Combined tube cystostomy and urethrotomy for the treatment of urethral obstruction due to urolithiasis in goats

Abstract

ObjectiveTo describe the treatment of goats with urethral obstruction secondary to urolithiasis by combining tube cystostomy and urethrotomy.AnimalsEight male goats.Study designShort case series.MethodsMedical records (September 2012–September 2017) of male goats treated for obstruction secondary to urolithiasis with tube cystostomy and urethrotomy were reviewed. Data collected included signalment, history, physical examination findings, diagnostic results, perioperative treatments, operative details, hospitalization duration, intraoperative and postoperative complications, urolith analysis, and time to restoration of urethral patency. Long‐term follow‐up (>12 months) was obtained by email or telephone interviews of owners or by clinical examination.ResultsSeven of eight goats were castrated males of various of breeds. All goats were tachycardic with urethral pulsation at admission. Uroliths were composed of calcium carbonate in four goats and silica in one goat. All goats regained urethral patency during hospitalization, and all were discharged alive from the hospital. Seven goats were alive at long‐term follow‐up. Postoperative complications included persistent urethral obstruction requiring a second urethrotomy 2 days postoperatively, premature dislodgement of the bladder catheter and jejunal obstruction secondary to adhesions, and recurrence of obstructive urolithiasis within the proximal perineal urethra requiring a second surgery 8 months later (1 each). Long‐term outcome was good, with urethral patency beyond 12 months in six of eight goats.ConclusionCombining tube cystostomy and urethrotomy restored urethral patency in goats with urethral obstruction from uroliths. Although none of the complications seemed directly related to the urethrotomy, formation of abdominal adhesions and recurrence of urolithiasis affected long‐term outcomes.Clinical significanceUroliths that do not dissolve in acidic urine may be more frequent in some practices. The combined approach of tube cystostomy and urethrotomy appears to successfully restore urethral patency with promising long‐term outcomes.

Risk factors for, frequency, and type of complications after temporary tube cystostomy in goats, sheep, and pigs

“…3 In contrast, reobstruction rates of <20% at 6 and ≥ 12 months after tube cystostomy were previously reported in small ruminants. 1 Furthermore, 75% of goats exhibited urethral patency beyond 12 months, 13 and 33% (5/15) of goats had postoperative complications reported 6 after urethrotomy and temporary tube cystostomy in two smaller recent case series. The time to occurrence of complications in our study was longer (desirable) in goats that underwent a combination of tube cystotomy and urethrotomy compared with those that had tube cystotomy alone performed.…”

“…Radiographs were performed postoperatively to confirm absence of urethroliths or cystoliths in one pig. Median (range) hospitalization period was 14.5 days (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and all pigs survived to discharge.…”

“…After having taken into consideration the age and use of the animal and other potential risk factors for reoccurrence of the disease, owners may consider alternative approaches or elect humane euthanasia if advised of a poor long‐term prognosis instead of pursuing costly surgical intervention. Reobstruction after temporary tube cystostomy has been reported for 20% to 29% of cases in recent literature 1,3,6,13 ; however, large attrition bias for long‐term follow‐up (>1 year) occurred in most studies. This exposes a knowledge gap regarding the frequency and type of long‐term complications as well as the average time until these complications occur in goats and sheep.…”

Assessment of preoperative and postoperative l‐lactatemia and clinical outcomes in goats undergoing tube cystostomy: A retrospective study of 34 cases (2015‐2020)

“…Medical management is often unrewarding with many goats requiring surgery due to failure to establish patency of the urethra, stricture formation, or reobstruction. Surgical methods for treating obstructive urolithiasis include tube cystostomy, urethrotomy, perineal urethrostomy, bladder marsupialization, and vesiculopreputial anastomosis 1‐4 . Multiple publications have focused on clinical outcomes associated with clinical variables on presentation and various surgical techniques that might predict survival 4,5 .…”

“…Surgical methods for treating obstructive urolithiasis include tube cystostomy, urethrotomy, perineal urethrostomy, bladder marsupialization, and vesiculopreputial anastomosis. 1 , 2 , 3 , 4 Multiple publications have focused on clinical outcomes associated with clinical variables on presentation and various surgical techniques that might predict survival. 4 , 5 Normal plasma potassium concentrations (<5.2 mEq/L), lack of peritoneal effusion, and an intact urethral process on admission are associated with increased survival.…”