SURGICAL DISORDERS OF THE EQUINE URINARY SYSTEM
VMED 5263 Daniel J. Burba, DVM, Dipl. ACVS
Louisiana State University, School of Veterinary Medicine
SURGICAL DISORDERS OF THE EQUINE URINARY SYSTEM
OJECTIVES:
Familiarize you to the common surgical disorders of the equine urinary system.
Familiarize you to the surgical procedures employed.
SURGICAL DISORDERS OF THE EQUINE URINARY SYSTEM
UROLITHIASIS
Composition = Calcium Carbonate Usually singular
SURGICAL DISORDERS OF THE EQUINE URINARY SYSTEM
UROLITHIASIS
LOCATION:
Female = Bladder
Male = Bladder - Pelvic urethra - Penile urethra
SURGICAL DISORDERS OF THE EQUINE URINARY SYSTEM
UROLITHIASIS
CLINICAL SIGNS:
COLIC
STRANGURIA HEMATURIA +/ OLIGURIA ANURIA = emergency!!
SURGICAL DISORDERS OF THE EQUINE URINARY SYSTEM
UROLITHIASIS
DIAGNOSIS: Clinical Signs Rectal palpation Urethral catheterization Cystoscopy
SURGICAL DISORDERS OF THE EQUINE URINARY SYSTEM
UROLITHIASIS
TREATMENT (female): Manual sphincter dilatation
Sphincterotomy
SURGICAL DISORDERS OF THE EQUINE URINARY SYSTEM
UROLITHIASIS
TREATMENT (male): For small cystic calculi or urethral calculi:
ISCHIAL
(perineal) URETHROTOMY: -Performed standing
SURGICAL DISORDERS OF THE EQUINE URINARY SYSTEM
UROLITHIASIS
TREATMENT (male): ISCHIAL (perineal) URETHROTOMY:
SURGICAL DISORDERS OF THE EQUINE URINARY SYSTEM
UROLITHIASIS
TREATMENT (male): ISCHIAL (perineal) URETHROTOMY: - Calculi fragmentation may be required
SURGICAL DISORDERS OF THE EQUINE URINARY SYSTEM
UROLITHIASIS
TREATMENT (male): For large cystic calculi:
CYSTOTOMY:
General anesthesia required. Positioned in dorsal recumbency. Paraprepucial incision.
SURGICAL DISORDERS OF THE EQUINE URINARY SYSTEM
UROLITHIASIS
TREATMENT (male): CYSTOTOMY (cont’d):
SURGICAL DISORDERS OF THE EQUINE URINARY SYSTEM
UROLITHIASIS
TREATMENT (male): CYSTOTOMY (cont’d): 2-layer closure/absorbable suture
SURGICAL DISORDERS OF THE EQUINE URINARY SYSTEM
UROLITHIASIS
PROGNOSIS:
Reoccurrence
is possible
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
PATENT URACHUS
Also called = Persistent urachus Occurrence: CONGENITAL (present at birth) In utero / post parturient umbilical trauma
ACQUIRED
(days - weeks of age) Urachal seal disruption = sepsis?
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
PATENT URACHUS
CLINICAL SIGNS: Umbilical stump: Swollen Moist
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
PATENT URACHUS
CLINICAL SIGNS: DRIBBLING of urine through umbilicus
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
PATENT URACHUS
DIFFERENTIAL DIAGNOSIS: OMPHALOPHLEBITIS
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
PATENT URACHUS
DIAGNOSIS:
Clinical
signs
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
PATENT URACHUS
TREATMENT: Clean, dry environment Daily cleansing Parenteral AB's Chemical cautery (I2)
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
PATENT URACHUS
TREATMENT: If no resolution by 3-4 days: OMPHALOPHLECTOMY/CYSTOPLASTY
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
PATENT URACHUS
OMPHALOPHLECTOMY/CYSTOPLASTY
x x
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
PATENT URACHUS
OMPHALOPHLECTOMY/CYSTOPLASTY
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
OMPHALOPHLEBITIS
Infected umbilical remnants
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
OMPHALOPHLEBITIS
CLINICAL SIGNS: Umbilical stump:
Swollen Painful when touched Hot to the touch Exudative
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
OMPHALOPHLEBITIS
CLINICAL SIGNS: Systemically ill: Pyrexia, Depression, Diarrhea, Pneumonia, Joint ill.
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
OMPHALOPHLEBITIS
DIFFENTIAL DIAGNOSIS:
UMBILICAL
PATENT
HERNIA
URACHUS
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
OMPHALOPHLEBITIS
DIAGNOSIS:
Clinical
signs Ultrasonography - Enlarged umbilical a. &/or v.
?
