (January 2004–January 2008) of dogs and cats that had tube cystostomy via an inguinal approach were reviewed. Retrieved data included signalment, diagnosis, surgical technique, and complications. Access to the bladder was through a muscle splitting approach in the inguinal region with the cystostomy tube placed through a skin incision made several centimeters proximal to this incision and secured in the bladder by a purse string suture. Cystopexy during closure of the muscle layers ensured secure closure and minimized the likelihood of uroabdomen if tube dislodgment occurred.
Results— Cystostomy tubes were placed in 5 cats as an emergency procedure for treatment of acute urinary tract obstruction or urethral rupture, and as an elective procedure in 9 dogs and 1 cat. No complications occurred during cystostomy tube placement. Postprocedural complications were minor (peristomal irritation in 2 dogs with latex catheters, catheter laceration, premature removal) and only occurred when tubes were retained for >4 weeks. Urinary tract infection at catheter removal in 6 dogs resolved with antibiotic administration.
Conclusions— An inguinal approach for cystostomy tube placement facilitated rapid catheter placement into the bladder with minimal soft tissue dissection. Cystopexy during abdominal wall closure provided peritoneal protection should premature dislodgement of the cystostomy tube occur.
Clinical Relevance— An inguinal approach should be considered for rapid tube cystostomy particularly in metabolically compromised animals.     

Radical mastectomy in 20 ruminants

OBJECTIVE: To describe a surgical technique for radical mastectomy in ruminants and to report experience and outcome in 20 animals. STUDY DESIGN: Retrospective study. ANIMALS: Seventeen goats and 3 cows. METHODS: Medical records of ruminants that had radical mastectomy between June 1, 1987 and June 1, 2003 were reviewed. Follow-up information was obtained by telephone interview of owners. RESULTS: One animal died within 24 hours from complications of gangrenous mastitis and another died from necrotizing cellulitis. Eighteen animals were discharged and follow-up information was available for 15 animals; 12 animals lived at least 1 year postoperatively. CONCLUSIONS: Ruminants with severe but localized diseases of the udder did well after radical mastectomy. The procedure was well tolerated, made the animals more comfortable, and potentially prolonged their lives as pets. CLINICAL RELEVANCE: Radical mastectomy can be a safe and effective procedure for ruminants with udder disease, with few complications.     

Seroprevalence and Factors Associated with Coxiella burnetii Infection in Small Ruminants in Baringo County,Kenya

To improve estimates of C. burnetii epidemiology in Kenya, a survey was undertaken in small ruminants in Baringo County, where acute cases of Q fever in humans had been reported in 2014. From 140 household herds selected, 508 (60.5%) goats and 332 (39.5%) sheep were included and an indirect ELISA assay for C. burnetii IgG antibodies performed. In addition, epidemiological information at both herd and animal level was collected. Generalized mixed‐effects multivariable logistic model using herd as the random effect was used to determine variables correlated to the outcome. Overall seroprevalence was 20.5% (95% CI: 17.8%, 23.3%). Goats had 26.0% (95% CI: 22.2%, 30.0%) compared to sheep 12.2% (95% CI: 8.7%, 16.0%). Nomadic pastoralism, goats and older animals (>1 year) were associated with greater risk of C. burnetii seropositivity (P = ≤0.05). Heterogeneity in C. burnetii seropositivity was observed across the sublocations (P = 0.028). Evidence of C. burnetii exposure in small ruminants revealed poses a potential risk of exposure to the people living in close proximity to the animals. We recommended integrated animal–human surveillance and socio‐economic studies for C. burnetii, to aid our understanding of the risk of transmission between the animals and humans, and in the design of prevention and control strategies for the disease in the region.     

Effect of a commercial anion dietary supplement on acid-base balance, urine volume, and urinary ion excretion in male goats fed oat or grass hay diets

OBJECTIVE: To determine whether feeding a commercial anionic dietary supplement as a urinary acidifier to male goats may be useful for management of urolithiasis. ANIMALS: 8 adult sexually intact male Toggenburg, Saanen, and Nubian goats. PROCEDURE: Goats were randomly assigned by age-, breed-, and weight-matched pairs to an oat or grass hay diet that was fed for 12 days. On days 13 to 14 (early sample collection time before supplementation), measurements were made of blood and urine sodium, potassium, calcium, magnesium, chloride, phosphorus, and sulfur concentrations; blood and urine pH; urine production; and water consumption. During the next 28 days, the anionic dietary supplement was added to the oat and grass hay diets to achieve a dietary cation-anion difference of 0 mEq/100g of dry matter. Blood and urine samples were analyzed during dietary supplementation on days 12 to 13 (middle sample collection time) and 27 to 28 (late sample collection time). RESULTS: Blood bicarbonate, pH, and urine pH of goats fed grass hay and goats fed oat hay were significantly decreased during the middle and late sample collection times, compared with the early sample collection time. Water consumption and urine production in all goats increased significantly during the late sample collection time, compared with the early sample collection time. CONCLUSIONS AND CLINICAL RELEVANCE: The anionic dietary supplement used in our study increases urine volume, alters urine ion concentrations, and is an efficacious urinary acidifier in goats. Goats treated with prolonged anionic dietary supplementation should be monitored for secondary osteoporosis from chronic urinary calcium loss.     

