Equis ISSN 2398-2977

Bladder: cystotomy

Contributor(s): David Moll, Graham Munroe

Introduction

  • Urolithiasisis uncommon in the horse but cystic calculi are the most commonly diagnosed. Sabulous urolithiasis is a separate condition which is usually secondary to bladder paralysis or other physical/neurological disorders where bladder emptying is abnormal. It is not treated surgically.
  • Surgical removal is the treatment of choice for cystic calculi. A variety of surgical approaches to the bladder are available to remove cystic calculi including laparotomy Abdomen: laparotomy and cystotomy.
  • Depending on the size of the stone it may be possible to fragment the urinary calculus (lithotripsy) so that it can be removed via the urethra (via sphincterotomy in females) or a smaller incision (perineal urethrotomy in males). Manual crushing and laser lithotripsy can be used to fragment the calculi followed by extensive flushing of the bladder to remove as much debris as possible.

Uses

  • Removal of cystic calculi.
  • Surgical exploration of bladder and possible removal of soft tissue lesions, including neoplasia.

Advantages

  • Any size of calculi can be removed.
  • Allows effective cleansing and evacuation of the bladder.
  • Standard surgical approach and equipment is used.

Disadvantages

  • General anesthesia Anesthesia: general - overview required.
  • Approach more difficult in male and large animals with poor exposure and abdominal incisional complications.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • See prognosis for primary reason for surgery, eg cystic calculi .

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Katzman S A et al (2016) Use of a laparoscopic specimen retrieval pouch to facilitate removal of intact or fragmented cystic calculi from standing sedated horses: 8 cases (2012-2015). JAVMA 249 (3), 304-10 PubMed.
  • Kilcoyne I & Dechant J E (2014) Complications associated with perineal urethrotomy in 27 equids. Vet Surg 43 (6), 691-6 PubMed.
  • Hawkins J F (2013) Surgical treatment of urolithiasis in male horses. Equine Vet Educ 25 (2) 60-62 VetMedResource.
  • Lund C M, Ragle C A & Lutter J D (2013) Laparoscopic removal of a bladder urolith in a standing horse. JAVMA 243 (9), 1323-8 PubMed.
  • Reichelt U & Lischer C (2013) Complications associated with transurethral endoscopic-assisted electrohydraulic lithotripsy for treatment of a bladder calculus in a gelding. Equine Vet Educ 25, 55-59 VetMedResource.
  • Watts A E & Fubini S L (2013) Modified parainguinal approach for cystic calculus removal in five equids. Equine Vet J 45 (1), 94-6 PubMed.
  • Röcken M et al (2012) Endoscopic-assisted electrohydraulic shockwave lithotripsy in standing sedated horses. Vet Surg 41 (5), 620-4 PubMed.
  • Russell T & Pollock P J (2012) Local anesthesia and hydro-distension to facilitate cystic calculus removal in horses. Vet Surg 41 (5), 638-42 PubMed.
  • Straticò P et al (2012) Laparoscopic-assisted cystotomy and cystostomy for treatment of cystic calculus in a gelding. Vet Surg 41 (5), 634-7 PubMed.
  • Abuja G A et al (2010) Pararectal cystotomy for urolith removal in nine horses. Vet Surg 39 (5), 654-9 PubMed.
  • Grant D C et al (2009) Holmium:YAG laser lithotripsy for urolithiasis in horses. J Vet Intern Med 23 (5), 1079-85 PubMed.
  • Duesterdieck-Zellmer K F (2007) Equine urolithiasis. Vet Clin North Am Equine Pract 23 (3), 613-29 PubMed.
  • Röcken M et al (2006) Laparoscopic-assisted cystotomy for urolith removal in geldings. Vet Surg 35 (4), 394-7 PubMed.
  • Beard W (2004) Parainguinal laparocystotomy for urolith removal in geldings. Vet Surg 33 (4), 386-90 PubMed.

Other sources of information

  • Schott H C (2012) Bladder. In: Equine Surgery. Eds: Auer J & Stick J. 4th edn. Elsevier. pp 927-939.


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