Nov 1, 2011 - of Veterinary Medicine , University of Utrecht , The. Netherlands .... American Veterinary Medical Association 1965; 147: 1329-30. 2. Kimberling ...
This article was downloaded by: [UOV University of Oviedo] On: 06 November 2014, At: 23:10 Publisher: Taylor & Francis Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Veterinary Quarterly Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/tveq20
Urolithiasis in small ruminants P. René van Weeren Voorhout
a b
a
, Wim R. Klein & George
a
a
Department of General and Large Animal Surgery and the Department of Veterinary Radiology, Faculty of Veterinary Medicine , University of Utrecht , The Netherlands b
Vakgroep Algemene Heelkundeen Heelkunde der Grote Huisdieren , Faculteit der Diergeneeskunde, Rijks Universiteit Utrecht , Postbus 80.153, Utrecht, 3508 TD Published online: 01 Nov 2011.
To cite this article: P. René van Weeren , Wim R. Klein & George Voorhout (1987) Urolithiasis in small ruminants, Veterinary Quarterly, 9:1, 76-79, DOI: 10.1080/01652176.1987.9694078 To link to this article: http://dx.doi.org/10.1080/01652176.1987.9694078
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sublicensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
CLINICAL PAPERS
Urolithiasis in small ruminants I. A retrospective evaluation of urethrostomy
Downloaded by [UOV University of Oviedo] at 23:10 06 November 2014
P. René van Weeren, Wim R. Klein, and George Voorhout' SUMMARY A retrospective study on the results ofurethrostomy in 28 small ruminants was made. Ten animals were euthanised during surgery. In the 18 remaining animals short-term results were good. Recurrence of symptoms occurred in 8 animals (45%). Five animals were operated a second time, leading to 4 recurrences. Two animals were operated a third time and remained free of symptoms. INTRODUCTION
Urolithiasis is common in many species of ruminants (5). Most studies of this disease have focused on aetiological factors. In small ruminants phosphate-containing stones are frequently encountered and it is generally agreed that food containing excessive amounts of phosphorus, especially in combination with low calciumlevels, is the most important aetiological factor (3, 5). Diagnosis is usually based on history and physical examination while laboratory tests (especially serum urea level) and radiology (survey abdominal radiographs) may be helpful in some cases. Treatment at various stages of the disease in cattle has been described (1, 4, 6, 7, 8). In small ruminants urethrostomy is suggested when conservative treatment (amputation of the urethral process, withholding food in conjunction with administration of ammonium chloride, administration of smooth muscle antispasmodics or tranquilisers (2, 6)) has failed (2). Following urethrostomy the animal can no longer be used for breeding (2, 6). To our knowledge there are no reports on the long-term results of surgery. This
paper reports on a retrospective study of the short- and long-term results of urethrostomy in sheep and goats. MATERIALS AND METHODS I. Animals
The retrospective study was made on 28 animals referred to the Large Animal Surgery Clinic,
University of Utrecht, during the period 1973-1982. This group represented the small
ruminants in which conservative treatment had failed and in which the owner desired further treatment. Table 1 shows the animals, classified according to species, age and sex.
2. Diagnosis Diagnosis was based on history, physical, laboratory and radiographic examination. Stranguria was the most frequent symptom. In 13 cases, serum urea levels were determined before treatment and ranged from 11.7 to 47.5 mmo1/1 (median 33.3 mmo1/1, reference values < 7 mmo1/1). From the Department of General and Large Animal Surgery and the Department of Veterinary Radiology, Faculty of Veterinary Medicine, University of Utrecht, The Netherlands. Send correspondence to: P. R. van Weeren, Vakgroep Algemene Heelkundeen Heelkunde der Grote Huisdieren, Faculteit der Diergeneeskunde, Rijks Universiteit Utrecht, Postbus 80.153, 3508 TD Utrecht. Acknowledgements: The authors would like to thank Prof. Dr. A. W. Kersjes, DVM, PhD for his critical reading of the manuscript.
