Tube cystostomy for management of obstructive urolithiasis in ruminants

Aim: The aim of this study was to evaluate the simple tube cystostomy procedure for management of urethral obstruction cases in ruminants. Materials and Methods: Tube cystostomy was used to treat a total of 58 ruminants, which included 35 buffalo calves and 23 goats. Diagnosis of the disease was made with the history of anuria, clinical signs, and physical examinations. Physical parameters like heart rate, respiratory rate, rectal temperature dehydration status of animals by skin tenting test, and intraoperative findings were compared. Results: Young ruminants were most commonly affected and the mean age was 4-5 months in both species. Only male were considered for the study in which buffalo calves were not castrated but in goat's 73.91% animal were castrated and 34.7% not castrated. Rupture of bladder was more common in buffalo calves as compared to goats. The confirmed cases of obstructive urolithiasis were selected for tube cystostomy with Foley's catheter. Postoperatively all cases were administered with broad spectrum antibiotic, anti-inflammatory agent, and caliculolytic agents like ammonium chloride. Postoperative complications recorded only in 10 animals and remaining 48 animals had an uneventful recovery. Conclusion: Tube cystostomy is a simple and effective procedure particularly in intact urinary bladder, which can be adopted at field level.


Introduction
is definitely surgical, once the obstruction is complete.Removal of calculi may be by direct or indirectly Urolithiasis describes the concretion of urinary bypassing the obstruction [5].Surgical tube cystotomy calculi or organic compound, which may lodge anyis the most commonly used treatment for long term where in the urinary system but most frequently at the management of obstructive urolithiasis in animals and distal end of sigmoid flexure in ruminants, and causes may be the best option for breeding animals.It redirects subsequent urine flow obstruction [1,2].Occurrence of the urine through a catheter placed from urinary urolithiasis is significantly more common in male bladder and exiting through the abdominal wall.The ruminants compared to females due to their anatomical success rate of this technique has been reported to be conformation of the urethral tract [3].The Female have 80% after 1 month of postoperative period [6].The short, wide, and straight urethra while the male has advantages of this technique are it is a simple procedure, long, narrow and tortuous urethra which makes them highly field applicable, a relatively short duration of more prone to urethral obstruction, particularly distal anaesthesia and attains a full urethral patency in short aspect of the sigmoid flexure in bovines and urethral period of time.process in sheep and goats.Early castration of male The present study described the clinical signs and animals might be the one of the reason because it surgical management of obstructive urolithiasis.causes hypoplasia of urethra and leading to reduction in bore size of urethra.The decreased urethral orifice is

