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Surgical Management of Obstructive Urolithiasis by Tube Cystotomy A Clinical Study of 5 Bovine calves.

Introduction

Obstructive urolithiasis is a fatal condition resulting due to combination of nutritional, physiological, geographical and managemental factors (Makhdoomi and Gazi, 2013). Obstructive urolithiasis in ruminants is most commonly due to urethral calculi rather than cystic calculi. Obstruction of urethra may be either partial or complete resulting in abnormal distension of urinary bladder. Upon distension, bladder or urethra may rupture leading to flow of urine into peritoneal cavity and subcutaneous infiltration, respectively (Hay, 1990). According to Tiruneh (2000), the descending order of incidence of urolithiasis in species is caprine (49.83%), cattle (32.87%), canine (14.53%), equine (1.38%), ovine (1.04%) and feline (0.34%). He also stated that among bovines, buffalo calves (81.25%) were highly affected as compared to cow calves (9.82%) and bullocks (8.92%). Tube cystotomy procedure along with urinary alkalinizer Ammonium chloride was proven highly effective in obstructive urolithiasis condition of ruminants (Tamilmahan et al., 2014). The present article puts forth the sequelae of urolithiasis conditions and their successful management by tube cystotomy.

History and Diagnosis

Case 1, 2 and 3

Three buffalo calves of age 22 days, 50 days and 90 days were presented with history of anorexia, bloat, distended abdomen, restlessness with frequent kicking at abdomen and stranguria. Transabdominal ultrasonographic examination revealed abnormally distended intact urinary bladder with sediment (Fig.1 and 2).

Case 4

Seven months old white calf was presented with history of bloat, restlessness, passing scanty faeces and drop by drop urine along with absence of intake of feed and water for three days, which suddenly disappeared. Clinically water belly abdomen with fluid thrill was observed and bladder was not palpated on per-rectal examination. Transrectal ultrasonographic examination revealed floating of intestines along with ruptured bladder (Fig. 3).

Case 5

Two months old buffalo calf was presented with history of severe abdominal colic, anuria and swelling along the preputial and parapreputial area. Clinically pain and pitting were observed in affected area and aspiration revealed urine. Trans abdominal ultrasonographic examination revealed pockets of anechoic area in subcutaneous tissue confirming it as subcutaneous infiltration of urine in urethral rupture condition (Fig. 4).

Treatment

As obstructive urolithiasis is an emergency condition it was decided to perform tube cystotomy procedure immediately in all the five animals. Animals were casted in right lateral recumbency and left side of abdomen near rudimentary teats was prepared for aseptic surgery. General anaesthesia was achieved with Diazepam @ 1mg/kg b.wt. I/V and Ketamine @ 10mg/kg b. wt. I/V. Local anaesthesia was achieved by local infiltration of Lignocaine hydrochloride 2% solution. Bladder was approached by paramedian incision after separating subcutaneous tissue and rectus abdominus muscle. In case no. 4 with cystorrhexis, bladder was highly congested with tear of around 5cm over the neck on the dorsal aspect. We were able to suture only a part of the tear with chromic catgut no.1 in lembert suture pattern due to difficulty in exposing the entire tear (Fig. 5). Then, in all animals a subcutaneous tunnel was made through artery forceps and skin was incised at the tip of artery forceps through which Folyes catheter no.14 was dragged and directly stabbed into bladder. Later bulb was inflated with 40ml of sterile normal saline solution (Fig. 6). Muscles were sutured with chromic catgut no.1 in continuous lock stitch manner and skin with black braided silk No.1 in horizontal mattress pattern. Catheter was secured to skin with interrupted suture (Fig. 7). Post-operatively it was advised to use Ceftriaxone ([Intacef.sup.a]) @ 10mg/kg b. wt. I/V, Meloxicam ([Melonex.sup.a]) @ 0.3mg/kg b. wt. S/C for 7 days and Ammonium chloride @ 200mg/kg b. wt. b.i.d daily for one month in all animals. After 7 days, owners were advised to plug the catheter for two hours initially to check for normal stream of urine through urethra and then gradually increase the duration. Skin sutures were removed on 10th post-operative day. Catheters were removed only after observing uninterrupted urine flow through urethra without discomfort after plugging the catheter for 48 hours. All animals recovered uneventfully without any complications.

