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Urolithiasis in Large Animals: Causes, Symptoms, Treatment

Learn about urolithiasis, formation of stones in urinary tract, risk factors, and clinical signs in large animals. Understand diagnosis, management strategies, and surgical options. Vital information for animal healthcare providers.

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Urolithiasis in Large Animals: Causes, Symptoms, Treatment

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  1. Urolithiasis Katie Simpson, DVM, MS, DACVIM Cross Timbers Large Animal Clinic April 30, 2016

  2. Urolithiasis • Definition • Formation of stones (calculi) in the kidneys, ureter, bladder, or urethra • Most commonly lodge in urethra • Can be anywhere in the urinary tract! • ‘Stones’ aka ‘calculi’ aka ‘uroliths’ • Concretions of solid mineral and organic compounds • Cause disease through • Direct trauma to urinary tract • Obstruction of urinary outflow

  3. Urolithiasis: The Basics • Males most affected • Long, narrow, non-distensible urethra • Often a herd problem • If one has it….assume they all might! • Significant losses • Monetary • Morbidity (sickness) • Mortality (deaths)

  4. Etiology: Types of Calculi • Struvite • Magnesium, ammonium, phosphate • Most common one in SR…C? • Apatite • Calcium & phosphate • Calcium carbonate • Legumes: clover, alfalfa

  5. Etiology: Types of Calculi • Silicate • Native grasses Western US • Diets high in corn gluten or soybean hulls? • Oxalate • Halogeton, sugar beet tops

  6. Causes & Risk Factors • Presence of a nidus • High concentrations of soluble minerals/salts • Diet (low calcium/high phosphorus, high magnesium) • Decreased water intake • Pelleted rations → less saliva → P excreted in urine • Concreting agents • Mucoproteins in grain • Basic urine pH • NORMAL in sheep, goats, camelids • Leads to certain common types of stones

  7. Risk Factors • Urethral diameter • Gender • Age at castration • Influenced by testosterone • Season • Winter: decreased water intake • Illness • Decreased water intake • Breed? • Texel, Scottish Blackface • Pygmy???

  8. Site of Obstruction • Sheep & goats • Urethral process & sigmoid flexure • Llamas & alpacas • DSF, distal penis, ischial arch

  9. Urolithiasis • Consequences • Urethral obstruction • Ruptured urethra • Urethral stricture (scarring) • Ruptured bladder* • Ruptured ureter • Hydroureter • Hydronephrosis • Rarely—ruptured kidney • Acute renal failure

  10. Clinical Signs, AKA What to look for… • Off feed • Depression • Weakness • +/- Ammonia smell to breath

  11. Clinical Signs… • Crystals on hairs around prepuce • Holding tail up/swishing tail • Pulsations of urethra below tail w/ no urine produced • Bloody appearance to urine* • Straining to urinate (can mistake for straining to defecate) • May lead to rectal prolapse • No urine production, or just dribbling • If not sure, put in a small dry area w/ no bedding

  12. Clinical Signs… • Colic signs • Vocalizing • Grinding teeth • Stretching abdomen • Stamping/shifting back feet • Kicking/looking at abdomen • ‘Standing at the pile’….

  13. Clinical Signs… • Ruptured urethra • Cool, non-painful swelling • Base of scrotum to prepuce • Ruptured bladder • Distention of abdomen—down low

  14. Physical Examination • Evidence of dehydration • Also toxin buildup in blood • Examination of penis • Integrity of urinary tract • Bloodwork • Electrolyte levels, acid-base status, toxin buildup • Evidence of infection

  15. Diagnosis • Species, gender, history, clinical signs • Physical examination • Analysis of urine • IF possible….incomplete obstruction or cystocentesis • Type of crystals/stones • Ultrasound • Urethra, bladder, kidneys, abdomen • Radiographs (x-rays) • Endoscopy

  16. Considerations • Location of obstruction • Concurrent inflammation/infection of bladder • Urethral diverticulum • Frenulum in young

