Minimally invasive removal of obstructive ureteral stones by intracorporeal lithotripsy in horses: 3 patients.

Three client-owned horses diagnosed with obstructive ureteral stones were referred and treated in a minimally invasive manner by retrograde ureteroscopy in conjunction with electrohydraulic lithotripsy (EHL) or laser Holmium:YAG lithotripsy (HYL). For all 3 horses, additional tests revealed variable degrees of azotemia and ureteral obstruction. Ultrasound examination (2 horses) revealed a loss of cortico-medullary distinction consistent with a chronic nephropathy. Ultrasound-guided biopsy of the right kidney in 1 horse revealed moderate glomerulosclerosis and lymphoplasmacytic nephritis. A standing anesthesia with a coccygeal epidural was done for each horse. A perineal urethrotomy was performed in 2 horses before the urethrocystoscopy. One horse was treated with Holmium:YAG laser lithotripsy and 2 others were treated using a electrohydraulic lithotripsy probe. Each procedure was successful. The ureteroscopy was successfully performed and visualization was excellent. Fragmentation of stones seemed easier with the electrohydraulic lithotripsy probe. No complications, pain, or signs of discomfort after the procedure were noticed. All 3 horses were discharged from the hospital. Key clinical message: Obstructive ureteral stones in horses can be successfully treated in a minimally invasive manner by retrograde ureteroscopy accompanied by lithotripsy. This technique is safe, not painful and did not require general anesthesia. Electrohydraulic lithotripsy appeared superior for stone fragmentation.

Exérèse minimalement invasive de calculs urétéraux obstructifs par lithotritie intracorporelle chez le cheval : trois patients. Trois chevaux appartenant à des clients diagnostiqués avec des calculs urétéraux obstructifs ont été référés et traités de manière peu invasive par urétéroscopie rétrograde en conjonction avec une lithotripsie électrohydraulique (EHL) ou une lithotripsie au laser Holmium:YAG (HYL). Pour les trois chevaux, des tests supplémentaires ont révélé des degrés variables d'azotémie et d'obstruction urétérale. L'échographie (deux chevaux) a révélé une perte de distinction cortico-médullaire compatible avec une néphropathie chronique. La biopsie échoguidée du rein droit chez un cheval a révélé une glomérulosclérose modérée et une néphrite lymphoplasmocytaire. Une anesthésie debout avec une péridurale coccygienne était effectuée pour chaque cheval. Une urétrotomie périnéale a été réalisée chez deux chevaux avant l'urétrocystoscopie. Un cheval a été traité par lithotripsie au laser Holmium:YAG et deux autres ont été traités à l'aide d'une sonde de lithotripsie électrohydraulique. Chaque procédure a réussi. L'urétéroscopie a été réalisée avec succès et la visualisation était excellente. La fragmentation des calculs semblait plus facile avec la sonde de lithotripsie électrohydraulique. Aucune complication, douleur ou signe d'inconfort après la procédure n'a été remarqué. Les trois chevaux ont obtenu leur congé de l'hôpital.Message clinique clé :Les calculs urétéraux obstructifs chez les chevaux peuvent être traités avec succès de manière peu invasive par urétéroscopie rétrograde accompagnée de lithotripsie. Cette technique est sûre, non douloureuse et ne nécessite pas d'anesthésie générale. La lithotritie électrohydraulique est apparue supérieure pour la fragmentation des calculs.(Traduit par Dr Serge Messier).

The Use of Pneumatic Impact Lithotripsy in a Laparoscopic Retrieval Pouch for Removal of Large Cystoliths in Two Female Horses.

