Surgical disorders of the urinary tract + umbilicus

Question 1

What could you do to examine the urinary tract?

Answer 1

• Take history
• Clinical exam - rectal
• Clinical pathology - biochem / haematology, Urinalysis
• Endoscopy - cystoscopy
• Ultrasonography
• (Radiography + scintigraphy)

Question 2

What would you look at with endoscopy?

Answer 2

• Evaluation of urine outflow from ureters - Every 20-45 seconds under xylazine sedation
• Catheterisation of ureters - Confirm unilateral / bilateral renal/ureteral disease

Question 3

What can you do with ultrasound?

Answer 3

• Transrectal
• Bladder in adults
• Transcutaneous
• Kidneys
• Bladder
• Umbilicus
• Guided needle biopsy of kidney(s)

Question 4

Why would you do radiography?

Answer 4

• Urinary tract in foals / yearlings

Question 5

Why would you do laparoscopy?

Answer 5

• Visualisation of perirenal regions, ureters & bladder
• Offers various treatment options

Question 6

Why would you scintigraphy?

Answer 6

• Assessment of renal function

Question 7

Why would you perform a nephrectomy?

Answer 7

• Renal neoplasia
• Pyelonephritis non-responsive to medical treatment

Question 8

What would you need to rule out in any case of urinary incontinence?

Answer 8

• Ectopic ureters

Question 9

What animals get ruptured bladders?

Answer 9

• Foals 1-5 days of age
• More common in colts
• Usually occur during parturition but clinical signs take time to develop
• Uncommon in adult horses but can occur

Question 10

What are clinical signs of a ruptured bladder?

Answer 10

• Depression / off suck
• Progressive abdominal distension
• Mild / moderate colic
• Increased frequency of urination and small urination volume, or no urination

Question 11

How is a ruptured bladder diagnosed?

Answer 11

• History & presenting signs
• Biochemistry & haematology - Hyper K+, Hypo Na+, hypo Cl-, Dehydration, Metabolic acidosis
• Peritoneal fluid analysis - Peritoneal creatinine more than double serum creatinine
• Ultrasonography
• Radiography & contrast studies

Question 12

How would you stabilise a ruptured bladder?

Answer 12

• Stabilisation is critical prior to general anaesthesia
  -HyperK+ can cause fatal arrythmias
  -K+ must be <5.5Meq/L before induction of anaesthesia
• Methods to rehydrate and reduce K+:
  = i.v. saline / Hartmann’s solution
  -+/- sodium bicarbonate
  -Calcium borogluconate
  -Insulin / glucose
• Abdominal drainage (slow) – reduce K+ but also improves ventilation
• Rule out concurrent disorders e.g. sepsis
• Antibiotics
• Check IgG status

Question 13

What would surgical treatment of ruptured bladder be?

Answer 13

• Surgical repair via midline laparotomy with resection of umbilicus and urachus
• The prognosis is good but also depending on other underlying conditions

Question 14

What are urolithiasis more common in?

Answer 14

• Adult Males - can block urethra
• females = remain in bladder

Question 15

What are 2 types of calcium carbonate urolithiasis?

Answer 15

• Type 1 = more common = spiculated, yellow / green
• Type 2 = smooth + white

Question 16

How are urolithiasis diagnosed?

Answer 16

• History & presenting signs
• Haematuria, Stranguria, +/- pollakiuria, pyuria or incontinence
• Clinical examination - Rectal + External palpation
• Ultrasonography
• Endoscopy

Question 17

How would you treat urolithiasis?

Answer 17

• Surgical removal - laparotomy, laparoscopy
• Electrohydraulic / laser lithotripsy
• If the horse cannot urinate due to a distal urethral obstruction, a temporary perineal urethrotomy may be needed

Question 18

What is seen with urolithiasis?

Answer 18

• Haematuria after exercise

Question 19

What are other bladder disorders?

Answer 19

• Sabulous cystitis =
  -Secondary problem, consequent to bladder paralysis or other physical or neurologic disorders interfering with complete bladder emptying
• Neoplasia (SCC)
• Bladder eversion - Due to excessive straining
  = Parturition or foaling

Question 20

What can urolithiasis in the urethra cause?

Answer 20

• Acute urinary obstruction + colic
  = surgical removal

Question 21

What other problems occur in the urethra?

Answer 21

• Obstruction due to soft tissue lesions (neoplasia)
• Lacerations - penile trauma

Question 22

What is the urachus?

Answer 22

• remnant of channel between bladder and
  umbilicus where urine drains in the foetus

Question 23

What is a patent urachus?

Answer 23

• Urachus fails to close spontaneously or can reopen if sepsis occurs
• Moisture around umbilicus +/- dripping of urine
• Check for concurrent septicaemia/septic arthritis/ physitis
• Assess IgG status

Question 24

How would you treat a patent urachus?

Answer 24

• Medical =
• Antibiotics
• Topical agents (concentrated phenol or 7% iodine
  solution or with silver nitrate applicators)
  (Often self-resolving)
• Surgical (if needed)
  = Resection of the urachus

Question 25

What is umbilical sepsis?

Answer 25

• First 1-2 weeks of life but can occur later
• Foal depressed & off suck
• Swollen, painful umbilicus
• Ultrasonography of the umbilicus reveals enlargement of structures

Question 26

How is umbilical sepsis treated?

Answer 26

• Assess IgG status & assess for concurrent septicaemia / septic arthritis / physitis
• Blood culture, haematology & biochemistry
• Systemic antibiotics
• Surgical resection if no response to therapy / deterioration

Question 27

What can happen with an umbilical hernia?
When would you surgically repair?

Answer 27

• Can cause strangulation of bowel if entrapped = immediate surgery
• Surgical repair required if:
• Large defect (>3-5cm)
• Defects persists more that 6 months
• Defect enlarges
• Associated with colic