Tube Cystostomy for Management of Obstructive Urolithiasis in Goats
Rashmi and Tamilmahan P.
- PhD scholar, Indian veterinary research institute, division of veterinary surgery and radiology, bareilly
- Assistant professor, Tamil Nadu veterinary and animal sciences university division of veterinary surgery and radiology
Introduction:
Urolithiasis is a term used for concretion of urinary caliculi which may lodge anywhere in urinary tract. It is disease of multifactorial origin. Factors like diet, age, sex, breed, genetics, season, soil, water, hormone levels, mineral, infection etc. play role in the genesis of urolithiasis. It is common in castrated sheep, goat & steers. Management of urolithiasis is a difficult proposition. The animals are often presented in different situations and duration of obstructive urolithiasis. Animals with prolonged obstruction are always considered as poor surgical risk patients due to the ensuing uremia. Common site of obstructions are reported in steers is sigmoid flexor and in rams it is vermiform appendage or sigmoid flexure. Urinary calculi are believed to be formed as a result of abnormally high concentration of insoluble complexes in the urine or mineralization of a nidus. The dietary cause of urinary calculi is feeding concentrate diets which are excessive in phosphorus and magnesium and/or have an imbalance of calcium and phosphorus. 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 castrated male animals have shown more incidences of obstruction that may be associated with might be the one of the reason because it causes hypoplasia of urethra and leading to reduction in diameter of urethra. The decreased urethral orifice is a major predisposing factor for obstructive urolithiasis (Smith and Sherman, 1994).
Signs:
The animals show variable clinica1 signs. The complaints reported by animal’s owner includes stranguria or anuria, frequent attempt of urination, partial anorexia, short periods of severe colic, tenesmus, muscle twitching and grating of teeth, sunken eyes, pale mucous, membrane and passage of dry mucous-coated faeces. Animals remain dull, depressed and reluctant to walk. On clinical examination they may show increased respiratory and heart rates. But the rectal temperature may either normal or slightly below the normal range. The clinical signs varied with the duration of illness. Bilateral ventral distension of abdomen may indicate ruptured bladder and confirmed with abdominocentesis. In case of ruptured urinary bladder, urine present in abdomen.
Surgical procedure:
Tube cystotomy:
Animals showing signs of severe dehydration and uraemia are stabilized preoperatively with proper fluid therapy. A Foley’s catheter is placed into bladder lumen via a laparotomy. This procedure is also an option for breeding males with urethral rupture, as it allows urine to bypass the urethral defects to facilitate urethral healing. Animals are anesthetized with lumbo-sacral epidural by using 2% lidocaine and are placed on lateral recumbency with left side upward. The paramedian site lateral to prepuce, is aseptically prepared. Skin, subcutaneous tissue and fascia are incised then the abdominal muscles are bluntly separated to reach the peritoneum (Figure-1). After invading peritoneal cavity urinary bladder was palpated. The status of bladder is examined whether it is intact or ruptured. If bladder is intact, subcutaneous tunnel is made parallel to the prepuce by passing straight artery forceps through the subcutaneous tissue at the end skin was incised intended for catheter outlet. A Foley’s catheter No.14 is passed thorough this subcutaneous tunnel and introduced in bladder lumen with the help of stellate (Figure-2 and 3). If bladder is found ruptured, catheter placement is done after cystorraphy and necessary debridement and irrigation to flush cystic caliculi. Then balloon of catheter is inflated with 8-10 ml of sterile normal saline for fixation, then patency of catheter is ensured. Laparotomy wound is sutured with chromic cat gut, skin with nylon and the end of catheter was secured on skin. Postoperatively owners are advised to give antibiotic Enrofloxacin @ 5mg/kg b.wt, I/M for 5 days, analgesic, meloxicam @ 0.2 mg/ kg for 3 days and ammonium chloride @ 200 mg/Kg b.wt, b.i.d. daily, orally for a period of one month. Antiseptic dressing with povidone iodine is also advised. Animals should be presented again to hospital for removal of catheter if normal urination is resumed through the urethra.
References:
Smith, M.C. and Sherman, D.M. (1994) Urinary System. In: Cann CG ed, Goat Medicine. Philadelphia: Lea & Febiger, 398-402. P 398-402.