Two mares, aged 15 and 21 years, were examined because of urinary incontinence, intermittent hematuria, and urine scalding. On admission of both horses, physical parameters were within normal limits and urine scalding of the skin at the ventral perineum was noted. Transrectal palpation and cystoscopy revealed a large type I cystolith (>10 cm) with associated hyperemia and focal ulceration of the bladder mucosa. In horse 1, hemogram, serum biochemical analysis, and renal ultrasound were not performed because of owner finances. In horse 2, results from hematological and serum biochemical analysis were unremarkable and renal ultrasonography did not reveal any abnormalities. Pneumatic impact lithotripsy in a laparoscopic retrieval pouch was performed under cystoscopic guidance after caudal epidural anesthesia, with the horses standing and under sedation. A laparoscopic retrieval device was passed alongside a flexible endoscope into the urinary bladder and the cystolith was manipulated into the pouch. A customized single stainless-steel rod scaler attached to an air compressor was used for fragmentation of the cystolith contained within the retrieval pouch. Lithotripsy time was 42 minutes for horse 1 and 31 minutes for horse 2. Both horses were released from hospital the day of surgery. Both horses were continent and voided normal streams of urine for the duration of the follow-up periods of 27 and 19 months for horse 1 and horse 2, respectively. Pneumatic impact lithotripsy in a laparoscopic retrieval pouch provided a time-efficient and minimally invasive surgical treatment option for removal of large cystoliths in mares.

Removal of lower urinary tract stones by percutaneous cystolithotomy: 68 cases (2012-2017).

OBJECTIVE: To describe the use and outcome of percutaneous cystolithotomy (PCCL) for removal of urethral and bladder stones in dogs and cats. STUDY DESIGN: Retrospective case series. ANIMALS: Sixty-eight client-owned dogs and cats. METHODS: Records were reviewed and analyzed for dogs and cats that underwent PCCL between January 2012 and December 2017. Signalment, clinical presentation, laboratory and imaging data, procedure time, use of lithotripsy, biopsy, perioperative and immediate postoperative complications, hospitalization times, stone composition, and urine culture results were recorded. Owners were contacted by phone or email 3 weeks after the procedure. Follow-up communications with the owner and referring veterinarian were also recorded. RESULTS: Seventy percutaneous cystolithotomies were performed in 59 dogs and nine cats. The median duration of the procedure was 95 minutes (45-420), and lithotripsy was required in 3% (2/70) of PCCL. Complications during the procedure were reported in one case. In eighty-three percent of procedures (58/70), animals were discharged within 24 hours postoperative. Twenty-four percent (16/68) of animals had minor complications (lower urinary tract signs), and one dog had a major complication (surgical wound dehiscence) during the 3 weeks after the operation. Long-term follow-up revealed stone recurrence in 21% of cases followed more than a year after the procedure (7/33). CONCLUSION: Percutaneous cystolithotomy allowed removal of bladder and urethral stones with rapid postoperative recovery and few major perioperative or short-term postoperative complications. CLINICAL SIGNIFICANCE: Percutaneous cystolithotomy provides an attractive minimally invasive surgical alternative for removal of lower urinary tract stones in small animals.

[Management of urethral stones in dogs using pneumatic and laser lithotripsy]. / Management von Urethralsteinen beim Hund mittels pneumatischer und laserenergetischer Lithotripsie.

OBJECTIVE: Description of clinical experience with two different lithotripsy modalities for treatment of urethral stones in dogs. MATERIAL AND METHODS: Retrospective analysis (October 2016 - November 2017) of medical records from dogs with urinary stones that underwent transurethral pneumatic or laser lithotripsy. RESULTS: In 28 male and 5 female dogs, either pneumatic lithotripsy (39 %) or laser lithotripsy (61 %) was performed. In the urethra, stone free rates of 100 % in females and over 85 % in males could be achieved using either fragmentation modality. In 3 of 28 (11 %) male dogs, after fragmentation of urethral stones, urethral patency was impaired because of endoscopically suspected polypoid urethritis requiring urethrostomy. In 8 out of 28 (29 %) male dogs and in 1 of 5 (20 %) female dogs, an additional lithocystotomy was necessary to achieve stone-free status in the lower urinary tract. CONCLUSION AND CLINICAL RELEVANCE: Transurethral pneumatic or laser lithotripsy of urinary stones is a successful procedure in dogs. Major pathological conditions of the urethral mucosa may require further surgical or interventional methods for the restoration of a functional urethra.