Helminths of sheep and goats in desert areas of south-west Mauritania (Trarza)

Faecal samples were obtained from sheep and goats before, during and after the rainy season at three locations in south-west Mauritania. Several animals were also necropsied at the same time.Haemonchus contortus was the most prevalent worm. Infection by digestive-tract strongyles andStrongyloides papillosus was always very light (prevalence less than 20%). Sheep were more heavily infected than goats but animals under 1 year of age were not infected by digestive-tract strongyles. It is likely that young small ruminants became infected during the rainy season and that the parasites so acquired are inhibited in their development and/or survive nearly one year as adults.     

Within—country variation in the ability of ruminants to degrade DHP following the ingestion of Leucaena leucocephala—a Thailand experience

Goats fed Leucaena leucocephala (leucaena) at an experimental site in Thailand were shown to be excreting DHP in their urine. This was unexpected as earlier results from another site had shown that goats and cattle fed leucaena did not excrete DHP and so possessed DHP—degrading bacteria. Goats sampled near the earlier sample site excreted no DHP in their urine. Rumen fluid taken from these goats was successfully used to transfer DHP—degrading ability to the goats at the Experimental site some 350 km away that did not show the presence of DHP-degrading bacteria. Degradation of mimosine in-vitro and excretion of DHP in the urine ceased 72 hr after addition of rumen fluid and infusion with rumen fluid from protected goats, respectively. The situation in Thailand may not be unique. Countries where leucaena is fed should check that animals are protected. Fortunately, the ferric chloride urine test is simple to use and effective in detecting the problem and also the recovery after transfer of rumen fluid from protected animals.     

Transurethral resection in the management of urethral and prostatic neoplasia in 6 dogs

OBJECTIVE: To assess cystoscopic transurethral resection (TUR) for the palliative management of dogs with neoplastic infiltration of the urethra. STUDY DESIGN: Prospective clinical trial. ANIMALS: Six client-owned dogs. METHODS: Cystoscopic examination and electrosurgical TUR were performed in dogs with urination difficulties caused by prostatic or urethral neoplasia. TUR was performed in a retrograde manner in female dogs and antegrade in male dogs via exploratory celiotomy and ventral cystotomy. Cystoscopic examination was used to determine the extent of neoplastic involvement of the urethra. TUR involved piecemeal removal of neoplastic tissue from the urethral lumen using an electrocautery cutting loop. Hemorrhage was controlled with a cystoscopic cauterized roller-ball. In 2 male dogs, intraoperative radiation therapy (IORT) was used to treat both prostatic neoplasia and the sublumbar lymph node bed. Surgical technique, complications, adjuvant treatment, and outcome were recorded. RESULTS: TUR was performed in 3 male dogs with prostatic carcinoma and 2 female dogs with urethral transitional cell carcinoma (TCC). In 1 female dog, TUR was attempted but not successful because of cystoscope diameter. Iatrogenic urethral perforation occurred during TUR in 3 dogs. In 2 dogs, prolonged exposure to lavage fluid resulted in clinical and biochemical abnormalities consistent with TUR syndrome. Dysuria resolved in 5 dogs within 10 days of TUR. Treatment-related complications included urinary tract infection and tumor seeding. Local tumor progression and metastasis occurred in all dogs. CONCLUSIONS: TUR (in combination with chemotherapy+/-IORT) resulted in rapid palliation of urination difficulties in male dogs with prostatic carcinoma. In female dogs with urethral TCC, however, electrosurgical TUR cannot be recommended because of a high intra- and postoperative complication rate with no improvement in postoperative management compared with historical reports of tube cystostomy. CLINICAL RELEVANCE: TUR is a novel alternative for the palliation of male dogs with prostatic carcinoma. In female dogs with urethral TCC, electrosurgical TUR does not provide any advantages compared with tube cystostomy.     

Tube cystostomy in the dog and cat]

Prepubic tube cystostomy was performed in 10 dogs and one cat. Indications include urinary bypass following urethral trauma or surgery (six cases), following surgery for prostatic abscesses or cysts (four cases) and bladder atony secondary to urethral obstruction (one case). Tubes were left in situ for a minimum of seven days. All patients returned to normal micturition following tube removal. Urine leakage occurred for up to four days after tube removal by which time the stoma was granulating. Nosocomial infection was a consistent finding, but was controlled with antibiotic treatment following tube removal. Tube cystostomy was considered an effective means for diverting irritant urine from healing epithelium and thereby minimising the risk of urethral cicatrisation. It may also be indicated in the management of urinary retention as an alternative to repeated urethral catheterisation. This study indicates that tube cystostomy is readily performed, with few unexpected or serious complications.     

Concurrent vaccination of goats with foot and mouth disease (FMD) and peste des petits ruminants (PPR) booster vaccines

Foot and mouth disease (FMD) remains subclinical and self-limiting in small ruminants, but risk of spread of infection to susceptible cohorts is of great epidemiological significance; therefore, small ruminants must be included in vaccination campaigns in FMD endemic regions. Three groups of goats already immunized against peste des petits ruminants (PPR) were vaccinated with FMD and PPR vaccines alone or concurrently. The specific antibody response against three FMD virus strains and PPR virus were evaluated by competitive enzyme-linked immunosorbent assay (cELISA). Goats concurrently vaccinated with PPR + FMD vaccines had significantly (p < 0.05) higher antibody titers to two serotypes of FMD virus at 28, 45, and 60 days post-immunization compared to goats vaccinated with FMD vaccine alone, while goats vaccinated with PPR vaccines alone or PPR + FMD vaccines concurrently showed similar antibody kinetics against PPR virus up till 60 days post-vaccination. Overall, antibody kinetic curves for all three tested strains of FMD virus and PPR virus were similar in vaccinated groups during the course of experiment.