Urolithiasis

Question 1

Who does urolithiasis occur in?

Answer 1

occasionally in feedlot steers
more common in small ruminants
especially common in pet animals

Question 2

What are complications of urolithasis?

Answer 2

bladder rupture

urethral rupture

Question 3

What are risk factors for urolithasis?

Answer 3

male
castrated--urethra is smaller
diet (high grain--high phosphorus)
small ruminants 
breed

Question 4

What is the most common urolithiasis stone?

Answer 4

struvite

calcium phsophorus magnesium mix

Question 5

Why are pet animals at risk of urolithiasis?

Answer 5

grain + grass

often don’t think about correct calcium phos ratio etc

Question 6

What animals are the worse for urolithiasis?

Answer 6

pet pygmy goats

Question 7

What is a second common stone of urolithiasis?

Answer 7

silicate but specific areas like in some areas of california

Question 8

What are the clinical signs of urolithiasis?

Answer 8

1. dysuria
2. stranguria
3. dribbling urine
4. vocalization
5. tail flagging
6. abdominal straining
7. colic
8. abdominal distension–bladder rupture, pendulous symmetric abdomen?
9. preputial edema–urethra ruptured-osmotically active!! draws fluid in!!! can be hot–severe inflam
10. bruxism
11. anorexia, weakness, depression

Question 9

How do you diagnose urolithaiss?

Answer 9

examination of penis–not uncommon to see hairs covered in crystals
rectal: bladder, urethra

Question 10

What might you feel of the urethra with palpation?

Answer 10

spasming of urethra trying to urinate, fluid filled

Question 11

Why does urinary catheterization not work with ruminants?

Answer 11

1. sigmoid flexure

2. dorsal diverticulum (a blinded ended sac just before reaches bladder)

Question 12

What is the chemistry seen with urolithiasis?

Answer 12

1. post renal uremia for cattle
   ruminants less severely affected
   ruminants and small ruminants have salivary glands to take out urea and potassium from blood and dump into mouth and goes to rumen and it is metabolized into protein by bacteria so get way less uremic, can also sequester a lot of potassium in GI tract

Question 13

Why should you smell cattle breath with urolithiasis?

Answer 13

smells like urea!!!! really gross toilet

Question 14

What are two ways can confirm diagnosis by getting at fluid?

Answer 14

1. belly tap

2. FNA of ventral body wall

Question 15

What should you use to confirm identity of fluid you get back from belly tap/FNA of ventral blood walls?

Answer 15

BUN strips to measure blood BUN (uremia) AND compare to body fluids (is body fluid more uremic than blood?)

Question 16

What are the toughest urolithiasis cases to dx?

Answer 16

those that have not ruptured

Question 17

What are the treatments for urolithiasis?

Answer 17

1. medical
2. surgical
3. euthanasia

Question 18

What are the treatments for urolithiasis in small ruminants?

Answer 18

1. most blockages are in the urethra process soooo SIMPLY REMOVE!–cut the urethral process

debate about importance of reducing ram fertility but noone has figured this out

Question 19

What is walpole’s solution used for?

Answer 19

it is an acidifier that is injected directly into the bladder
some success in goats
(research)
but would take a while for stone to dissolve

Question 20

what are surgical methods of correcting urolithiasis?

Answer 20

1. tube cystotomy (gold standard).

2. perineal urethrostommy

Question 21

What are the features of tube cystotomy?

Answer 21

gold standard, maintains fertility
1. percutaneous catheter into bladder–could punch through body wall if bladder really large
allows urine to drain and allow inflam to decrease in urethra and hopefully stone passes on own

Question 22

What is post op care for tube cystotomy?

Answer 22

1. fluids
2. antimicrobials
3. urinary acidifiers
4. smooth muscle relaxants
5. analgesics
   wait about 10 days then clamp off the foley (do NOT pull out right away)

Question 23

What are the features of perineal urethrostomy?

Answer 23

1. surgically prepare area below rectum
2. incise over penis and dissect around bend penis at ventral aspect of sigmoid flexure and pull to get a lot of penis! need a stump 2-3inches long
   2cut penis
3. reflect caudally
4. ligate dorsal artery and vein
5. transect retractor penis muscle proximally
6. suture penile stump to skin
7. avoid any pressure dosrally (where urethra now lies!–want to avoid the urethra because don’t want swelling to put pressure on urethra)
8. close the incision ventrally
   SALVAGE–get them out of uremic state and get the mto slaugther
   need to have a big stump because contracts as it dries–need 2 inches sticking out

Question 24

What should you do with bladder rupture?

Answer 24

drain urine from bladder slowly

repair (usuallly ruptured dorsally)

Question 25

What do you do with urethral rupture? (the prepucial edema)

Answer 25

flay open skin to facilitate drainage but fly strike can be a big issue

Question 26

how do you prevent urolithiasis?

Answer 26

adequate water access
ensure balanced minerals in diet
avoid high grain low forage diets
(or balance calcium, phosphorus)