a major predisposing factor for obstructive urolithiasis
Ethical approval: Ethical approval was not necessary.[3].In addition, calculi formation usually results from a All the clinical cases under this research were treated combination of nutritional, physiological, geographical, and examined as per standard treatment and examiseasonal, age, sex and management factors [4].nation procedure.Obstructive urolithiasis in ruminants has been corrected with medical treatment but the result is Animals: The present study was conducted at the unrewarding one.Treatment of obstructive urolithiasis Division of Surgery and Radiology, Referral Veterinary Polyclinic, Indian Veterinary Research Institute-Izatnagar.Total 58 male animals, in which 35 buffalo calves and 23 goats were formed the material of the study, which were suffering from complete retention of urine and presented for treatment at Referral Veterinary anterior to the rudimentary teat; bladder was located Polyclinic.
after separating subcutaneous tissue and muscles by These animals were subjected to a thorough blunt incision (Figure -1).The status of bladder was clinical examination to check the condition of animals.
checked whether intact or ruptured and appearance of Physical examination was done to check the status of the bladder also noted.If bladder intact, subcutaneous the urethra and urinary bladder and physiological tunnel was made parallel to the prepuce by passing parameters like heart rate (H/R, beats/minute), respirastraight mosquito forceps through the subcutaneous tory rate (R/R, beats/ minute), rectal temperature (°C), tissue at the end skin was incised intended for catheter colour of mucus membrane and dehydration status by outlet (Figure-2 and 3).Folye's catheter was passed skin tenting test for confirmation of the tentative from outside to abdominal cavity where the catheter tip diagnosis.Intra operatively the bladder was examined was held in stilette and directly stabbed the bladder and whether it is intact/ruptured, appearance of bladder its bulb was inflated with sterile normal saline for (smooth, rough, inflamed and necrosed).Animals were fixation.Conversely if bladder ruptured cystorraphy stabilized preoperatively with fluid therapy and followed by catheter placement was done after supportive therapy to those animals which have severe necessary debridement and irrigated with normal saline dehydration and uraemia as the case required.
to remove concretions and cystic calculi.Muscles and Stabilized animals were prepared for tube cystotomy subcutaneous tissue was sutured with No.1 catgut in and operated on same day.continuous suture pattern.Skin was sutured with Surgical procedure: All the animals were anaesthe-horizontal mattress with nylon No. 1.The Foley's tised with local anaesthetic 2% lignocaine at catheter was sutured at multiple sites on the ventral lumboscaral epidural and line infiltration at surgical abdomen (Figure -4).
Postoperatively owners were advised to give site.Animals were placed in right lateral recumbency.
antibiotic Entrofloxacin @ 5mg/kg b.wt, I/M for 6 Left side of the abdomen near the rudimentary teat area days, analgesic, meloxicam @ 5 mg/ kg for 3 days and was cleanly shaved and scrubbed with antiseptic ammonium chloride @ 200 mg/Kg b.wt, b.i.d.daily, solution.After scrubbing, an incision was made nearly  per Os for a period of one month.Application of local was within the normal reference value of calves (38.5antiseptic dressing with povidone iodine was advised 39.5°C) and goats (38.5-40.5°C).Dehydration status for a week.The catheter was allowed to drain freely for of animals was measured by skin tenting test, which four days (or until normal urination resumed) after showed that ruptured bladder cases had shrunken eye which it was clamped on every alternate day with balls (sinking eye balls in the socket), severely dull and infusion set flow regulating clamp to determine the depressed and rough hair coat.Mild to moderate urethral patency.All the animals were presented again dehydration was notice in those animals which had to our hospital for removal of catheter if normal intact bladder.The level of dehydration in animals urination is resumed through the urethra.Similarly ranged from 4-10% (>2-10 sec) in which most of the calves which had retention of urine due to blockage in buffalo calves within 4-6% (26 animals out of 35) urethra or the catheter were also presented for further remaining had 6-8%.While in goats (17 out of 23) had treatment.

