Surgical Disorders of the Urinary Tract & Umbilicus

What are the surgical disorders of the kidneys and ureters that can be seen?

• Nephrectomy

  • Renal neoplasia

  • Pyelonephritis non-responsive to medical treatment

• Ectopic ureters are rare but do occur

  • Rule out in cases of urinary incontinence

At what age do ruptured bladders often occur?

Foals 1-5 days of age (usually during parturition)

What are the clinical signs of a ruptured bladder?

• Depression / off suck

• Progressive abdominal distension

• Mild / moderate colic

• Increased frequency of urination and small urination volume, or no urination (depending on the size of the tear)

How do you diagnose a bladder tear?

• History & presenting signs

• Biochemistry & haematology

  • Hyper K+

  • Hypo Na+ hypo Cl-

  • Dehydration

  • Metabolic acidosis

• Peritoneal fluid analysis

  • Peritoneal creatinine more than double serum creatinine

• Ultrasonography - looking for a small bladder surrounded by fluid in the abdomen

• Radiography & contrast studies

  (reffer)

What do you need to do initially when you have a ruptured bladder before surgical treatment?

• Stabilisation

• i.v. saline / Hartmann’s solution with calcium

• Abdominal drainage (slow)

• Rule out concurrent disorders e.g. sepsis

• Antibiotics

• Check IgG status

How does urolithiasis differ in males and females?

• More common in males:

  • Can block urethra

• Less common in females:

  • Can remain in bladder and cause mild haemorrhage during urination (cystitis)

What do you diagnose uroliths?

• History & presenting signs

  • Haematuria

  • Stranguria

  • +/- pollakiuria, pyuria or incontinence

• Clinical examination

  • Rectal examination

  • External palpation (males)

• Ultrasonography - if you are suspecting a kidney issue

• Endoscopy

How do you treat urolithiasis?

• Surgical removal

  • Laparotomy (can give epidural in female and grab with hand)

• If the horse cannot urinate due to a distal urethral obstruction, a temporary perineal urethrotomy may be needed

What other bladder disorders can you get?

• Sabulous cystitis

• Neoplasia (SCC)

• Bladder eversion

What does urolithiasis of the urethra cause?

Acute urinary obstruction & colic

What is the urachus?

Remnant of channel between bladder and umbilicus where urine drains in the foetus (should be closed over at birth)

What are the clinical signs that will be seen with patent urachus and what other things do you need to make sure to check?

• Moisture around umbilicus +/- dripping of urine

• Check for concurrent septicaemia/septic arthritis/ physitis

• Assess IgG status

How do you treat a patent urachus?

• Antibiotics

• Topical agents (concentrated phenol or 7% iodine solution or with silver nitrate applicators)

• Often self-resolving

• Surgical (if needed)

  • Resection of the urachus

What are the clinical signs of umbilical sepsis?

• Foal depressed & off suck

• Swollen, painful umbilicus

How do you diagnose umbilical sepsis?

Ultrasonography of the umbilicus reveals enlargement of structures

How do you treat umbilical sepsis?

• Assess IgG status & assess for concurrent septicaemia / septic arthritis / physitis

  • Blood culture, haematology & biochemistry

• Systemic antibiotics

• Surgical resection if no response to therapy / deterioration

What do you need to determine about an umbilical hernia?

• Size

• Reducible / non reducible

  • If defect is non-reducible, immediate surgery is needed

  • Owner must evaluate daily

When would you carry out surgical repair of an umbilical hernia?

• Large defect (>3-5cm)

• Defects persists more that 6 months

• Defect enlarges

• Associated with colic