[Therapeutic options of obstructive urolithiasis in small ruminants]. / Therapeutische Möglichkeiten bei obstruktiver Urolithiasis des kleinen Wiederkäuers.

The diagnosis of obstructive urolithiasis in small ruminants frequently results in a multitude of decisions that have to be made by the consulted practitioner. Factors that influence the decision for therapy (or euthanasia) are the type of the animal's use, economic aspects and specific options of the veterinarian practice as well as emotional aspects depending on the owners of small ruminants kept as companion animals. The present article aims to present the currently available methods of therapy to facilitate a decision by the practicing veterinarian based on the present state of the science. Naturally, the individual method of choice may differ from the scientific point of view depending on the practitioner's evaluation.

Minimally Invasive Management of Uroliths in Cats and Dogs.

Urolithiasis commonly affects cats and dogs. The American College of Veterinary Internal Medicine established guidelines for the treatment of uroliths that reflect modern techniques prioritizing minimally invasive procedures with an emphasis on prevention strategies to limit morbidity and mortality. Extracorporeal shockwave lithotripsy and endoscopic nephrolithotomy constitute some of the minimally invasive treatment modalities available for upper urinary tract uroliths. Cystoscopic-guided basket retrieval, cystoscopic-guided laser lithotripsy, and percutaneous cystolithotomy are minimally invasive options for the management of lower urinary tract uroliths. Following stone removal, prevention strategies are essential to help reduce morbidity and mortality associated with stone recurrence.

New alternatives for minimally invasive management of uroliths: lower urinary tract uroliths.

In small animals, removal is indicated for lower urinary tract calculi that are not amenable to medical dissolution and are causing, or may cause, urinary tract obstruction, inflammation, or recurrent infection. Surgical removal of lower urinary tract uroliths by cystotomy or urethrotomy has been the traditional method. The current standard of care for human urinary tract stones involves the use of lithotripsy and is minimally invasive. This article reviews the current literature on the various minimally invasive options available for managing lower urinary tract stones in small animal veterinary patients. Options for managing nephroliths and ureteroliths will be presented in forthcoming companion articles.

New alternatives for minimally invasive management of uroliths: nephroliths.

Urolithiasis is a common clinical problem in small animal veterinary patients. Management of upper urinary tract calculi can be particularly challenging in small animals, as traditional surgical removal can be associated with significant morbidity. In humans, minimally invasive treatment options have replaced traditional surgical removal in many cases. This article reviews the current literature on the various types of lithotripsy and some of the newer minimally invasive options available for management of nephrolithiasis in small animal veterinary patients. An article in the January 2013 issue addressed management of lower urinary tract uroliths; a future article will discuss current management strategies for ureteroliths.

New alternatives for minimally invasive management of uroliths: ureteroliths.

Ureterolithiasis is a serious clinical problem in small animal veterinary medicine, and management can be challenging and frustrating. Various traditional surgical treatment options exist but are associated with significant morbidity and mortality. In humans, minimally invasive treatment options have overtaken traditional surgical removal. This article reviews the current literature on the management of ureteral stone disease, including various types of lithotripsy, and discusses some of the newer minimally invasive options available for small animal veterinary patients. It is important to realize that much of the data in this article is only published in abstract form and is largely one institution's experience with these novel techniques. Articles on minimally invasive management of lower urinary tract uroliths and nephroliths were published in the January 2013 and February 2013 issues, respectively.

Endoscopic-assisted electrohydraulic shockwave lithotripsy in standing sedated horses.

