SURGICAL TECHNIQUE FOR THE MANAGEMENT OF OBSTRUCTIVE UROLITHIASIS IN A CATTLE CALF: A CASE REPORT
Dr Ajeet Kumar Singh
Veterinary Surgeon
Founder and director of Global Veterinary Clinic and Surgery Centre Gorakhpur
ABSTRACT:
In the present study a technique of tube cystostomy using Foley’s catheter in terms of tolerance by the animal and overall outcome of the patient suffering from obstructive urolithiasis is reported and discussed. Diagnosis of the disease was made on the basis of a history of anuria, inappetance , sunken eyes, engorged urethra, anal sphincter movement, to and fro movement of the penis, frequent attempt to urinate. Appearance of bladder was smooth and rupture. Foley’s catheter was blocked permanently when free flow of urine was observed through urethra. Post-operatively, the calf remained in good health. Foley’s catheter was removed by pulling after deflating its balloon on 12 days after the free flow of urine had established. The wound healed uneventful and small opening left after removal of Foley’s catheter was dressed antiseptically until healing. Tube cystostomy and oral administration of ammonium chloride along with anti-inflammatory drugs and antibiotics were resulted in speedy and uneventful recovery.
Keywords: Foley’s catheter, tube cystostomy, obstructive urolithiasis, cattle calf
Introduction:
Urolithiasis describes the concretion of urinary calculi or organic compound, which may lodge any-where in the urinary system but most frequently at the distal end of sigmoid flexure in ruminants, and causes subsequent urine flow obstruction (Radostitis et al., 2000; Kushwaha et al., 2011). Occurrence of urolithiasis is significantly more common in male ruminants compared to females due to their anatomical conformation of the urethral tract (Smith and Sherman, 1994). The Female have short, wide, and straight urethra while the male has long, narrow and tortuous urethra which makes them more prone to urethral obstruction, particularly distal aspect of the sigmoid flexure in bovines and urethral process in sheep and goats. Early castration of male animals might be the one of the reason because it causes hypoplasia of urethra and leading to reduction in bore size of urethra. The decreased urethral orifice is a major predisposing factor for obstructive urolithiasis (Smith and Sherman, 1994) . In addition, calculi formation usually results from a combination of nutritional, physiological, geographical, seasonal, age, sex and management factors (Pond et al., 2005). Obstructive urolithiasis in ruminants has been corrected with medical treatment but the result is unrewarding one. Treatment of obstructive urolithiasis is definitely surgical, once the obstruction is complete. Surgical tube cystotomy is the most commonly used treatment for long term management of obstructive urolithiasis in animals and may be the best option for breeding animals. It redirects the urine through a catheter placed from urinary bladder and exiting through the abdominal wall. The success rate of this technique has been reported to be 80% after 1 month of postoperative period (Fazili et al., 2012). The advantages of this technique are it is a simple procedure, highly field applicable, a relatively short duration of anaesthesia and attains a full urethral patency in short period of time. The present study described the clinical signs and surgical management of obstructive urolithiasis.
Materials and Methods:
Case History and Clinical Examination:
A four month old cattle calf was presented in Teaching Veterinary Clinical Complex, DUVASU, Mathura with the history of anuria, inappetance, sunken eyes, engorged urethra, anal sphincter movement, to and fro movement of the penis, frequent attempt to urinate at all for the last four days. Physical examination revealed there was marked pitting edema on ventral abdominal area and penis could not be extruded due to marked subcutaneous edema (Figure 1). On the basis of clinic-physical examinations the animal was diagnosed as suffering from obstructive urolithiasis. Keeping in view the fact of the complete blockage of the urinal passage may result in rupture of urethra or the bladder. Animal was stabilized preoperatively with fluid therapy and supportive therapy and it was decided to performed tube cystostomy using Foley’s catheter to correct the disorder.
