Delayed Urethral Obstruction after Migration of a Ballistic Pellet in an Alpine Wether

A one-year-old alpine wether was presented for emergency evaluation of stranguria. Diagnostics identified a moderately distended bladder and mild dehydration. Preliminary lateral radiographs identified two metallic structures consistent with projectile pellets in the pelvic and perineal regions and no evidence of radiopaque uroliths. A tube cystostomy was performed, and a contrast urethrogram revealed one of the pellets in the perineal region was in proximity to the urethral obstruction. Subsequent radiography and ultrasound identified the pellet as being within the lumen of the urethra. Examination of the trichotomized skin revealed two scars, including a scar over the paralumbar fossa in the region of the urinary bladder suggestive of a projectile injury. The pellet was removed by a perineal urethrotomy. The patient was able to spontaneously urinate after urethrotomy, passed a tube cystostomy challenge two weeks after surgery, and was discharged. No complications were reported. While uncommon in the veterinary and comparative medical literature, clinicians should consider the potential for projectile pellets to migrate into the urinary tract after initial injury.

Assessment of preoperative and postoperative l-lactatemia and clinical outcomes in goats undergoing tube cystostomy: A retrospective study of 34 cases (2015-2020)

BACKGROUND

Urolithiasis in small ruminants has a poor long-term prognosis, and long-term clinical outcomes are variable and unpredictable.

OBJECTIVES

To assess the accuracy of preoperative and postoperative blood l-lactate concentrations in predicting a negative outcome in goats undergoing tube cystostomy.

ANIMALS

Thirty-four male goats undergoing tube cystostomy.

METHODS

Retrospective study. Medical records of goats undergoing tube cystostomy from 2015 to 2020 were reviewed. Clinical variables recorded included signalment, procedures before surgery, urolith location and type, duration of hospitalization, and heart rate. PCV, plasma total protein, potassium, preoperative and postoperative blood l-lactate concentrations, preoperative and postoperative creatinine concentrations, and relative changes in blood l-lactate and creatinine concentrations over time were measured using heparinized blood. A negative outcome was defined as death or euthanasia from urolithiasis complications at 6 months after discharge. Negative outcomes as a function of independent clinical variables were evaluated using χ² or Fisher's exact tests, and multivariate logistic regression. P < .05 was considered significant.

RESULTS

Median (95% confidence interval) preoperative, postoperative, and the relative change over time of blood l-lactate concentrations were 3.3 mmol/L (2.2, 4.8), 1.0 mmol/L (0.7, 1.3), and 0.4 mmol/L (-3.5, 3.2), respectively. Preoperative (P = 1), postoperative (P = .14), and the relative change over time (P = .63) of blood l-lactate concentrations were not significant predictors of a negative outcome. Furthermore, all other clinical variables measured were not significant predictors of a negative outcome (P > .05).

CONCLUSIONS AND CLINICAL IMPORTANCE

Veterinarians should advise clients that clinical outcomes after tube cystostomy in goats are likely unpredictable.

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

OBJECTIVE

To describe risk factors for as well as type and frequency of complications, time to occurrence of complications, and mortality after temporary tube cystostomy alone or in combination with other surgical procedures, in goats, sheep, and pigs.

STUDY DESIGN

Retrospective case series.

ANIMALS

One hundred thirteen goats, eight sheep, and six pigs.

METHODS

Medical records of goats, sheep, and pigs that underwent temporary tube cystostomy alone or in combination with urethrotomy at the Veterinary Medicine Teaching Hospital, University of California-Davis from January 1, 2007 to December 31, 2018 were reviewed. Signalment, presurgical and surgical procedures, urolith type and location, and postoperative complications and mortality were analyzed. In goats, logistic regression analysis was performed to determine association between the presence of complications or mortality as well as candidate predictor variables.

RESULTS

Postoperative complications were reported in 54.9% (62/113) of goats, 37.5% (3/8) of sheep, and 50% (3/6) of pigs. The most frequent type of complication was reobstruction. Median (range) time to first complication was 171 days (1-2247) for goats. In sheep and pigs, the range for time to re-presentation for complications was 11 to 37 and 17 to 1182 days, respectively. Proportions of nonsurvivors after tube cystostomy were 48.4% (30/62) goats, 1/8 sheep and 2/6 pigs. No association between examined predictor variables and the occurrence of complications or mortality was detected.

CONCLUSION

The risk of complications and mortality after temporary tube cystostomy was high, especially in goats.

CLINICAL SIGNIFICANCE

Owners should be made aware of the high complication rate after temporary tube cystostomy alone or in combination with other procedures. Investigation of alternative approaches to manage obstructive urolithiasis in goats, sheep, and pigs should be considered.