Endoscopic-assisted electrohydraulic shockwave lithotripsy in standing sedated horses.

The research article reports on the use of transendoscopic electrohydraulic shockwave lithotripsy, a method to break down urinary stones in horses through a non-invasive procedure, and its success rate and complications encountered during the process.

Objective and Methodology

• The primary aim of this study was to test the effectiveness of using transendoscopic electrohydraulic shockwave lithotripsy for fragmenting urinary stones (calculi) in horses.
• The researchers employed a case series methodology involving 21 male horses that suffered from urinary cystic calculi, which ranged in size from 4cm to 11cm in diameter.
• The procedure was performed on standing sedated horses and involved introducing an electrohydraulic shockwave fiber into the animal’s urinary tract through the biopsy channel of an endoscope.
• The fiber was manipulated until it came into contact with the stone, then it was repeatedly activated to break down the calculus into fragments smaller than 1cm in diameter.
• The bladder was regularly flushed with saline solution to maintain visibility within the organ during the procedure.

Results and Findings

• Successful removal of the entirety of the calculus was achieved in 20 of the 21 horses (95%) involved in the study. The mean surgical time was approximately 168.6 minutes, with times ranging from 45 minutes to 450 minutes.
• For horses with a single calculus, it took 1-6 sessions of the procedure to completely fragment the stone.
• With the exception of one horse, in which a surgical procedure called perineal urethrotomy was required to remove the fragments, the calculus fragments were naturally excreted by the horses through the urethra.
• The postoperative complications observed included blood in the urine due to severe erosion of the bladder lining (2 horses), difficulty urinating due to a trapped fragment in the urethra (2 horses), and a small amount of urinary debris (1 horse). Unfortunately, one horse had to be euthanized because of a bladder rupture.
• The complete clearance of stones and urinary debris was confirmed in a postoperative endoscopy 20 days after the last session, with the range of confirmation period being from 3 days to 45 days.
• On a follow-up call after an average of 18.8 months (ranging 7-24 months), it was revealed that the horses had returned to their previous levels of activity, and there was no recurrence of clinical signs.

Conclusions

• The researchers concluded that transendoscopic electrohydraulic lithotripsy is an effective method for fragmenting low-density calcium carbonate cystic calculi in male horses.
• However, they also reiterated the possible complications and safety precautions that need to be taken into account when implementing this methodology.