SURGICAL TECHNIQUE:
Animal was anaesthetised with local anaesthetic 2% lignocaine at lumboscaral epidural and line infiltration at surgical site. Animal was placed in right lateral recumbency. Left side of the abdomen near the rudimentary teat area was cleanly shaved and scrubbed with antiseptic solution (Figure 2). After scrubbing, an incision was made nearly anterior to the rudimentary teat (Figure 3); bladder was located after separating subcutaneous tissue and muscles by blunt incision (Figure 4). The status of bladder was ruptured and soft appearance (Figure 5). Subcutaneous tunnel was made parallel to the prepuce by passing straight mosquito forceps through the subcutaneous tissue at the end skin was incised intended for catheter outlet (Figure 6 and 7). Folye’s catheter was passed from outside to abdominal cavity where the catheter tip was insert in to bladder through rupture site and cystorraphy was performed and its bulb was inflated with sterile normal saline for fixation (Figure 8). Muscles and subcutaneous tissue was sutured with No.0 vicryl in continuous suture pattern. Skin was sutured with horizontal mattress with nylon No. 0. The Foley’s catheter was fixed to the abdominal wall with simple interrupted sutures along the length of the tube (Figure 9). The post-operative care included daily dressing of the skin wound with 0.5% povidone iodine solution till healing. Antibiotic Entrofloxacin @ 5mg/kg b.wt, I/M for 6 days, analgesic, meloxicam @ 0.2 mg/ kg for 3 days and ammonium chloride @ 200 mg/Kg b.wt, b.i.d. daily, per Os for a period of one month. Foley’s catheter was removed by pulling after deflating its balloon 12 days after the free flow of urine had established. The wound healed uneventful and small opening left after removal of Foley’s catheter was dressed antiseptically until healing. Figure 7: Indwelling Foleys catheter was inserted into subserous ruptured bladder
RESULTS AND DISCUSSION:
The occurrence of urolithiasis most commonly encountered in winter season. Obstructive urolithiasis causes economic loss to the farmer due to loss of animals and cost of treatment. Mortality rate in cases of obstructive urolithiasis is very high which is mainly due to rupture of urethra or urinary bladder (Gasthuys et al., 1993). In the present study, the case was attended instantly without delay as the complete blockage of urinary passage may result in rupture of urethra or the bladder. The Foley’s tube cystostomy was performed in this as advocated by William and White (1991) in dog and cat. Foley’s catheter was much flexible and its inflated balloon or cuff covered the entire circumference of the catheter, which prevented leakage of urine. This is in agreement with the findings of Singh (2005). Foley’s catheter was well tolerated by the cattle calf. The surgical maneuvering of the bladder through para-median was found easier when the calf was kept in dorsolateral recumbency as reported by Ansari (2005). Difficulty in placing the catheter and suturing of bladder as observed in other approaches (Prasad et al., 1978) could be overcome since the bladder lies very superficially and can be approached conveniently. The abdominal wound healed without any complication in 12 days and calf urinated through the urethra without any difficulty. Additional combination therapy can be considered more fruitful in combating uraemic toxaemia primarily due to bladder rupture. Ammonium chloride was used for acidification of the urine to induce dissolution of the calculi. The efficacy of ammonium chloride in the management of urolithiasis has been described by others also Jones et al. (2009). No occurrence of urolithiasis or other condition leading to retention of the urine was observed. Author is of the opinion that postoperative oral administration of ammonium chloride might have helped to avoid recurrence. Similar observation has earlier been reported by Ansari (2005) in a cattle calf.
REFERENCES:
Ansari MM. 2005. Surgical management of obstructive urolithiasis in a calf. Veterinary World, 4: 73-75.
Fazili MR, Bhattacharyya HK, Buchoo BA, Malik HU, Dar SH. 2012. Management of obstructive urolithiasis in dairy calves with intact bladder and urethra by Fazili’s minimally invasive tube cystotomy technique, Veterinary Science Devlopment, 2: 50-53.
Gasthuys F, Steenhaut M, De Moor A, Sercu K. 1993. Surgical treatment of urethral obstruction due to grazed in pastures containing large quantities of urolithiasis in male cattle: a review of 85 cases. Veterinary Record, 133: 522-526.
Jones ML, Streeter RN, Goad CL. 2009. Use of dietary cation anion difference for control of urolithiasis risk factors in goats. American Journal of Veterinary Research, 70: 149-155.
Kushwaha RB, Gupta AK, Dwivedi DK, Sharma A. 2011. Obstructive urolithiasis in Small Ruminants and its surgical management. Intas Polivet, 12: 359–62.
Pond WG, Church DC, Pond KR, Schoknecht PA 2005. Sheep and Goats. In: Raphael C, Wolfman,Robichaud S eds, Basic Animal Nutrition and Feeding. Hoboken: John Wiley and Sons, Inc. p 439-461.
Prasad B, Sharma SN, Singh J, Kohli RN. 1978. Surgical repair and management of bladder rupture in bullocks. Indian VeterinaryJournal, 55: 905.
Radostitis OM, Blood DC, Gay CC, Hinchcliff KW. 2000. Veterinary Medicine: A Textbook of the Diseases of Cattle, Sheep, Pigs, Goats and Horses. Bailliere Tindall, London. p493-498.
Singh T. 2005. Studies on aetiopathogenesis and surgical management of urolithiasis in goats. Ph.D. Thesis, IVRI, Izatnagar, India.
Smith MC, Sherman DM. 1994. Urinary System. In: Cann CG ed, Goat Medicine. Philadelphia: Lea & Febiger, 398-402. p398-402.
William JM, White RAS. 1991. Tube cystostomy in dog and cat. Journal Small Animal Practice, 32: 598-602.