OBJECTIVE: To report use of transendoscopic electrohydraulic shockwave lithotripsy for fragmentation of urinary calculi in horses. STUDY DESIGN: Case series. ANIMALS: Male horses (n = 21). METHODS: Fragmentation of cystic calculi (median, 6 cm diameter; range, 4-11 cm diameter) was achieved by transurethral endoscopy in standing sedated horses using an electrohydraulic shockwave fiber introduced through the biopsy channel of an endoscope. The fiber was advanced until it contacted the calculus. Repeated activation of the fiber was used to disrupt the calculus into fragments <1 cm diameter. Visibility within the bladder was maintained by repeated lavage with saline solution. RESULTS: Complete calculus removal was achieved in 20 horses (95%) with mean total surgical time of 168.6 minutes (range, 45-450). In the 20 horses with single calculi, 1-6 sessions were required to completely fragment the calculus. Except for 1 horse, in which perineal urethrotomy was eventually performed for complete fragment removal, fragments calculi were excreted via the urethra. Postoperative complications included hematuria because of severe mucosal erosion (n = 2), dysuria because of a trapped urethral fragment (2), small amount of urinary debris (1). One horse was euthanatized because of bladder rupture. Complete clearance of calculi and urinary debris was confirmed endoscopically 20 (3-45) days after the last session. Telephone follow-up (mean, 18.8 months; range, 7-24 months) revealed that horses had returned to previous activity levels without recurrence of clinical signs. CONCLUSIONS: Transendoscopic electrohydraulic lithotripsy appears to be an effective method for fragmentation of low-density calcium carbonate cystic calculi in male horses.

Methods of urolith removal.

Multiple techniques exist to remove uroliths from each section of the urinary tract. Minimally invasive methods for removing lower urinary tract stones include voiding urohydropropulsion, retrograde urohydropropulsion followed by dissolution or removal, catheter retrieval, cystoscopic removal, and cystoscopy-assisted laser lithotripsy and surgery. Laparoscopic cystotomy is less invasive than surgical cystotomy. Extracorporeal shock wave lithotripsy can be used for nephroliths and ureteroliths. Nephrotomy, pyelotomy, or urethrotomy may be recommended in certain situations. This article discusses each technique and gives guidance for selecting the most appropriate technique for an individual patient.

Changing paradigms in the treatment of uroliths by lithotripsy.

Surgery remains a common procedure for removal of uroliths from the lower urinary tract of dogs. Incorporation of intracorporeal laser lithotripsy and extracorporeal shock wave lithotripsy has provided impetus for a paradigm shift in the way veterinarians manage urinary stones, however. These minimally invasive techniques provide a successful alternative to surgical urolith extraction.

Use of electrohydraulic lithotripsy in 28 dogs with bladder and urethral calculi.

BACKGROUND: Electrohydraulic lithotripsy (EHL) has been used as an alternative to cystotomy in human medicine to remove urinary calculi. This prospective study evaluated the efficacy and safety of EHL to remove urinary calculi in dogs. HYPOTHESIS: EHL is an efficient and safe method of treatment of bladder and urethral calculi in dogs. METHODS: Dogs presented between January 1, 2005 and June 1, 2007 with lower urinary tract calculi diagnosed by radiographs or ultrasound examination were included in the study. Physical examination, CBC, biochemistry, urinalysis, and urine culture were performed at presentation. EHL and voiding urohydropulsion were performed under general anesthesia. Patients received IV fluids for 12 hours after which they were rechecked by ultrasound examination and discharged with antibiotics and anti-inflammatory drugs for 5 days. All patients were reevaluated 1, 3, and 6 months after presentation by physical examination, urinalysis, and ultrasonography. RESULTS: Twenty-eight dogs (19 males, 9 females) presented with bladder or urethral calculi or both underwent lithotripsy. Their median weight was 8.3 kg. Calcium oxalate calculi were present in 22 dogs, struvite in 4, and mixed calculi in 2. Fragmentation was done in the bladder (23 dogs) and in the urethra (12 dogs). Calculus-free rate was higher for urethral than for bladder calculi in males and higher for bladder calculi in females than in males. No major complications were reported. Twelve dogs relapsed within 6 months. CONCLUSIONS: Results of this study support the use of EHL as a minimally invasive treatment for bladder calculi in females and for urethral calculi in male dogs.

[Focused extracorporeal shock wave therapy in an isolated calcification in the equine ligamentum nuchae--case report]. / Einsatz der fokussierten extrakorporalen Stosswellentherapie bei einer isolierten Kalzifikation im Bereich des Ligamentum nuchae beim Pferd--Fallbericht.