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
ROUND LIGAMENT OF THE LIVER
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
OMPHALOPHLEBITIS
TREATMENT: Parenteral AB's based on C/S
OMPHALOPHLEBECTOMY/CYSTOPLASTY
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
OMPHALOPHLEBITIS
TREATMENT: OMPHALOPHLEBECTOMY/CYSTOPLASTY
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
OMPHALOPHLEBITIS
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
RUPTURE OF THE URINARY BLADDER (CYSTORHEXIS)
INCIDENCE: Mainly male foals. Typically occurs at birth.
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
RUPTURE OF THE URINARY BLADDER (CYSTORHEXIS)
INCIDENCE: Rupture occurs due to compression of bladder during parturition. Rupture usually occurs at dorsal apex (thinnest area)
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
RUPTURE OF THE URINARY BLADDER
CLINICAL SIGNS: Foal appears normal at birth. Foal becomes symptomatic 1-3 days of age.
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
RUPTURE OF THE URINARY BLADDER
CLINICAL SIGNS: Frequent posturing to urinate:
Ventral bowing of the back.
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
RUPTURE OF THE URINARY BLADDER
CLINICAL SIGNS: Depression, anorexia Abdominal distention / scrotal swelling Dyspnea
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
RUPTURE
OF THE
URINARY BLADDER
DIFFERENTIAL DIAGNOSIS: Colic Meconeum impaction Displays arching of the back.
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
RUPTURE
OF THE
URINARY BLADDER
DIAGNOSIS: Clinical signs (1) ABDOMINOCENTESIS (2) SERUM CHEMISTRIES (3) adjunct diagnostics (4)
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
RUPTURE
OF THE
URINARY BLADDER
DIAGNOSIS: ABDOMINOCENTESIS: (2) Large volume of fluid. (urine) Creatinine 2 - 3 times serum levels.
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
RUPTURE
OF THE
URINARY BLADDER
DIAGNOSIS: SERUM CHEMISTRIES: (3)
Hyponatremia Hypochloremia
Na+ Cl
Hyperkalemia
K+
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
RUPTURE
OF THE
URINARY BLADDER
Adjunct DIAGNOSTICS: (4) DYE INDICATOR: Methylene blue, Fluoroscein. Instilled into the bladder via catheter. Evaluate abdominal fluid for presence of dye.
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
RUPTURE
OF THE
URINARY BLADDER
TREATMENT: CYSTORRHAPY Rent in bladder repaired. Omphalophlebectomy/cystoplasty Closed system urethral catheterization. 48 hours duration.
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
RUPTURE
OF THE
URINARY BLADDER
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
RUPTURE
OF THE
URINARY BLADDER
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
RUPTURE
OF THE
URINARY BLADDER
TREATMENT: CYSTORRHAPY
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM
Other considerations for UROPERITONEUM: Rupture of the URACHUS.
Diagnosis:
Dye indicator instilled into bladder.
Treatment:
Omphalophlebectomy/cystoplasty
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM Other considerations for UROPERITONEUM: Rupture of a URETER. RARE!!! Diagnosis: Retrograde instillation of dye. Treatment: Abdominal exploratory:
–Repair
of defect –Ureteral catheterization –Nephrectomy
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM ECTOPIC URETER
Etiology:
Faulty
differentiation of metanephric duct.
Rare No sex predilection
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM ECTOPIC URETER
CLINICAL SIGNS: URINARY INCONTINENCE. Due to insertion of ureter distal to trigone area of bladder.
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM ECTOPIC URETER
DIAGNOSIS: Clinical signs. Constrast radiography Endoscopy Surgical exploration
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM ECTOPIC URETER
TREATMENT: Unilateral NEPHRECTOMY. If hydronephrosis or ascending UTI is present.
NEOURETEROSTOMY
SURGICAL DISORDERS OF THE EQUINE NEONATAL URINARY SYSTEM ECTOPIC URETER
TREATMENT: NEOURETEROSTOMY
SURGICAL DISORDERS OF THE EQUINE URINARY SYSTEM
NEPHRECTOMY
INDICATIONS: Hydroureter (ectopic) Hydronephrosis Pyelonephritis +/Neoplasia Nephrolithiasis
SURGICAL DISORDERS OF THE EQUINE URINARY SYSTEM
NEPHRECTOMY
RARELY PERFORMED:
Complicated
surgical technique.
IN the FOAL:
Ventral
midline celiotomy approach
SURGICAL DISORDERS OF THE EQUINE URINARY SYSTEM
NEPHRECTOMY
ADULT: Placed in lateral recumbency Rib resection required.
X
SURGICAL DISORDERS OF THE EQUINE URINARY SYSTEM
NEPHRECTOMY
ADULT: Rib resection
SURGICAL DISORDERS OF THE EQUINE URINARY SYSTEM
NEPHRECTOMY
ADULT: