Hand-assisted laparoscopic nephrectomy for the treatment of ureterolithiasis and nephrolithiasis in an adult horse

Abstract

An 18-year-old Hanoverian Warmblood gelding was presented with a history of acute haematuria. On rectal examination, a severely dilated right ureter with a concrement was palpated. Transabdominal sonography raised the suspicion of right kidney enlargement and loss of normal architecture. An exploratory laparoscopy was performed to evaluate the diagnostic findings. The tentative plan was to perform a laparoscopic ureterolith removal and a hand-assisted right nephrectomy, as high ureterolith recurrence rates are reported without nephrectomy. Right hand-assisted laparoscopic nephrectomy was performed and confirmed nephrolithiasis. Since the ureteral stone could not be mobilised, it was left in situ. Post-operative pain management proved a major challenge in this case, and was initially insufficient in spite of a multi-modal approach. Applied pain management techniques as used in human donor nephrectomy require further investigation for potential future use in equine patients. The gelding resumed his activity as a leisure horse six weeks after surgery, but was euthanized three months after surgery due to an unrelated cause. Nephrectomy without ureterolith removal provided a successful solution for this case of severe kidney disease.