Surgical Approaches to Bladder Stones

Surgical approach of bladder stones will focus on the male horses. Females have a short, wide accessibles urethra that allows manual removal, urethral sphincterotomy with or without physical crushing before removal of the stones and flushing of the bladder and urethra.

In males, surgical approaches are more challenging and reported techniques are as follows: laparocystotomy with or without laparoscopy; physical crushing of the calculus through perineal urethrostomy; Gockel’s cystotomy; electrohydraulic/laser lithotripsy.

The most common clinical sign associated with urolithaisis in the male is haematuria. Other clinical signs include stranguria, pollakiuria, dysuria and ventral abdominal/preputial urine scalding.

Urolithiasis can be confirmed with one or more diagnostic techniques such as rectal palpation of the urinary bladder, ultrasonography and cystoscopy. The latter technique is the most relevant as it quantifies the number of the calculi present.

Once urolithiasis has been confirmed, surgical options should be discussed with the owner. If financially feasible, most of the publications recommend surgical management using laparocystotomy.

Although technically challenging, this procedure has the advantage of removing the calculus in one piece without fragmentation. The fragmentation of urinary calculi, as performed when using perineal uretrostomy, has been associated with a higher risk of recurrence because of incomplete removal of debris from the urinary bladder or urethra.

Owners not electing for laparocystidotomy have the following options: perineal urethrotomy with fragmentation of the calculus, Gokel’s cystotomy, and laser or electrohydraulic lithotripsy.  [...]