  17. Management • Stage of disease • Urethral obstruction • Ruptured urethra • Ruptured bladder • ‘Water belly’

  18. Management • Class of animal • Commercial/salvage • Breeding • Pet

  19. Obstructed Urethra • Urethral process amputation • Sheep & goats • Catheter & flushing

  20. Catheterize Bladder • IF possible • Lavage w/ acidic solution • Most effective w/ phosphate stones

  21. Decision time! • Urethrostomy • Urethrotomy • Cystotomy/Cystostomy tube • Bladder marsupialization?

  22. Obstructed Urethra • Commercial/salvage animal • Urethrostomy • AKA ‘PU’ • AKA ‘Rerouting’ • They will urinate like a female

  23. Small Ruminants: ‘Rerouting’ • Also camelids? • PU’s stricture/reobstruct • Most w/in 1 year, some w/in 6 wks-months • Good for urethral ruptures • Time to clear bloodstream of toxins • If valuable as a breeding animal or pet…. DON’T DO THIS

  24. Small Ruminants • Most have multiple stones • Urethral process amputation alone cures < 25% long term • Many reobstruct w/in 3 days

  25. Abdominal Surgery: Urinary Bladder • Cystotomy • Remove all the stones • Flush the urethra • ± Leave in tube after surgery

  26. Breeding or Pet Animal: Gold Standard • Cystostomy tube • Also…for ruptured bladder

  27. Cystostomy Tube, or C-Tube • ~75% prognosis if non-ruptured • $1500-2000 • Aftercare is KEY!! • Stall confinement • Goats can chew out tubes • Ascending kidney infection possible…must keep sterile

  28. Ruptured Urethra • Salvage animal • Urethrostomy • Pet • Cystostomy/other • Breeding animal • Now salvage animal • Try C-tube?

  29. Ruptured Bladder • Majority are dorsal • May happen w/ restraint of camelids in chute • Also reported during palpation for pregnancy • Drain abdomen • Gradually

  30. Ruptured Bladder • Valuable breeding animal/pet/show • Drain abdomen/stabilize • Repair bladder – celiotomy • Achieve urinary patency • Or else use C-tube

  31. Bladder Marsupialization • NOT for breeding animals or indoor pets • Prognosis variable • Complications • Urine scald • Cystitis • Ascending UTI • Stricture • Reobstruction • Bladder prolapse

  32. Pain Management • Banamine, NSAIDs???? • USE WITH CAUTION • Butorphanol - $$$

  33. Prevention • Identify risk factors • Diet • Management • Water • Castration • Environment

  34. Prevention… • Diet • Ration analysis • Extension agents, nutritionists • DO NOT feed horse feeds to SR/C unless specifically instructed by a veterinarian • Mineral analysis of stone!! • Increase salt (water) intake • Salt licks/blocks/loose salt • Add 2-4% salt to diet if high grain

  35. Prevention: Diet • Phosphatic stones (MOST COMMON) • Dietary calcium:phosphorus ratio of 2:1 (or greater) • Magnesium content maintained at recommended levels • Decreased amount of pelleted feed • Increased amount of forages fed • Ammonium chloride

  36. Prevention: Diet • Calcium carbonate stones • Reduce alfalfa/legume consumption • Decrease calcium in diet • Ammonium chloride?????

  37. Prevention: Diet • Urinary acidification • Ammonium chloride • In feed up to 1% • Drenching • Bio-Chlor

  38. Prevention: Management • Water • Maximize water intake • CLEAN WATERERS • Summer: shade on waterers • Winter: dark liners or heaters on waterers* • Check automatic waterers frequently to ensure fxn • Shallow water containers = high turnover, less stagnant • Large pastures/many animals • Lots of waterers • Esp sheep

  39. Prevention: Management • Castration • Sheep & goats: castrate at 6-12 months old • Llamas & alpacas: castrate at 2-3 years

  40. Questions?

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