Original Article Buffalo Bulletin (April-June 2017) Vol.36 No.

MANAGEMENT OF URINARY OBSTRUCTION IN BUFFALO

CALVES BY TUBE CYSTOSTOMY

Rammehar Singh1, Satbir Sharma2, Deepak Kumar Tiwari1,*, R.N. Chaudhary1,

Sandeep Saharan2 and Anand Kumar Pandey2

ABSTRACT INTRODUCTION

Urinary obstruction in calves is a fatal Obstructive urolithiasis causes economic

disease that predisposes to high mortality rate, loss to the farmer due to loss of animals and
due to subsequent uraemia, unless the animal is cost of treatment. Factors such as diet, age,
subjected to emergency treatment for correction of sex, breed, genetic makeup, season, soil, water,
the obstruction. The present study was conducted hormone, mineral, and urinary tract infections
to evaluate tube cystostomy procedure for play an important role in the genesis of urolithiasis
management of urethral obstruction in 108 male (Udall and Chow, 1969). Urolithiasis describes
buffalo calves of age 1 to 5 months presented to the concretion of urinary calculi or organic
TVCC, LUVAS, Hisar (Haryana) from November, compound, which may lodge anywhere in the
2013 to February, 2014. Diagnosis of the disease urinary system but most frequently at the distal
was made with the history of anuria, distended end of sigmoid flexure in ruminants, and causes
abdomen, fluid thrill, abdominocentesis and subsequent urine flow obstruction (Radostitis et
ultrasonographic examinations. All the calves al., 2000; Kushwaha et al., 2011). Occurrence of
were treated surgically by tube cystostomy. urolithiasis is significantly more common in male
Simultaneously ammonium chloride 500 mg/ calves compared to females due to their anatomical
kg b. wt. was administered orally to dissolve the conformation of the urethral tract (Smith and
calculi. Out of 108 cases, 102 animals recovered Sherman, 1994).
uneventfully while six died within 24 to 48 h after Urethral obstruction in calves is a fatal
the surgery. disease that predisposes to high mortality rate,
due to subsequent uraemia, unless the animal is
Keywords: buffalo calves, buffaloes, Bubalus subjected to emergency treatment for correction
bubalis, tube cystotomy, urinary obstruction of the obstruction. Treatment of obstructive
urolithiasis is definitely surgical if the urethral
obstruction is complete (Haven et al., 1993; House
et al., 1996). Multiple surgical techniques have been
described for treatment of such affection including
1
Department of Veterinary Surgery and Radiology, College of Veterinary Sciences, Lala Lajpat Rai University
of Veterinary and Animal Sciences, Hisar, Haryana, India, *E-mail: dr.deepaktiwari@rediffmail.com
2
Teaching Veterinary Clinical Complex, College of Veterinary Sciences, Lala Lajpat Rai University of
Veterinary and Animal Sciences, Hisar, Haryana, India

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urethrotomy (Singh et al., 2010), urethrostomy was performed in the cases showing ‘water
(Stone et al., 1997), tube cystostomy (Williams belly’ appearance to confirm cystorrhexis, if any.
and White, 1991), bladder marsupialization (May Dehydration status was evaluated by physical
et al., 1998) and penile transaction with urethral appearance and skin tent test.
fistulation (Misk and Semieka, 2003) with little Intraoperatively the bladder was observed
practical value in treating obstructive urolithiasis. for its integrity and appearance (smooth, rough,
Tube cystostomy together with medical dissolution inflamed or necrosed). Animals which have
of calculi is considered an effective technique severe dehydration and uraemia were stabilized
for resolution of obstructive urolithiasis in small preoperatively with fluid therapy, corticosteroids
ruminants (Ewoldt et al., 2008). Advantages of and drainage of urine from abdominal cavity by
this technique include simple procedure, fewer centesis. Animals were prepared for aseptic surgery
recurrences, preservation of the reproductive and tube cystostomy was performed.
function of the animal (May et al., 1998), an
opportunity for the removal of cystic calculi, Surgical procedure
attains a full urethral patency in short period of All the animals were controlled in right
time and easy application in field conditions. The lateral recumbency with left hind limb flexed and
tube cystostomy gives passage for removal of abducted from trunk under mild sedation with
urine and prevents its accumulation which might xylazine hydrochloride 0.05 mg/kg intravenously.
lead to the rupture of bladder or the urethra (Dubey Prepubic paramedian left abdominal area was
et al., 2006). Animals with prolonged obstruction prepared for aseptic surgery. Site of incision was
have high morbidity due to subsequent uraemia. infiltrated with 2% lignocaine hydrochloride. A
Tube cystostomy, though reportedly successful linear skin incision was given (Figure 1). Fascia,
in small ruminants but it is not widely used in muscles and the peritoneum were separated by
large ruminants. The present study describes the blunt incision to open the abdominal cavity and
clinical signs, surgical management of obstructive the bladder was identified. The status of bladder
urolithiasis and its outcome in 108 cases of male was checked. If bladder was intact, a subcutaneous
buffalo calves. tunnel starting from anterior end of incision and
parallel to the prepuce was made by passing
straight artery forceps through the subcutaneous
MATERIALS AND METHODS tissue opening near the prepucial orifice (Figure
2). Foley’s catheter (#18G/ 20G) was passed
Animals through tunnel and stabbed at an acute angle into
A retrospective study was conducted the bladder at an avascular healthy area (Figure
on 108 male buffalo calves of age 1 to 5 month 3 and Figure 4). Once the urine starts to dribble
with obstructive urolithiasis presented to TVCC, through drainage channel then catheter bulb was
LUVAS, Hisar (Haryana) from November, 2013 inflated with sterile normal saline (30 ml) to fix
to February, 2014. Thorough clinical examination the catheter tip inside the bladder. Alternatively,
was conducted for vital parameters and the status in cases of ruptured urinary bladder, cystorrhaphy
of urethra and urinary bladder. Abdomenocentesis was done with chromic catgut (#1) followed by

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catheter placement after necessary debridement 2011).

