EQUINE VETERINARY EDUCATION Equine vet. Educ. (2020) 32 (8) 399 doi: 10.1111/eve.13064_1


Case Report


Transurethral intraluminal closure of a caudally located bladder neck tear in a standing mare


M. D. Hall†* and D. H. Rodgerson‡ †Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, Georgia; and ‡Hagyard Equine Medical Institute, Lexington, Kentucky, USA


*Corresponding author email: mark.hall@ucdconnect.ie Keywords: horse; surgery; urinary tract


Summary This case report describes a minimally invasive transurethral approach to repair a caudally located, ventral tear in the neck of the bladder in a standing mare. The mare was diagnosed with a ruptured bladder 16 h post partum based on clinical signs, transabdominal ultrasonography, peritoneal fluid and serum biochemistry and cystoscopy. Surgery was performed 19 h after admission. The mare was


restrained in standing stocks and sedated with detomidine hydrochloride (Dormosedan, 40 mcg/kg bwt) i.v. and butorphanol tartrate (Torbugesic, 0.01 mg/kg bwt) i.v. Sedation was maintained with boluses of i.v. detomidine and i.v. butorphanol as required. Caudal epidural anaesthesia was performed with 1.5 mL xylazine (100 mg/mL), 0.3 mL mepiva- caine hydrochloride (20 mg/mL) diluted to 9 mL with sterile water. Faeces were manually evacuated from the rectum and the mare’s tail was restrained dorsally using a rope. The vulva, perineal region and anus were prepared preoperatively with Iodine scrub solution (Betadine). The operating surgeon was positioned behind the mare. A


sterile disposable foil large animal vaginal speculum (Henry Schein) was introduced into the urethra. A 10 mm diameter, 31 cm in length laparascope (Hopkins forward-oblique telescope 30°) was introduced through the vaginal speculum and each positioned such that the defect in the region of the neck of the bladder could be visualised (Fig 1). A surgical assistant stood to the right and another to the left of the operating surgeon to aid in manipulation of the vaginal speculum and laparoscope. The operating surgeon introduced a Karl Storz Macro needle holder grasping a cutting needle with


399


Fig 2: Karl Storz Macro needle holder grasping a cutting needle with 0 Polyglactin 910 (Vicryl).


0 Polyglactin 910 (Vicryl)(Fig 2). Beginning at the cranial aspect of the tear, the needle was passed through both wound edges and grasped with a second Karl Storz Macro needle holder. The needle was then passed through a small preformed loop in the opposite end of the suture. The edges of the wound were apposed in a cranial to caudal direction using 0 Polyglactin 910 (Vicryl) in a simple continuous pattern. The Karl Storz Macro needle holders were removed and the wound closure evaluated. A 30 French Foley urinary catheter was placed transurethrally into the bladder immediately post- operatively. The surgical time was 30 min and no complications were encountered. The mare has shown no signs of urine pooling, urine dribbling or cystitis since the operation. She is alive at the time of submission (130 days post-operatively).


Key points


• Advantages of this technique include the avoidance of general anaesthesia, the absence of any incision into the peritoneal cavity, and excellent surgical access to bladder tears which may otherwise have been challenging to reach.


• For lesions in the caudal area of the bladder, this standing transurethral technique provides a viable surgical approach with excellent visualisation and accessibility in mares.


Fig 1: Introduction of the instruments through the vaginal speculum. © 2019 EVJ Ltd


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