Surgical management of urolithiasis in small ruminants

Twenty-one cases of urolithiasis in small ruminants were examined to evaluate the efficacy of various surgical treatments. Of 21 cases, all but 1 had multiple calculi. Urethral process amputation and medical therapy either did not relieve the obstruction or provided only temporary relief (< 36 hours) in 14 of 16 cases. In 2 cases, obstruction recurred in 1 year and 4 years, respectively, after urethral process amputation. Ten of 13 animals that had perineal urethrostomy (PU) experienced short-term complications, including postoperative hemorrhage, dehiscence of the surgical wound, and subcutaneous accumulation of urine. Urethral stricture occurred in 7 of 9 animals in which follow-up information was obtained, and long-term survival was 55%. Cystotomy alone was performed on 8 of 21 cases, and 7 of 8 (88%) were healthy at the time of follow-up. In order to relieve the obstruction with cystotomy alone, multiple attempts at normograde and retrograde flushing were required. Cystotomy allowed removal of multiple calculi, bidirectional flushing of the urethra, and posed less risk for short-term postoperative complications and urethral stricture. These data suggest that cystotomy was more effective than PU for the management of urolithiasis in small ruminants.