Variables of initial examination and clinical management associated with survival in small ruminants with obstructive urolithiasis

Abstract

BackgroundObstructive urolithiasis is a common disease associated with a guarded prognosis in small ruminants.Hypothesis/ObjectiveThe results of physical examination, laboratory analyses, and clinical management of male small ruminants presented to 2 referral clinics were investigated to identify variables significantly associated with disease outcome, so as to provide better recommendations to animal owners regarding the management of these patients.AnimalsTwo‐hundred ten small ruminants (130 sheep and 80 goats) with confirmed diagnosis of obstructive urolithiasis.MethodsClinical findings (including diagnostic imaging) and laboratory results of the 210 animals were reviewed, and relevant information regarding clinical and laboratory variables recorded upon admission and clinical management was retrieved. The association of the different variables with nonsurvival was investigated by univariable and multivariable logistic regression models.ResultsOnly 39% of all patients considered for treatment and 52% of those undergoing tube cystostomy survived to be released from the clinic. Nonsurvival was strongly associated with a very poor clinical condition upon presentation, obesity, castration, and evidence of uroperitoneum. Among blood variables, abnormal PCV, severely increased serum creatinine concentrations, and increased activity of the creatine kinase were associated with increased risk of nonsurvival. Presence of signs of colic or macroscopic appearance of urine was not significantly associated with outcome.Conclusions and Clinical ImportanceThe prognosis of obstructive urolithiasis was guarded with survival rates of 39% (overall) to 52% (after tube cystostomy). Intact young males with normal body condition presented early in the course of disease had the best chances of survival.

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

“…On the basis of P < .25 in the univariate analysis, use of animal ( P = .126), location of the urolith ( P = .222), and presurgical procedures ( P = .158) performed prior to temporary tube cystostomy were further considered in the logistic regression model to predict occurrence of complications. Time from placement of the transabdominal catheter to surgery was entered in the model to explore its effect on occurrence of complications, whereas age was considered for the model as a continuous variable on the basis of the results of a previous study 2 …”

“…In contrast to our hypothesis, none of the examined candidate predictor variables were associated with an increased risk of complications or mortality after temporary tube cystostomy in goats. While several previous larger studies focused on assessing risk factors for survival/nonsurvival as the outcome of interest 1,2 after tube cystostomy, our study focused on specifically assessing risk factors for occurrence of complications and mortality as well as time to, frequency, and type of complications in a larger number of goats.…”

“…Success rates and cost of the proposed treatment as well as individual animal factors such as disease duration, age and use of the animal, and potential comorbidities usually guide clinical decision making for animals with urolithiasis. Temporary tube cystostomy, alone or in combination with urethral process amputation and/or urethrotomy, is the most commonly performed procedure for small ruminants with obstructive urolithiasis; however, reported success rates vary greatly, ranging from 52% to 92% 1‐3,6,12 . Factors previously reported to improve initial surgical outcomes in goats and sheep include young age (<4 years), lack of castration, early presentation to a veterinarian (clinical signs ≤24 hours duration), normal body condition score and demeanor, absence of free abdominal fluid, and absence of visible uroliths on radiographs 2 …”

Therapeutische Möglichkeiten bei obstruktiver Urolithiasis des kleinen Wiederkäuers

“…Im Rahmen einer retrospektiven Auswertung von Klinikdaten konnte die Bedeutung verschiedener klinischer sowie labordiagnostischer Parameter hinsichtlich der Überlebenschance bei Urolithiasispatienten ermittelt werden [11]. So ist beispielsweise das Vorliegen einer ausgeprägten Dehydratation mit erhöhtem Hämatokrit und lethargischem Allgemeinzustand sowie eine gesteigerte Kreatinkinaseaktivität mit einer höheren Wahrscheinlichkeit des Misserfolgs trotz Therapie verbunden [11]. Die aufgrund des Verschlusses der Urethra vergrößerte Blase lässt sich durch vorsichtige Abdomenpalpation oder aber meist einfacher mittels transabdominaler Sonographie dargestellen und diagnostizieren [9].…”

“…Das Vorliegen einer obstruktiven Urolithiasis stellt einen akuten Notfall dar und führt häufig trotz Therapie zum Tod des Patienten. Die prognostische Einschätzung muss anhand der klinischen Untersuchung sowie einiger mit einer schlechten Prognose assoziierter Parameter (hoher Hämatokrit, deutlich erhöhte Kreatininkonzentration und gesteigerte Aktivität der Kreatinkinase) getroffen werden [11]. Fällt die Entscheidung zur Behandlung, sollte abgewogen werden, ob eine Therapie mit möglichst erreichbarem Langzeiterfolg oder aber ein Eingriff zur Verwertung des Tieres durchgeführt wird.…”