Results
All the cases attained adequate analgesia at The occurrence of urolithiasis most commonly surgical site, there was no complication encountered.encountered in winter season.Most of the animals, Catheterization of urinary bladder and positioning of buffalo calves were not castrated but in goats 17 tube was achieved without any difficulties.After tube (73.91%) animal were castrated and 6 (26.08%) were placement, flow of urine through the tube was observed not castrated.The age of calves mostly affected from in all the cases.3-10 months (average age 4.5 month) and maximum Those animals presented within 2 days (16 number of animals between 4-5 months (62.8%) buffalo calves, 9 goats) of urinary obstruction cases followed by animals of 6-8 months (25.7%) and 8-10 were having healthy urinary bladder, appeared smooth months (11.42%).In goats the same strategy was and pink in colour intra operatively.Those cases which followed 56.5% animals were in 4-5 months (average 4 presented after 3 days (10 calves/ 8 goats) showed months) and remaining 26.08% were in 6-8 months tensed bladder filled with urine, which appeared rough group and 17.3% were 2 months old.In both species slightly and colour varied from pinkish to blue.In young animals were mostly affected (Table-1).
ruptured bladder cases out of 9 calves, 4 had serosal Clinical signs of most of the animals with intact rupture, 3 were severely necrosed, remaining 2 moderately bladder were complete anorexia or inappetance, necrosed.In goats out of 6 two were necrosed and 4 stranguria or anuria, reluctant to walk and frequent animals had serosal rupture.Ruptured bladder cases attempt to urination.Deep palpation on both side of mostly presented after 4 days to our hospital and the abdomen found that out of 35 calves 26 were intact colour of bladder was more dark bluish in colour.urinary bladder, remaining 9 cases were suspected for Post operatively the signs of acute pain and ruptured bladder.In goat most of the animals had intact distress reduced immediately after surgery and animals bladder 17/23 with remaining the 6/23 animals were started to feed normally after 6 hr.Different postopesuspected for ruptured bladder.In case of ruptured rative complications recorded in both the species, urinary bladder, bilateral ventral distension of abdomen which included urethral rupture in 5 calves, 2 tube might be noted and confirmed with abdominocentesis blocks and three goats tube blocks were encountered.in which urine present in abdomen.Among calves with In buffalo calves (80%) and goats (86.7%) animal got ruptured bladder, 2 animals were in recumbent position uneventful recovery without any complications and and had bradycardia with louder heart sound.
resumed normal urination through the urethra on 12-18 On physical examination 6 calves showed days of postoperatively onwards.Tube was removed tachycardia (95 beats /min range 40-120/min) and 3 after resuming normal urination through the external goats showed tachycardia (mean 98 beats/minute ranges urethral orifice, the owner was advised to give more 60-100/min).Rectal temperature of all the calves are in water and less concentrate feed.range of 37.5°C and goats in the range of 38.4°C, which

Discussion
shock [18].Previous worker also reported the same in calves by Jadon et al.

