The Use of Pneumatic Impact Lithotripsy in a Laparoscopic Retrieval Pouch for Removal of Large Cystoliths in Two Female Horses.

This research article discusses the novel use of pneumatic impact lithotripsy, a technique used to break down bladder stones, within a laparoscopic retrieval pouch for the treatment of two female horses suffering from large bladder stones (cystoliths). The study demonstrated this methodology as a viable, time-efficient, and minimally invasive surgical option for the treatment of equine cystoliths.

Stating the Problem

• The research focuses on two mares that presented a common issue of urinary incontinence, intermittent hematuria, or blood drops in urine, and urine scalding, skin inflammation caused by consistent contact with urine.
• Through physical examination techniques including transrectal palpation and cystoscopy, both horses were diagnosed with large type I cystoliths, bladder stones greater than 10 cm in diameter.
• The commonly known complication of such cystoliths is the potential for local inflammation and focal ulceration, or sores, in the bladder lining.

Approach to the Problem

• Both horses underwent an operation involving pneumatic impact lithotripsy, a technique which uses pressurized air to break stones into smaller pieces, within a laparoscopic retrieval pouch, a small bag used in minimally invasive surgeries for removing tissues or stones from the body.
• This operation was performed under cystoscopic guidance, allowing for real-time visual monitoring of the surgery, while the animals stood under sedation and local anesthetic.
• A laparoscopic retrieval device, a specialized tool for laparoscopic surgeries, was used to guide the bladder stone into the retrieval pouch where it was then broken down by a customized steel rod scaler.

Results and Implications

• This surgical method demonstrated to be time-efficient as it took 42 and 31 minutes for each horse, respectively.
• Following the procedure, both horses were able to return home on the same day and showed significant improvement, showing normal urinary functions throughout the follow-up periods of 27 and 19 months, respectively.
• Therefore, the use of pneumatic impact lithotripsy in a laparoscopic retrieval pouch presented as a successful, time-saving, and minimally invasive surgical option for treating large cystoliths in horses.