(Figure 5 and Figure 6). Peritoneum, muscles and Majority of affected buffalo calves were
subcutaneous tissues was sutured with absorbable of the age of 2 to 4 months. Sharma et al. (2007)
suture material using simple continuous or lock recorded about 60% urethral obstruction occurs
stitch pattern. Skin was sutured with non-absorbable at an early age in ruminants. Gugjoo et al. (2013)
suture in routine manner. The free excess hanging reported that 84.61% affected buffalo calves were
Foley’s catheter was fixed at multiple sites on the of the age of 4 to 7 months. Duration of urine
ventral abdomen (Figure 7). retention was less than three days in 80% of all cases
Postoperatively, ceftriaxone 20 mg/ while more than five days in the 12%. In eighteen
kg and amikacin 5 mg/kg combination along buffalo calves, urinary bladder was ruptured which
with analgesic meloxicam (0.5 mg/kg) were were subjected to cystorrhaphy followed by tube
administered by intramuscular route for five days. cystostomy. The prevalence of urolithiasis may
Ammonium chloride 500 mg/kg per day orally was occur due to imbalance of mineral intake in feed as
given for one month. Local antiseptic dressing with the calves receive more cereals and concentrated
povidone iodine was done twice a day till healing. feeds during growing period. These feeds contain
The catheter was allowed to drain freely for three more level of phosphorus and magnesium and
days; thereafter the owner was instructed to clamp relatively less level of calcium and potassium, as
the urinary drainage outlet of catheter to block the a result may lead to urolithiasis (Unmack et al.,
urine flow for a brief period of 1 to 2 h in order 2011).
to determine the urethral patency. After the normal Clinical signs in calves with intact bladder
urination through urethra resumed, the time of were complete anorexia or inappetance, stranguria
blockage of catheter was increased systematically or anuria, reluctant to walk and frequent attempt
in installments up to 24 h in 3 to 4 days. Then for urination. In eight cases with a history of
catheter was removed by deflating the bulb. The urine retention for more than seven days, rectum
skin sutures were removed after 10 days. prolapse was accompanied due to constant
straining. In case of ruptured urinary bladder,
bilateral ventral distension of abdomen was noted
RESULTS AND DISCUSSION and on abdomenocentesis urine was present in
abdomen. Two calves with ruptured bladder were in
The occurrence of urolithiasis in peak recumbent position and had tachycardia with feeble
winter season i.e. during the period of study may heart sound. The dehydration was usually much
be due to the decreased water intake and deficiency more marked due to loss of water and electrolyte
of vitamin- A, arising from lesser availability of over a period of several days. This results in loss
green fodder (Radostits et al., 2000). Desquamated of skin elasticity, dryness of the skin and mucosa,
epithelial cells may be due to deficiency of vitamin and a reduction and retraction of the eyeball
A and infections (Jones and Miesner, 2009). This (enophthalmia) due to reduction in the volume of
may be related to water imbalance of animals, the postorbital fat deposits. Dehydration was more
during winter animals will not take much water in cases of ruptured urinary bladder which might
and produce concentrated urine (Kushwaha et al., be due to the loss of fluid from the interstitial and

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Figure 1. Skin incision. Figure 4. Stabbing of Foley’s catheter avascular

area on bladder.

Figure 2. Subcutaneous tunnel.
Figure 5. Cystorraphy in ruptured bladder.

Figure 3. Passing of Foley’s catheter at through

Figure 6. Placement of Foley’s catheter in bladder.
the tunnel

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solution. Catheter was removed at an average period

of 13 to 15 days after normal urination through
the external urethral orifice. Out of 108 cases,
102 animals recovered uneventfully and six died
within 24 to 48 h after the surgery. Complication
of tube cystostomy might be due to blockade of
tube with blood or tissue debris, urethral rupture,
tube dislodgement, and suppurative infection of
subcutaneous tunnel (Parrah et al., 2010). The free
flow of urine through the external urethral orifice
Figure 7. Fixing of Foley’s catheter on ventral
could be due to many factors which include post-
abdomen.
operative medication with anti-inflammatory drugs
that relived the spasm and inflammation of urethra.
intracellular spaces into peritoneal cavity.
Calculolytic agent like ammonium chloride
Late reporting of cases and indiscriminate
along with water reduced the pH of urine which
use of diuretic (Frusemide) by local practitioners
promotes the dissolution of calculi. Bypassing of
were the main cause of the rupture of the bladder.
urine through the Foley’s catheter may reduce the
The increasing pressure and distended stretching
calculi size and frequent occlusion of catheter with
of bladder wall results in inflammation, pressure
clamp could lead to flushing urethra of all debris
ischaemia, devitalization, thinning, trabeculae
and calculus material with urine.
formation and herniation of mucosa through the
musculature of the urinary bladder leading to
seepage of urine into the peritoneal cavity resulting
CONCLUSIONS
in uroperitoneum (Makhdoomi and Ghazi, 2013).
When the urinary bladder ruptures, it gives
Tube cystostomy along with oral
relief for 1 or 2 days then severe uremia and
administration of ammonium chloride has a good
uroperitoneum develops. Cystorrhaphy followed
success rate in management of cases of urinary
by tube cystostomy was done for all cases of
obstruction in buffalo calves with intact as well as
ruptured bladder.
ruptured urinary bladder.
Different post-operative complications
were observed in 66 cases which include
suppurative infection of subcutaneous tunnel
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