A non-invasive technique for standing surgical repair of urinary bladder rupture in a post-partum mare: a case report.
Abstract: An 11-year-old mare presented 36 hours after foaling with a ruptured bladder. Uroperitoneum was diagnosed on ultrasound and from the creatinine concentration of the peritoneal fluid. Bladder endoscopy demonstrated tissue necrosis and a rent in the dorsocranial aspect of the bladder. Following stabilisation, including abdominal drainage and lavage, the mare was taken to standing surgery. Under continuous sedation and epidural anaesthesia, and after surgical preparation, a Balfour retractor was placed in the vagina. Using sterile lubricant and moderate force, it was possible to insert a hand into the bladder. The tear was easily palpable on the dorsal portion of the bladder. Two fingers were inserted through the tear and used to provide traction to evert the bladder completely into the vagina where it could grasped with the surgeons other hand to prevent further trauma. A second surgeon could then visualise the entire tear and repaired this using a single layer of size zero PDS suture in a single continuous pattern. As soon as the bladder was repaired, it was replaced via the urethra. The mare did well after surgery and was discharged after 48 hours, apparently normal.This report is the first describing repair of the bladder without an abdominal incision or incision into the urethral sphincter. This greatly reduces the chance of possible complications such as urine pooling after surgery with the previously described standing technique or bladder trauma due to traction with abdominal surgery.
Publication Date: 2009-11-01 PubMed ID: 21851726PubMed Central: PMC3113760DOI: 10.1186/2046-0481-62-11-734Google Scholar: Lookup
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Summary
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This research describes a non-invasive surgical method to repair a ruptured bladder in a post-partum mare. The unique technique involved standing surgery without an abdominal incision or incision into the urethral sphincter, reducing the risk of complications.
Research Details and Patient Presentation
- An 11-year-old mare, which had foaled 36 hours prior, arrived with a ruptured bladder condition.
- The diagnosis of Uroperitoneum was confirmed through an ultrasound and evaluating the creatinine concentration in peritoneal fluid.
- Upon performing bladder endoscopy, tissue necrosis was observed along with a tear in the dorsocranial (towards the back and head) aspect of the bladder.
Treating the Mare
- The mare was first stabilized, which involved draining and cleansing the abdomen.
- Post stabilization, the mare was made to stand for surgery. The horse received continuous sedation and epidural anaesthesia for the procedure.
- A Balfour retractor was used to access the vagina, facilitating a hand to reach the bladder using sterile lubricant and moderate force.
- The tear in the bladder was located on the dorsal portion and could easily be reached with a hand. To avoid causing further trauma, a second surgeon held the bladder as it was brought entirely into the vagina.
Surgery Process and Post-op Recovery
- The tear in the bladder was repaired with a single layer of size zero PDS suture in a continuous pattern by the second surgeon.
- Upon complete repair, the bladder was reinstated via the urethra.
- The mare showed promising recovery signs post-surgery and was discharged after 48 hours, appearing normal.
Significance of the Technique
- The research details a first-of-its-kind method to fix a bladder rupture without making an abdominal or urethral sphincter incision, therefore greatly minimizing the chance of potential complications like post-op urine pooling or bladder trauma due to traction in abdominal surgery.
Cite This Article
APA
Stephen J, Harty M, Hollis A, Yeomans J, Corley K.
(2009).
A non-invasive technique for standing surgical repair of urinary bladder rupture in a post-partum mare: a case report.
Ir Vet J, 62(11), 734-736.
https://doi.org/10.1186/2046-0481-62-11-734 Publication
Researcher Affiliations
- Anglesey Lodge Equine Hospital, The Curragh, Co, Kildare, Ireland.
References
This article includes 6 references
- Corley KTT, Stephen JO. Appendix in: The equine hospital manual. Blackwell Publishing, Oxford; 2008. pp. 654–89.
- Divers TJ. Bladder rupture in adult horses. Large animal internal medicine 4. Smith BP, editor. St. Louis, Mosby; 2009. pp. 946–947.
- Higuchi T, Nanao Y, Senba H. Repair of urinary bladder rupture through a urethrotomy and urethral sphincterotomy in four postpartum mares.. Vet Surg 2002 Jul-Aug;31(4):344-8.
- Nyrop KA, DeBowes RM, Cox JH. Rupture of the urinary bladder in two postparturient mares. Comp Contin Educ Pract Vet 1984;6:S510–S513.
- Rodgerson DH, Spirito MA, Thorpe PE, Hanson RR. Standing surgical repair of cystorrhexis in two mares.. Vet Surg 1999 Mar-Apr;28(2):113-6.
- White KK. Urethral sphincterotomy as an approach to repair of rupture of the urinary bladder: A case report. J Equine Med Surg 1977;1:250–253.
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