[19] Obstructive urolithiasis causes economic loss to
Rectal temperature of all the animals were within the farmer due to loss of animals and cost of treatment.
the normal range, which was concurrent with the study Mortality rate in cases of obstructive urolithiasis is of Parrah et al. [20] in experimentally created urethral very high which is mainly due to rupture of urethra or obstruction in calves.This was most likely due to urinary bladder [7].In the present study, affected various stages of uraemia, hemodynamic changes and animals age were within the range of 4-5 months in degree of illness [21].The dehydration was usually both buffalo calves and goats, this finding was in much more marked if water and electrolyte losses have consistent with the study of Sharma et al. [8] who been occurring over a period of several days.This documented that 60% animals urethral obstruction results in loss of skin elasticity, dryness of the skin and occurs mostly in young ruminants.Similar results were mucosa, and a reduction and retraction of the eyeball observed by other workers on urethral obstruction of (enophthalmia) due to reduction in the volume of the buffalo calves [9,10].The incidence of urolithiasis was postorbital fat deposits [1].Dehydration was more in more common in male buffalo calves and goats cases of ruptured urinary bladder which might be due to compared to female animals.This may be due to the loss of fluid from the interstitial and intracellular anatomical confirmative changes in the urethra [11].
spaces into peritoneal cavity [22].Castrated male goats had higher urethral obstruction Diagnosis of urethral obstruction cases can be when compared to intact males.This variation in much easier; however selecting treatment modalities is occurrence is because after castration the production of much more difficult.Treatments include medical testosterone was reduced which may cause hypoplasia dissolution of calculi and surgical management.In of urethral orifice [12].The reduction of testosterone general less severe cases can be corrected with medical may also decrease the protective hydrophilic colloid in management.Some report says that medical treatment the urine which increased the incidence of urolithiasis is not effective for long term and only provided [3].However, this variation was only noticed in goats temporary relief [23].In more severely obstructed not in buffalo calves.In addition desquamated epithelial cases surgery is the only option.cells can act as nidus for urethral calculi precipitation.
Surgical tube cystostomy is the most promising Desquamated epithelial cells may be due to deficiency procedure for obstructive urolithiasis in small of vitamin A and infections [13].
ruminants intended for use as breeding animals.The Seasonal variation may be one of the causative procedure is relatively simple, requiring a short agents because both in winter and summer the duration of anaesthesia and resulting in restoration of occurrence of urolithiasis is more.This may be related full urethral patency in successful cases [24,5].The to water balance of animals, during winter animals will free flow of urine through the external urethral orifice not take much water and produce concentrated urine could be due to many factors.Such as by giving anti-[1].Conversely, during the summer, urine may be more inflammatory drugs relived the spasm and inflammation concentrated due to increased water loss in the heat.In of urethra, caliculolytic agent like ammonium chloride our study most of the obstructive urolithiasis cases and sodium chloride along with water reduced pH of were come across only in winter seasons.
urine and it promotes the dissolution of calculi, bypassing The prevalence of urolithiasis may occur due to of urine through the Foley's catheter may reduce the imbalance of mineral intake in feed.Lot animals while calculi size and frequent occlusion of catheter with fattening/growing received more cereals and concenclamp could bring urethral patency by flushing urethra trated feeds.These feeds contain more level of phosphorus of all debris and calculus material [23].A retrospective and magnesium and relatively less level of calcium and study of short and long term outcome of surgical tube potassium predisposed to this condition [14].
cystostomy in ruminants reported reobstruction of On physical examination most of the animals catheter was minimal compare to previous studies and showed tachycardia, which was above the normal attributed with recommended dietary management at reference value.This was recorded by many authors in the time of discharge [23].Complication of tube cystotheir cases of obstructive urolithiasis [15].Increased stomy might be due to blockade of tube with blood or heart rate may be due to the accumulation toxic tissue debris, urethral rupture, tube dislodgement, and metabolites/waste product which were produced in infection [25].Different surgical treatments are uremic animals [16].In another study prolonged illness, available for obstructive urolithiasis but each operation anorexia, progressive systemic disturbance may result having their own advantages and disadvantages.Tube in electrolyte disturbances like hyponatremia and cystostomy surgery provides alternatives to those hyperkalemia in ruminants suggested as a possible operations.Perineal Urethrotomy (PU) and urethrostomy causes of increasing heart rate in obstructive urolithiasis has been used to relive the obstruction on post scrotal or cases [17].
post ischial depending upon calculi lodgement.However, Respiratory rate was higher than the normal postoperative complications associated with poor long reference value, which could be due to pain produced term outcomes due to stricture formation, resulting in by urethral obstruction, electrolyte disturbance like recurrent obstruction [26].Bladder marsupialisation is hypocalcemia, hypomagnesemia and hypovolumic prolapse of bladder mucosa [27].
In ruptured urinary bladder most of the animals to cause rupture of the bladder.This could be one of the

( 2005 )
Sheep and Goats.In: Raphael C, Wolfman,Robichaud another surgical option but the quality and duration of S eds, Basic Animal Nutrition and Feeding.Hoboken: John postoperative life may be limited by such problems as Wiley and Sons, Inc. p 439-461.urine scald, urinary tract infection, stricture, and 5. Ewoldt, J.M., Jones, M.L. and Miesner, M.D. (2008) Surgery .R., Bhattacharyya, H.K., Buchoo, B.A. Malik, were treated with frusemide HCl by local veterinarians H.U. and Dar, S.H. (2012) Management of obstructive before presented to the hospital.Frusemide is a loop urolithiasis in dairy calves with intact bladder and urethra by diuretic which increases the urine production by its Fazili's minimally invasive tube cystotomy technique, Vet.loop diuretic action.Diuretics are recommended only Sci.Dev., 2: 50-53.7. Gasthuys, F., Steenhaut, M., De Moor, A. and Sercu, K. for partial obstruction not for complete obstruction [1]. (1993) Surgical treatment of urethral obstruction due to In complete obstruction, the production of urine was grazed in pastures containing large quantities of urolithiasis more because of diuretic action and it might have lead in male cattle: a review of 85 cases.Vet.Rec.133: 522-526.

Table - 1
: Distribution of cases and different occurrence of urolithiasis in ruminants