Management of Bladder Uroliths

CHAPTER 162 Management of Bladder Uroliths

The most common type of uroliths in the horse are those composed of calcium carbonate, but a few are composed of calcium phosphate. The former are rough and friable, and the latter are smooth and solid stones. A urolith forms over a nidus of cellular debris and will readily form over a foreign body such as a fragment of nonabsorbable suture. Management of a male horse with a bladder urolith is one of the most challenging surgical problems involving the equine urinary system. Over their career, most equine clinicians will diagnosis only a few of these calculi, and the difficulties of treatment and need to manage and monitor affected horses on a long-term basis after surgery make a lasting impression on both owner and veterinarian. Combined with the technical challenges of urolith removal is the dearth of evidence-based information on postoperative clinical management that will best minimize recurrence. Identification of the specific components of primary inhibitors and promoters (e.g., Tamm Horsfall glycoprotein, nephrocalcin, pyrophosphate, and uromucoid) of calculus formation in the horse awaits research. Elucidating the mechanisms of failure of the natural inhibitors of calculus formation may hold the key to improved approaches for diagnosis and prevention.

Management of a female horse with a bladder urolith requires the same monitoring and management, but calculus removal is more straightforward and is performed via urethral-vaginal extraction. Mares with bladder uroliths are admitted to referral hospitals less than one fourth as often as male horses. Horses of nearly any age can form bladder uroliths; middle-aged horses undergo surgery most frequently, but the incidence appears to be highest in horses in their late teens and 20s. The geriatric horse is underrepresented at referral hospitals because diagnosis of bladder uroliths in the field is straightforward and because most owners decline referral because of cost and the need for continued care. Recently attitudes seem to be changing, and an increasing willingness on the part of owners to pursue treatment of a geriatric horse is mirrored in current reports of cystic urolithiasis.

May 28, 2016 | Posted by in EQUINE MEDICINE | Comments Off on Management of Bladder Uroliths

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