76
THE VETERINARY QUARTERLY, VOL.
9, No. I, JANUARY 1987
Table I.
Small ruminants presented for urethrostomy.
Species
N
6
Goats Rams Total
18 10
8 10 18
28
?!
10
0 10
< 1 yr
> 1 yr
5 7 12
11 1
12
unknown 2 2
4
6 = intact
4 = castrated
Downloaded by [UOV University of Oviedo] at 23:10 06 November 2014
Survey abdominal radiographs were made in 9 out of 28 patients. These radiographs were examined for the presence of uroliths in the bladder and/or urethra. In two animals uroliths were visualised: in the bladder and urethra (just proximal to the sigmoid flexure) in one animal, and in the bladder in the other. In 7 animals no uroliths were visible.
3. Surgery Urethrostomy was performed with cranial epidural anaesthesia (lidocaine hydrochloride 2% cum adrenaline, 1 m1/10 kg body weight). The patients were positioned in ventral recumbency. After routine preparation and draping, a midline skin incision (approximately 5 cm long) was made in the perineal region at the site of the ischial arch. After deeper dissection (exactly in the midline) between the retractor muscles, the bulbospongiosus muscles were incised. The urethra was elevated and a longitudinal incision of about 2.5 cm was made. With a flexible catheter the patency of the urethra in both ascending and descending directions was tested. Any obstructions encountered were flushed out with sterile saline. If flushing towards the bladder was impossible, the animal was
euthanised. When flushing towards the external urethral orifice proved impossible, the obstruction was left in place. A flexible catheter' was inserted into the bladder. In 14 cases the
urethral mucosa was sutured to the perineal skin using simple interrupted sutures. In the remaining 4 this was not done. The catheter was sutured to the skin in all cases. The catheter was left in place for about 10 days. Antibiotics (usually a combination of penicillin and streptomycin) were administered intramuscularly for 5 to 10 days. The animals were discharged a few days after removal of the catheter if micturition presented no problems
at that time. RESULTS
The results of a follow-up study (contact with the owners) have been summarised in table 2. DISCUSSION
From the present results it may be concluded that some basic requirements must be
met before starting surgery. If the general condition of the animal is too bad, euthanasia may be the only reasonable course. Secondly, short-term results may be regarded as favourable. Of 18 animals in which surgery was performed, all 18 left the Clinic in a reasonable condition, micturition presenting no problems at the time of discharge. The long-term prognosis seems to be unfavourable. Of the 18 animals that left the Clinic as 'cured', only three had good long-term results (?.- 1 year) after first surgery. Two animals showed good long-term results but only after the third operation. These results agree with Oehme (6), who mentions favourable results but adds that 'animals should not be kept more than 3 to 4 months following corrective surgery'. As nearly all goats and half the sheep presented to the Clinic were kept as pets, the aim of the operation was life-time' success and not a palliative temporary solution. The unfavourable long-term results are caused by the high percentage of recurrences. '
Misch Ernahrungssonde Ch. 10, Willy Misch GmbH & Co KG, D 7033 Kerm, Western Germany.
THE VETERINARY QUARTERLY, VOL. 9, No, I. JANUARY 1987
77
Table
2.
Results of 28 cases of urethrostomy.