In recent years extracorporeal shock wave therapy (ESWT) is used in veterinary medicine especially in equine orthopedics. Different ESWT generators are commonly used in equine medicine with varying energy density and depth of penetration. The presented case report described the treatment of a ligamentum nuchae calcification with focused extracorporeal shock wave therapy with SONOCUR Plus generator combined with SONOLINE Prima ultrasound. Negligible adverse effects, the non-invasive character of the treatment, the time-saving therapy, and the positive results make the focused extracorporeal shock wave therapy to an useful application.

Extracorporeal shockwave therapy in a dog with chronic bicipital tenosynovitis.

A 15-month-old, spayed female, Bernese mountain dog was presented to the Institute of Small Animal Surgery at the University of Zurich because of chronic left forelimb lameness. The referring veterinarian diagnosed pain in the left shoulder region and had treated the dog with systemic non-steroidal anti-inflammatory drugs and restricted exercise for a two-week period. The follow-up examination revealed only minimal improvement and therefore, the dog was referred for further diagnostic evaluation. Chronic bicipital tenosynovitis and tendinitis of the infraspinatus muscle was diagnosed based on survey radiographs, arthrography, ultrasound, computed tomography (CT), and synovial fluid cytology. The dog underwent three sessions of extracorporeal shockwave therapy and substantial clinical improvement was observed. On follow-up examinations, only mild left forelimb lameness was evident following exercise, and changes in the intertubercular groove and at the supraglenoid tuberosity appeared less active on radiographs and CT. However, six months following treatment, mild degenerative joint disease was apparent.

Effects of extracorporeal shock wave therapy on bone.

Extracorporeal shock waves have been used for 30 years to fragment uroliths for nonsurgical treatment for urolithiasis in humans. Applied to bone, shock waves delivered at the appropriate energy and pulse number, can stimulate osteogenesis. In Europe, shock waves are routinely used to treat nonunions in humans despite poor understanding of the mechanism of action. Shock wave therapy has also been used clinically in horses. Preliminary experimental studies indicate that shock wave therapy does not damage soft tissue in the distal aspect of the equine limb and can stimulate osteogenesis throughout the depth of the near cortex of the metacarpus and metatarsus.

Ballistic shock wave lithotripsy in an 18-year-old thoroughbred gelding.

Prolonged postoperative recuperation time and restricted exercise were circumvented by using ballistic shock wave lithotripsy to break up an 8-cm diameter vesical calculus and by flushing out the sand-like residue under epidural anesthesia with the horse standing. Recovery was uneventful.

Cholelithiasis and cholecystitis in a dairy cow.

A 9-year-old Holstein cow was evaluated for colic and decreased milk production of 2 days' duration. Preoperative serum biochemical results suggested hepatic damage and cholestasis. On the basis of persistent signs of abdominal pain that were nonresponsive to analgesics, exploratory laparotomy was performed. The cow was found to have choleliths. Cholecystocentesis was performed, and samples were submitted for cytologic examination and bacterial culture. Bacterial culture yielded Escherichia coli and Clostridium perfringens. Using digital pressure, choleliths were reduced until they could be passed through the bile duct into the duodenum. The cow recovered from surgery without complications, and all serum biochemical test results returned to reference ranges. Cholelithiasis is rare in cattle but can result in signs of abdominal pain.

Primer tratamiento de litotripsia extracorporal en un perro usando un generador de ondas de choque experimental hecho en México / First extracorporeal shock wave lithotripsy in a dog using an experimental device made in Mexico

La litotripsia extracorporal por ondas de choque ha sido usada con éxito para fragmentar cálculos renales y ureterales en humanos desde 1980. En este artículo se informa de un tratamiento de litotripsia estracorporal en un perro con un cálculo no inducido implantado en la vejiga, usando un generador de ondas de choque experimental hecho en el país. Después de dos tratamientos el perro eliminó todos los fragmentos y las arenillas del cálculo. Este artículo puede representar la base para el desarrollo de la litrotipsia extracorporal para animales usando equipos relativamente baratos y fáciles de construir