Discussion

Obstructive urolithiasis condition is most commonly seen in male ruminants due to long tortuous narrow urethra with sigmoid flexure rather than females with short wide straight urethra (Tamilmahan et al., 2014). In ruminants, calves below 6 months are more prone to obstructive urolithiasis due to high protein diet (Lipsmita, 2011). In the present study also, average age of calves is 2.86 months. Calculi formed of silica, magnesium ammonium phosphate, calcium carbonate and calcium oxalate are the most common types found in ruminants (Makhdoomi and Gazi, 2013). Earlier signs of obstructive urolithiasis were bloat and distended abdomen with anorexia which might be misinterpreted for acute gastrointestinal disorder as seen in first three calves. In such cases bloat might be due to activation of sympathetic nervous system due to painful abdominal process (Van Metre, 2004). In advanced cases it may lead to either rupture of bladder or urethra giving temporary relief as seen in case 4 and case 5 respectively (Makhdoomi and Gazi, 2013). Transabdominal and transrectal ultrasonography provided the best means to confirm obstructive urolithiasis condition and it was observed that it is mostly due to multiple calculi rather than single large calculus. Xylazine was not used as pre-anesthetic agent due to its diuretic effect which may further worsen bladder distension. Tube cystotomy procedure is just to provide urinary diversion and hence inorder to treat the root cause,

Ammonium chloride, a urinary acidifier must be used post-operatively, without which the surgery will be in vain. Complications associated with tube cystotomy procedure are urine leakage, wound infection or dehiscence, irritation, obstruction or accidental dislodgment (Makhdoomi and Gazi, 2013). Complications like blockage of holes of catheter was seen in Case 4, which was treated by flushing it with normal saline solution and even without suturing the entire defect of bladder, animal survived due to location of defect on dorsal aspect rather than on ventral aspect as reported by Van Metre (2004). Important preventive measures include gradual increasing the salt levels to 3.5% of diet in order to stimulate water consumption and increase urine volume and Ammonium chloride to a level of 1-2% of dry matter in the diet (Lipsmita, 2011) along with providing plenty of soft water. The use of Ammonium chloride should be in caution due to its potential effect of reducing bone mineral content (Van Metre, 2004).

References

Hay, L. (1990). Prevention and treatment of urolithiasis in sheep. J. Vet Post Graduate Clinical Studies 12: 87-91.

Lipismita, S., Ashok Kumar, P., Chinmoy, M., Biswa, R.M., Laxmi Narayan, S. and Rubina, K.B. (2011). Nutritional strategies to prevent urolithiasis in animals. Vet. World 4: 142-44.

Makhdoomi, D.M. and Gazi, M.A. (2013). Obstructive urolithiasis in ruminants - A review. Vet. World 6 : 233-38.

Tamilmahan, P., Mohsina, A., Karthik, K., Gopi, M., Gugjoo, M.B., Rashmi and Zama, M.M.S. (2014). Tube cystostomy for management of obstructive urolithiasis in ruminants. Vet. World 7: 234-39.

Tiruneh, R. (2000). A retrospective study on ruminant urethral obstruction in Debre Zeit area, Ethiopia. Revue. Med. Vet. 151: 855-60.

Van Metre, D.C., (2004b). Urolithiasis in small ruminants: Surgical and dietary management. Cornell Urolith Surg. J.: 1-11.

N. Sumiran (1), G. Kamalakar, J. Devarathnam, L. Siva Sudarshan and K. Rambabu

Department of Veterinary Surgery and Radiology College of Veterinary Science Sri Venkateswara Veterinary University (SVVU) Proddatur Y.S.R. Kadapa - 516360 (Andhra Pradesh)

(1.) Assistant Professor and Corresponding author.

E-mail: drnsumiran@gmail.com

(a) - Brand of Intas Animal Health, Ahmedabad
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Article Details
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Title Annotation:Clinical Article
Author:Sumiran, N.; Kamalakar, G.; Devarathnam, J.; Sudarshan, L. Siva; Rambabu, K.
Publication:Intas Polivet
Article Type:Clinical report
Date:Jul 1, 2017
Words:1263
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