Number of patients operated
28
Died/euthanatized during or shortly after surgery
10
Discharged
18
Further fate unknown
1
Two months later in good health; further information not available
Downloaded by [UOV University of Oviedo] at 23:10 06 November 2014
18
No further complaints (till death or sale for other reasons, 3, 6, 24 and 30 months after discharge)
4
4
Died suddenly of unknown cause, 3 weeks after discharge
1
Recurrence (1-8 months postoperatively)
8
8
Died/slaughtered after recurrence
3
Second operation
5
Died suddenly of unknown cause 7 weeks after second discharge
1
Death associated with urolithiasis
1
Second recurrence (4-7.5 months after second operation) Died/slaughtered after second recurrence
5
3
3
1
'
Third operation
2
No further complaints, still in good health 30 and 72 months post-operatively
-
2
2
At discharge of the animals the owners were advised to feed no more concentrates. However, it is not known if all owners kept strictly to the advised diet of grass and hay only. So post-operative dietary factors may have been important in some cases of recurrence. The diagnosis of urolithiasis in small ruminants is still troublesome. With the help of physical and laboratory findings it is not always possible to differentiate between uroliths and cystitis as the main cause of stranguria. Uroliths were visible on survey radiographs in only a small minority of the patients. Apparently in many cases the
difference between radiopacity of uroliths and soft tissues is not sufficient for visualisation. As a consequence many false negative survey radiographs are to be expected. There is a need for improvement of the radiographic visualisation of the
bladder and lower urinary tract in small ruminants. This will be the basis for improving treatment, whereby not only surgery but also preventive measures
should be included in the approach. 78
THE VETERINARY QUARTEFt1
VOI 9, No. I, JANUARY 1987
REFERENCES 1.
Hastings DH. Retention catheters for treatment of steers with ruptured bladder. Journal of the
American Veterinary Medical Association 1965; 147: 1329-30. Kimberling CV, Arnold KS. Disease's of the urinary system of sheep and goats. Veterinary Clinics of North America: Large Animal Practice 1983; 5 (3): 637-40. 3. McIntosh GH. Urolithiasis in animals. Australian Veterinary Journal 1978; 54: 267-71. 2.
4.
Metcalf FL. Removal of calculi from the bovine urethra. Journal of the American Veterinary
5.
Medical Association 1965; 147: 1327-8. Nicks B, Bienfait JM. L'urolithiase chez les bovins et ovins. Annales de Medicine Veterinaire 1978; 122: 397-407.
Oehme FW, Tillmann H. Diagnosis and treatment of ruminant urolithiasis. Journal of the American Veterinary Medical Association 1965; 147: 1331-9. 7. Prasad B, Sharma SN, Singh J, Kohli RN. Surgical repair and management of bladder rupture in bullocks. Indian Veterinary Journal 1978; 55: 905-11. 8. Samanta PK, Khan AA. An experimental study on suprapubic cystotomy in the treatment of urolithiasis in bovine. Indian Journal of Animal Health 1976; June: 41-4.
Downloaded by [UOV University of Oviedo] at 23:10 06 November 2014
6.
Urolithiasis in small ruminants Cysto-urethrography as a new aid in diagnosis
P. René van Weeren, Wim R. Klein, and George Voorhout' SUMMARY A technique for catheterising 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 studiesof bladder and urethra in animals suspected of urolithiasis. Differentiation between cystitis and obstructive urolithiasis is possible and the indications for urethrostomy can be reduced. INTRODUCTION
Contrast radiography is a widely used technique in the diagnosis of urinary tract diseases in companion animals. In these animals the technique is of great diagnostic value and often has great influence on the choice of therapy (2). In small ruminants catheterisation of the bladder has been described to be impossible due to the presence of the urethral divcrticulum (1, 4, 5). Excretory urography may adequately demonstrate the urinary tract when pneumoperitoneum is created (3). However, this procedure provides information on the kidney and ureters, but inadequate information on the urethra or bladder. In this paper a technique for catheterisation of the bladder in small ruminants is presented. This technique enables use of contrast and double contrast techniques in small ruminants, thus refining the diagnostic possibilities in diseases of the lower urinary tract. '
From the Department of General and Large Animal Surgery and the Department of Veterinary Radiology, Faculty of Veterinary Medicine, University of Utrecht, The Netherlands. Send correspondence to: P. R. van Weeren, Vakgroep Algemene Heelkunde en Heelkunde der Grote Huisdieren, Faculteit der Diergeneeskunde, Rijks Universiteit Utrecht, Postbus 80.153, 3508 TD Utrecht. Acknowledgements: The authors would like to thank Prof. Dr. A. W. Kersjes, DVM, PhD for his critical reading of the manuscript.
THE VETERINARY QUARTERLY, VOL. 9, No. I, JANUARY 1987
79
