Percutaneous ultrasound-guided pyelography aided diagnosis of ectopic ureter and hydronephrosis in a 3-week-old filly

Surgery of the Equine Urinary Tract

Urinary surgery in the horse may be challenging. More straightforward procedures, such as urinary bladder or urachal defects, do not usually require specialized equipment or imaging, although laboratory work is helpful. Congenital or acquired conditions of the ureters or kidneys may necessitate advanced diagnostic work-ups including advanced imaging /or and minimally invasive procedures. Some surgery of the lower urinary tract is done in the sedated, standing adult horse. Surgery involving the kidney typically requires general anesthesia. Laparoscopy and associated tools are frequently used. Although many of the surgical procedures discussed are quite involved, they are becoming more commonplace.

Imaging of the Urinary Tract

This article provides a comprehensive review of imaging techniques used to evaluate the equine urinary tract. This overview includes officially recognized modalities and new applications reported in the most current literature. Technical aspects and indications for use of endoscopy and ultrasonography are highlighted. Normal endoscopic and ultrasonographic appearance of the upper and lower urinary tract is described, with characterization of common abnormalities found in patients with hematuria, stranguria, and renal failure. Visual examples of several pathologic conditions from clinical cases are provided. An outline of the main features, potentials, and limitations of radiography, nuclear scintigraphy, and computed tomography is provided.

Urogenital Hypoplasia and X Chromosome Monosomy in a Draft Horse Filly

A 5-month-old draft horse filly was presented with incontinence and severe perivulvar dermatitis, which developed during the previous 2 months. Left-sided ectopic ureter entering in the caudal vaginal lumen, signs of cervix hypoplasia, and urine accumulation in the uterus were found during initial vaginal endoscopy. Therefore, a left ureter-nephrectomy was conducted under general anesthesia. Additionally, a cytogenetic examination was performed, which showed a XO monosomy with a 63,X/64,XX mosaic. This is the first case report presenting a chromosome abnormality in a draft horse filly combined with a left-sided ectopic ureter. Cytogenetic evaluation is recommended in any female horse with developmental abnormalities of the cervix, uterus, ovaries, or with irregularities of estrus.

A minimally invasive surgical technique for ureteral ostioplasty in two fillies with ureteral ectopia

CASE DESCRIPTION 2 fillies, aged 3 months and 1 month, were examined because of urinary incontinence and urine scalding. CLINICAL FINDINGS In horse 1, ultrasonography did not reveal any structural abnormalities of the kidneys; however, unilateral ureteral ectopia was diagnosed cystoscopically. In horse 2, CT revealed bilateral nephropathy, bilateral distended ureters (up to 3.6 cm in diameter), and bilateral ureteral ectopia. Cystoscopy revealed intramural ureteral ectopia with abnormally caudally positioned ureteral ostia in both horses. TREATMENT AND OUTCOME Ureteral ostioplasty was performed under cystoscopic guidance. Laparoscopic scissors (horse 1) or a vessel-sealing device (horse 2) was introduced, and the tissue separating the intramural portion of the ureter from the urethra and bladder was cut longitudinally in a cranial direction toward the trigone. After surgery, both horses were continent and voided normal streams of urine for the duration of the follow-up periods of 20 and 9 months for horse 1 and horse 2, respectively. CLINICAL RELEVANCE Cystoscopically guided ureteral ostioplasty provided an effective and minimally invasive surgical treatment option for correction of ureteral ectopia in 2 fillies.

Sondagem da pelve renal guiada por cistoscopia em éguas

RESUMO O objetivo deste trabalho foi padronizar a técnica de acesso à pelve renal por meio de sondagem ureteral guiada por cistoscopia em éguas. Foram utilizados oito animais, de raças variadas, com peso médio de 439kg. As éguas foram sedadas e mantidas em tronco de contenção para a realização da cistoscopia com endoscópio flexível. Após identificação do óstio ureteral esquerdo, uma sonda de polietileno foi introduzida em seu lume, até a pelve renal. A localização da sonda no rim foi confirmada por meio de ultrassonografia transcutânea. Foram coletados 3mL de urina, de forma asséptica, para citologia e cultura bacteriana. Todas as amostras obtiveram resultados negativos na cultura e análise do sedimento urinário. Nenhum dos animais apresentou quaisquer complicações após a sondagem. Este estudo demonstrou que a coleta de urina diretamente da pelve renal em éguas, com auxílio da cistoscopia na realização da sondagem ureteral, consiste em um procedimento viável e seguro.

Bilateral ureterocystostomy to correct left ureteral atresia and right ureteral ectopia in an 8-month-old standardbred filly

OBJECTIVES

To report the diagnosis and outcome after surgical correction of bilateral distal ureteral anomalies in a Standardbred filly.

STUDY DESIGN

Clinical case report.

ANIMAL

An 8-month-old, 310 kg Standardbred filly with left ureteral atresia and right ureteral ectopia.

METHODS

The filly was admitted for evaluation of incontinence since birth and severe urine scalding of the hindquarters. Diagnosis was made by both direct (cystoscopy and vaginoscopy) and indirect (intravenous pyelography, ultrasonography, and scintigraphy) evaluation of the ureters and bladder. The filly had left ureteral atresia, hydronephrosis, and decreased left-sided renal function and right ureteral ectopia before surgery. Surgical correction was performed on the left by an end-to-side stapled anastomosis technique and on the right by a side-to-side hand-sewn anastomosis technique.

RESULTS

Surgical correction was successful. The filly had no postoperative complications and remained continent 18 months after surgery. Left renal function improved.

CONCLUSION

Ureteral anomalies can be successfully repaired in larger (>300 kg) foals and some renal function may be restored after surgical correction.

CLINICAL RELEVANCE

Scintigraphy should be considered in diagnosis of ureteral anomalies, assessing renal function, and determining prognosis for horses with hydronephrosis caused by ureteral ectopia and atresia.

Treatment of a second carpal bone fracture by removal under ultrasonographic guidance in a horse

OBJECTIVE

To report an unusual 2nd carpal bone (C2) slab fracture and its treatment, using an ultrasonographically assisted, minimally invasive arthrotomy technique, for fragment removal.

STUDY DESIGN

Case report.

ANIMALS

An 11-year-old crossbred Warmblood gelding.

METHODS

A bone fragment, spanning the height of C2, identified on the palmaromedial aspect of C2 was demarcated intraoperatively using ultrasonographically guided needles and removed by arthrotomy.

RESULTS

Fracture fragment removal was achieved using a small, ultrasonographically guided arthrotomy. The horse has become sound after treatment and returned to the previous level of pleasure riding activity.

CONCLUSIONS

Perioperative ultrasonography was used to delineate and facilitate removal of an unusual slab fragment of C2, through a minimally sized arthrotomy. Despite the presence of pancarpal osteoarthritis and partial involvement of the medial collateral ligament, the prognosis appeared to be satisfactory for this pleasure riding horse.

CLINICAL RELEVANCE

Ultrasonographic guidance may be used to optimize the approach to C2 articular bony fragments that may not be observed using arthroscopy.