engleski

Nonsurgical Removal of Uroliths in Horse

Horses with uroliths are most commonly admitted to hospital because of the inability to pass urine, and the treatment of choice is ultrasonic fragmenting, lithotripsy and surgical removal. A 19 year-old castrated gelding was admitted to the clinic due to histhe inability to urinate for 24 hours, but still in a generally good condition. The horse was straining to urinate and would pass a few drops of urine. On rectal palpation a distended bladder was found. The results of blood analysis indicated renal failure. Urethroscopy was preformed and the first stone was found 30cm into the urethra, wedged in the urethra obstructing the whole lumen. Surgical removal of the stone was suggested to the owner, but he wanted to euthanise the horse. Urethroscopy was then repeated and the removal of the stone was attempted with a small animal gastroscope, grasping forceps, stone retrieval baskets and retrieval snare. The plan was to attempt to crush the edges of the stone so as to unwedge it, and the snare or basket could then be positioned for retrieval. The animal was sedated and kept on analgesics during the whole process. Upon removal of the stone the mucous membrane of the urethra was severely damaged. Multiple stones were removed from 4 locations in the urethra and the two final ones were removed from the bladder. The largest removed piece was 2.5 cm long and 1 cm in diameter. Antibiotics were given order to prevent urinary infection. On the second day the urethra was examined by endoscope and multiple adhesions were found, some of them almost completely obstructing the lumen. The adhesions were torn with the endoscope and flushed with saline. After a few days the owner reported normal urination without straining. Reevaluation was performed two months after the procedure and minimal scaring with two minor strictures in the urethra were found, but no signs of inflammation or new stones. Endoscopic urethral stone removal with stone crushing by forceps is not a treatment of choice for urethrolits and uroliths, but with euthanasia being the only alternative it is worth a try.

Horse, Uroliths, Nonsurgical

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