Laparoscopic-assisted cystotomy for urolith removal in geldings

OBJECTIVE: To describe a technique for laparoscopic-assisted removal of cystic calculi in geldings and report outcome. STUDY DESIGN: Clinical report. ANIMALS: Four geldings with cystic calculi. METHODS: Laparoscopic-assisted cystotomy and urolith retrieval was performed in 4 anesthetized geldings positioned in dorsal recumbency. With a laparoscope portal located at the umbilicus, the abdomen was insufflated and then the surgical table was tilted (30 degrees head-down position) before an instrumental portal was created parallel and 2-3 cm medial to the left external inguinal ring. Laparoscopic grasping forceps were inserted to grasp the cranial aspect of the bladder and elevate it to the ventral abdominal wall. With the instrumental portal as mid-point, the parainguinal skin incision was longitudinally extended cranial and caudal (approximately 8-10 cm) to accommodate the size of the urolith. The apex of the bladder was exteriorized and sharply incised, the urolith extracted, and after cystotomy closure, the bladder was repositioned. The mini-laparotomy and trocar incisions were closed in layers. RESULTS: There were no intra- or post-operative complications. All horses had minor incisional swelling for 3-4 days. No signs of abdominal or incisional pain were observed. Hematuria and slight stranguria occurred until the 3rd or 4th day. Surgical time (skin incision to skin closure) was 35-40 minutes. On long-term follow-up (up to 12 months) no recurrence of clinical signs associated with cystic calculi occurred. CONCLUSION: Uroliths (6-8 cm diameter) can be removed by laparoscopic-assisted cystotomy in geldings. CLINICAL RELEVANCE: Laparoscopic-assisted cystotomy combines the advantages of the parainguinal laparocystotomy with laparoscopic technique for removal of cystic calculi while avoiding their disadvantages.     

Parainguinal laparotomy as an alternative surgical approach for removal of an enterolith in the small colon of a horse

This report describes the use of a parainguinal approach to the abdomen to remove an obstruction in the small colon that could not be removed using an initial ventral midline approach. The use of a parainguinal approach should be considered for removal of an obstruction in the distal portion of the small colon.     

Modified parainguinal approach for cystic calculus removal in five equids

This report describes a modification of the parainguinal approach for removal of cystic calculi: a ventral midline laparotomy‐guided parainguinal laparocystotomy. The ventral midline approach to the abdomen is rapid and routinely used by equine surgeons. With an arm introduced to the abdomen via the ventral midline, the surgeon is able to select the ideal parainguinal laparotomy incision location that allows bladder exteriorisation with the minimum amount of tension. Because the surgeon's hand is introduced via the ventral midline incision, the parainguinal incision can be sized to just allow exteriorisation of the urinary bladder and urolith, increasing extra‐abdominal bladder security during cystotomy while reducing incision size in the parainguinal region. Finally, an assistant's hand via the ventral midline incision can maintain bladder stability within the parainguinal incision during cystotomy closure.     

The use of pneumatic impact lithotripsy and a retrieval pouch to create a closed system for removal of cystic calculi in standing male horses

Multiple techniques exist for removal of cystic calculi in the male horse, some of which use a perineal urethrotomy (PU) to facilitate access to the urinary bladder for removal of small uroliths in the standing, sedated horse. These techniques have limited efficacy in the removal of uroliths that have a diameter larger than the PU site, typically 4–5 cm. Pneumatic lithotripsy as reported in this article provides a novel way to fragment these larger uroliths while containing the fragments and protecting the urethra and urinary bladder. Ten geldings and one stallion underwent a lithotripsy procedure to remove one (n = 10) or several (n = 1) uroliths ranging in diameter from 4 to 9 cm. A PU was performed and a laparoscopic retrieval bag was inserted into the urinary bladder through the PU site. The urolith was manipulated into the bag using blind transrectal manipulation or endoscopic guidance and the opening of the bag was exteriorised out of the PU site. A pneumatic lithotrite was used to fragment the stone. When the urolith was adequately fragmented, the fragments were removed by the use of sponge forceps and by flushing the fragments from the bag with obstetrical lube. This was continued until the bag could smoothly be withdrawn from the urinary bladder. All uroliths were successfully removed. The PU sites healed without complication and none of the horses had recurrence of presenting clinical signs. This article also discusses the difference between two types of laparoscopic retrieval bags. Pneumatic impact lithotripsy in combination with a retrieval pouch offers a safe alternative to other methods for removal of cystic calculi in the horse.     

The use of porcine urinary bladder matrix (UBM) to repair a perforated corneal ulcer with iris prolapse in a horse

This report describes the use of porcine urinary bladder matrix (UBM) to repair a full thickness defect in the cornea of a Thoroughbred racehorse. The horse presented with acute keratomalacia of the right eye of 12 h duration that had rapidly progressed to perforation of the cornea with partial iris prolapse. The cornea was surgically debrided with the horse under general anaesthesia and the defect repaired with ACell multilayer wound matrix. A temporary tarsorrhaphy was performed. The defect in the cornea was successfully repaired and the horse regained vision in the eye. Four months after surgery the defect was still undergoing remodelling and the area of opacity in the cornea was progressively reducing.     

犬膀胱结石的化学成分分析研究

应用化学定性分析、X 射线衍射物相分析、扫描电镜观察与X 射线能谱分析等方法 ,对 3例取自临床病例的犬膀胱结石样品进行了化学成分分析。结果表明 ,3例结石的化学成分分别为磷酸钙、磷酸铵镁和混合性结石。对 3种结石晶体的生成机理进行了讨论 ,分析了犬膀胱结石的发病原因。     

Conservative management of cystorrhexis in four adult horses

Rupture of the urinary bladder is rare in adult horses with various standing or recumbent surgical repair techniques historically reported as the treatments of choice. This case series describes the successful conservative management of cystorrhexis in 4 adult horses. Conservative management is therefore a potentially viable treatment option which forgoes the risks of general anaesthesia and may reduce the post operative complications associated with surgery of the bladder.     

Megavesica in a neonatal foal

A newborn male foal was diagnosed with a greatly enlarged urinary bladder (megavesica), a urinary bladder diverticulum, and a herniated and abnormal umbilical remnant. Approximately 50% of the cranial bladder including the abnormal structures was surgically resected; the foal recovered and was still asymptomatic 15 months after surgery. The aetiology of megavesica in foals is unknown but successful outcome may be achieved with surgical intervention and adequate medical support.     

Standing laparoscopic repair of a ruptured urinary bladder in a mature draught horse

Rupture of the urinary bladder, although relatively common in foals, is an infrequent occurrence in adult stallions. Standing laparoscopic repair of a ruptured urinary bladder offers significant advantages over other treatment options, and to date, there are no reports describing this technique in treating adult stallions. This case study details the treatment of a mature draught horse for uroperitoneum secondary to a ruptured urinary bladder. Standing laparoscopic repair of the ruptured bladder was performed. No major post operative complications developed, and the horse has not had any recurrence of problems with the urinary bladder. Successful standing laparoscopic repair in this horse demonstrated the method's viability, which offers superior intraoperative visualisation and access to the bladder, while eliminating the risks of general anaesthesia.     

Haemangiosarcoma in two full sibling American Quarter Horse geldings

This case report describes two full sibling gelding American Quarter Horses that presented separately for evaluation of an external mass (Case 1) and signs of colic and epistaxis (Case 2). The horses had the same owner and resided on the same property for the majority of their lives. Both horses were definitively or presumptively diagnosed antemortem with haemangiosarcoma, and on necropsy, multicentric (Case 1) and primary renal (Case 2) haemangiosarcoma were confirmed. A unique finding on necropsy was extensive bilateral renal involvement. Due to the low incidence of haemangiosarcoma in horses, the unique organ involvement and common ancestry of these two horses, a genetic cause is suspected.     

Transitional cell carcinoma of the urinary bladder in a 12‐year‐old Belgian Warmblood gelding

A 12‐year‐old Belgian Warmblood gelding was examined for haematuria and dysuria of 24 h duration. Cystoscopy revealed an intraluminal multinodular soft tissue mass originating from the dorsal bladder neck. Histopathological examination of biopsies identified transitional cell carcinoma. The bladder mass was surgically debulked via a temporary perineal urethrotomy. The horse commenced treatment with oral piroxicam. Follow‐up examination 18 months post operatively revealed no evidence of tumour recurrence. Neoplasia of the equine bladder is uncommon and this case describes the successful short‐term outcome of treatment of a transitional cell carcinoma by surgical debulking and oral piroxicam.     

Inguinal rupture with herniation of the urinary bladder through the scrotal fascia in a Shetland pony foal

Herniation of the urinary bladder in the inguinal region has not previously been described in the horse. A case of inguinal rupture with herniation of the bladder through the scrotal fascia in a 3‐month‐old Shetland pony, diagnosed by external palpation, urinary catheterisation and external ultrasonographic examination is reported. Surgical management of the case was by dissection of the scrotal fascia, partial cystectomy and unilateral castration. During the period of hospitalisation the only complication was a slight seroma, which resolved spontaneously. Follow‐up after 6 months did not reveal any abnormality.     

In vitro prediction of canine urolith mineral composition using computed tomographic mean beam attenuation measurements

Determination of urolith mineral composition is critical for management of urolithiasis in dogs and cats. Using computed tomography, urolith physical density, and hence chemical composition, can be quantified using mean beam attenuation measurements (Hounsfield units; HU). This study was designed to establish in vitro reference ranges for three types of compositionally pure uroliths retrieved from dogs. Sixty-six canine uroliths (22 uric acid, 21 calcium oxalate, 14 struvite, nine mixed or compound) were placed in a phantom array. Uroliths were scanned at 120 kVp, 200 mA, and 80 kVp, 200 mA. The region of interest (ROI) for mean HU calculation was determined using two techniques, and reference ranges were calculated for each kVp using either ROI technique. HU for urolith types of pure composition were statistically different (Wilcoxon's two-sample test, P < 0.0083 [Bonferonni correction with six comparisons for total P < 0.05]) using both ROI techniques at either kVp. Struvite uroliths were not statistically different from mixed or compound uroliths. The accuracy for determination of composition of pure uroliths ranged from 86% to 93%; the prediction accuracy for each urolith mineral type and for all uroliths in general was highest when the ROI was hand-drawn just within the visible urolith border at 80 kVp. Technique of ROI determination and kVp that yielded the highest sensitivity, specificity, and positive and negative predictive values varied for each urolith type. Therefore, in this study, HU could be used to differentiate three types of uroliths of pure mineral composition in vitro. Further studies are needed to determine the predictive value of HU in vivo.     

Idiopathic renal haematuria in an Egyptian Arabian stallion

A 17-year-old Egyptian Arabian stallion was presented for haematuria and blood clots in the urine of 4 days’ duration. During micturition, haematuria was noted mid-stream with passage of blood clots occurring at the end of urination. Physical examination findings were unremarkable aside from pale mucous membranes. Cystoscopic examination revealed intermittent passage of frank blood (with clots) from the left ureteral orifice compared to grossly normal-appearing urine issuing from the right ureteral orifice. Transcutaneous ultrasonographic evaluation of the right kidney yielded normal findings while the left kidney exhibited pyelectasia, a decreased cortico-medullary ratio, and markedly increased echogenicity of the renal pelvis. Diagnosis of idiopathic renal haematuria was confirmed at necropsy.     

Urinary bladder rupture secondary to penile and preputial squamous cell carcinoma in a gelding

Squamous cell carcinoma (SCC) is the most common external genital neoplasm. Early detection, diagnosis and treatment are paramount to successful outcome; overlooked or misdiagnosed SCC can rapidly invade tissues and metastasise, producing potentially fatal complications. This report describes a case of overlooked SCC that resulted in severe penile infiltration, urethral stricture, and subsequent urinary bladder rupture and peritonitis.     

Hereditary xanthinuria in a goat

A 2‐year‐old mixed breed goat was presented for a 1‐day history of anorexia and 1 week of weight loss. Serum biochemistry disclosed severe azotemia. Abdominal ultrasound examination showed decreased renal corticomedullary distinction, poor visualization of the renal pelves, and dilated ureters. On necropsy, the kidneys were small, the pelves were dilated, and the medulla was partially effaced by variably sized yellow nephroliths. Histologically, cortical and medullary tubules were distended by yellow‐brown, multilayered crystals. Stone composition was 100% xanthine. Exonic sequencing of xanthine dehydrogenase (XDH) and molybdenum cofactor sulfurase (MOCOS) identified 2 putative pathogenic variants: a heterozygous XDH p.Leu128Pro variant and a homozygous MOCOS p.Asp303Gly variant. Variant frequencies were determined in 7 herd mates, 12 goats undergoing necropsy, and 443 goats from genome databases. The XDH variant was not present in any of these 462 goats. The MOCOS variant allele frequency was 0.03 overall, with 3 homozygotes detected. Hereditary xanthinuria is a recessive disorder in other species, but the XDH variant could be causal if the case goat is a compound heterozygote harboring a second variant in a regulatory region not analyzed or if the combination of the XDH and MOCOS variants together abolish XDH activity. Alternatively, the MOCOS variant alone could be causal despite the presence of other homozygotes, because hereditary xanthinuria in humans often is asymptomatic. Ours is the first report describing the clinical presentation and pathology associated with xanthine urolithiasis in a goat. The data support hereditary xanthinuria, but functional studies are needed to conclusively determine the causal variant(s).     

Removal of cystic calculi using a transinguinal laparoscopic‐assisted technique in two stallions

A 12‐year‐old donkey and a 6‐year‐old Connemara pony, both sexually intact males, were admitted for surgical removal of urinary calculi. Both underwent a laparoscopic‐assisted cystotomy technique to exteriorise the bladder and remove uroliths via the inguinal canal after hemi‐castration. Both surgeries were successful and no complications occurred. This modified technique, which is minimally invasive, may be a safe and efficient way to remove bladder stones from adult stallions.