The use of pneumatic impact lithotripsy and a retrieval pouch to create a closed system for removal of cystic calculi in standing male horses

Abstract

Summary Multiple techniques exist for removal of cystic calculi in the male horse, some of which use a perineal urethrotomy (PU) to facilitate access to the urinary bladder for removal of small uroliths in the standing, sedated horse. These techniques have limited efficacy in the removal of uroliths that have a diameter larger than the PU site, typically 4–5 cm. Pneumatic lithotripsy as reported in this article provides a novel way to fragment these larger uroliths while containing the fragments and protecting the urethra and urinary bladder. Ten geldings and one stallion underwent a lithotripsy procedure to remove one (n = 10) or several (n = 1) uroliths ranging in diameter from 4 to 9 cm. A PU was performed and a laparoscopic retrieval bag was inserted into the urinary bladder through the PU site. The urolith was manipulated into the bag using blind transrectal manipulation or endoscopic guidance and the opening of the bag was exteriorised out of the PU site. A pneumatic lithotrite was used to fragment the stone. When the urolith was adequately fragmented, the fragments were removed by the use of sponge forceps and by flushing the fragments from the bag with obstetrical lube. This was continued until the bag could smoothly be withdrawn from the urinary bladder. All uroliths were successfully removed. The PU sites healed without complication and none of the horses had recurrence of presenting clinical signs. This article also discusses the difference between two types of laparoscopic retrieval bags. Pneumatic impact lithotripsy in combination with a retrieval pouch offers a safe alternative to other methods for removal of cystic calculi in the horse.

Use of a pneumatic device for intraluminal enterolith fragmentation in horses

“…Successful fragmentation of urinary, biliary and intestinal calculi has been reported (Cho et al, 2014; Kim et al, 2010; Large & Krambeck, 2019). Removal of cystic calculi in horses employing pneumatic impact (or ballistic) lithotripsy has recently been reported (de Bernardis et al, 2019; Sassot et al, 2020). In those studies, the time required for calculus fragmentation ranged from 25 to 60 min (de Bernardis et al, 2019) and 31–42 min (Sassot et al, 2020).…”

“…Also important, the tip of the lithotripsy device must be aimed at the core of the enterolith at all times. As emphasised by de Bernardis et al (2019), appropriate training is critical to minimise the risk of injury.…”

“…The procedure was thought to be faster and less traumatic than traditional cystotomy (de Bernardis et al, 2019;Sassot et al, 2020).…”

“…Urolith removal using pneumatic impact lithotripsy has recently been reported in horses. The procedure was thought to be faster and less traumatic than traditional cystotomy (de Bernardis et al, 2019; Sassot et al, 2020).…”

Strategies to relieve intraluminal obstructions in inaccessible segments of the ascending, transverse and descending colon

“…The article by Machado Amaral Rosa et al ( 2023) noted that smooth-surfaced enteroliths were more difficult to fragment than irregular-surfaced enteroliths, as were enteroliths with rigid cores and less porosity. Similarly, type 1 calcium carbonate uroliths in horses have been described as easier to fragment than the harder and smoother type 2 calcium carbonate uroliths (De Bernardis et al, 2019). Although ingesta and foreign bodies, such as hay nets, twine, plastic or rope, can serve as a nidus for mineralised concretions, most enteroliths have small, solid niduses, such as metal fragments, rocks or grains of sand (Hassel, 2002;Pierce, 2009).…”