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Surgical Management of Urolithiasis in Buffalo calves via Tube Cystotomy.

Introduction

Urolithiasis is lodging of concretion of urinary calculi or organic compounds anywhere in urinary system but most frequently at the distal end of sigmoid flexure in ruminants leading to subsequent obstruction of urine flow (Kushwaha et al., 2011). The surgical techniques used include penile transaction with urethral fistulation (Hussain and Moulvi, 1986), pelvic urethrostomy (Ravi Kumar and Shridhar, 2003), percutaneous tube cystotomy (Streeter et al., 2002) and bladder marsupialization (May et al., 1998). This paper communicates successful management of urolithiasis by tube cystotomy in buffalo calves.

History and Observations

Three calves of different ages were presented with history of anorexia, dullness and bilateral ventral abdominal distension (Table 1).

Treatment

All animals were resuscitated by administering two liters of Ringers lactate intravenously. The ventral abdomen was prepared for aseptic surgery in all animals. Local analgesia was achieved by linear infiltration by administering 2% Lignocaine hydrochloride to the effect at the site. A linear incision was made infront of rudimentary teats on left side of ventral abdomen. Urinary bladder was exteriorized after careful blunt dissection of subcutaneous tissue and aponeurosis of abdominal muscles. In all animals, the urinary bladder found ruptured and vent in urinary bladder was identified after injecting normal saline into bladder. Cystorrhaphy was carried using chromic catgut no. 3-0. In case 2, calculi observed in bladder were flushed out by irrigation with normal saline (Fig. 1 and 2). Folleys catheter (18F) was inserted into the bladder after making a subcutaneous tunnel for passage of catheter and bulb was inflated by injecting 25 ml of |Normal saline (Fig. 3). Abdominal wound was closed in standard manner after thorough lavage with normal saline. Following closure of celiotomy wound, residual catheter was secured to abdominal wall with Chinese finger trap method (Fig. 4). In case no.3, rectal prolapse was treated by repositioning the rectum and retension with purse string sutures.

Post-operatively, calves was administered with Dicrysticine (a) -1g and Meloxicam (Melonex (b))@0.2mg/kg b. wt. for 5 days besides daily dressing of wound with Povidone iodine. Ammonium chloride 200mg/kg b. wt. and two Cystone (c) tablets BID, per os and catheter was allowed to drain freely until normal urination resumed. Mean while, the draining tube of the catheter was clamped for every three days to determine the patency of urethra. Skin sutures were removed on 10th post-operative day in all animals. All animals recovered uneventfully without any complications. Normal urination resumed within 20, 16, 18 days in case 1, 2, 3 respectively. Catheter was removed after attaining normal urination by deflating the bulb.

Discussion

The incidence of urolithiasis is high in males compared to females because of anatomical difference i.e. having long and narrow urethra in males (Thilagar et al., 1996). Urolithiasis may occur due to imbalance of mineral intake in feed (Unmack, 1963). Urinary acidifiers like Ammonium chloride and calculolytic agents like [Cystone.sup.c] reduce the pH of urine and promote dissolution of calculi respectively and folleys catheter bypasses the urine from urethra as used in the present surgical procedure. Tube cystotomy provides an alternative surgical treatment to urethrotomy techniques used to manage urinary obstructions in ruminants and long term outcome of urethrotomy techniques is reported to be poor (Vanweeren et al, 1987). Hence, tube cystotomy is felt as the most promising technique for obstructive urolithiasis, which is relatively simple, requiring short duration of anesthesia and resulting in restoration of urethral patency within a short period as mentioned by Ewoldt et al, 2008.

References

Ewoldt, J.M., Jones, M.L. and Miesner, M.D. (2008). Surgery of obstructive urolithiasis in ruminants. Vet. Clin. North Amer. Food Anim. Pract. 24: 455-65.

Kushawaha, R.B., Gupta, A.K., Dwivedi, D.K. and Sharma, A. (2011). Obstructive urolithiasis in small ruminants and its surgical management. Intas Polivet 12: 359-62.

Hussain, S.S. and Molvi, B. A. (1986). Treatment of ruptured urinary bladder in a male calf: a case report. Indian Vet. J. 63: 948-51.

May, K., Moll, A.H.D., Wallace, L.M., Pleasant, R.S. and Howard, R.D. (1998). Urinary bladder marsupilization for treatment of obstructive urolithiasis in male goats. Vet. Surg. 27: 583-88.

Ravi Kumar, S.B. and Shridhar, W.B. (2003). Pelvic urethrotomy through infra anal approach in a bullock- a case report. Indian Vet. J. 80: 59-60.

Streeter, R.N., Washburn, K.E. and Mccauley, C.T. (2002). Percutaneous tube cystotomy and vesicular irrigation for treatment of obstructive urolithiasis in a goat. J Am Vet Med Assoc 221: 546-49.

Thilagar, S., Balasubramanian, N.N. and Archibald, D. (1996). A retrospective study of urinary obstruction in dog-A radioscopic study. Indian Vet. J. 73: 1183-84.

Unmack, A. (1963). Constituents of calculi from the urinay tract of bulls and bullocks. Evidence of silica urolithiasis in cattle in Denmark. Kongelige Veterinaer-og Landbohoiskles Aarsskrift, p. 1-12.

Vanweeren, P.R., Klein, W.R. and Voorhout, G. (1987). Urolithiasis in small ruminants. A retrospective evaluation of urethrostomy. Vet Quarterly. p. 76-79.

R. Mahesh (1), G. Kamalakar, N. Sumiran, V. Devi Prasad and K. Rambabu

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

(1.) Assistant Professor and Corresponding author.

E-mail: mahivet04@gmail.com

(a) - Brand of Zydus Animal Health, Ahmedabad

(b) - Brand of Intas Animal Health, Ahmedabad

(c) - Brand of Himalaya Drugs Company, Bengaluru
Case   Age of     Period of   Clinical features
no.    animal     illness
       (months)   (days)

1.     4          3           Anorexia, anuria,
                              arched back during
                              urination and skin
                              fold test-5 sec
2.     2          2           Inappetence,
                              dribbling of urine and
                              skin fold test-4 sec
3.     5          3           Anorexia, rectal
                              prolapse and skin
                              fold test-6 sec
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Title Annotation:Clinical Article
Author:Mahesh, R.; Kamalakar, G.; Sumiran, N.; Devi Prasad, V.; Rambabu, K.
Publication:Intas Polivet
Article Type:Clinical report
Date:Jul 1, 2017
Words:936
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