Tuesday, February 28th, 2017 | Filed under Medical

I love hearing about innovative ways to help the horses!  Bladder stones are rough, difficult to remove and very painful… The team at Idaho Equine Hospital figured out a new and different way to remove bladder stones and ease the auxiliary pain of mares in this difficult procedure!  Read about a successful and less invasive procedure Idaho Equine Hospital is using!

Tell your local vet!!!

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Someone thinks it is really time to go home from the hospital!

(from Idaho Equine Hospital FB page)

We had a really exciting case the other day. Reyna is a sweet little mare who came to us because her owner, Debbie Maxwell, had noticed discolored urine. When we tested her urine, we found that it had a high number of both white and red blood cells in it. We identified a stone in her bladder that measured 5.3 cm across.

This picture shows the stone sitting in the bladder prior to removal. This image was taken with the flexible endoscope which we passed through the urethra. We used the scope throughout the procedure so that we could see when we got the stone in the bag.

Ultrasound picture and measurement of the stone

Dr Liz Scott had recently learned about a new technique using an instrument designed for use in human laparoscopic surgery to facilitate removal of the stone. The instrument is inserted into the bladder through the urethra (following an epidural) and then the bag is extended out. The stone is scooped up into the bag and then the bag and the stone are pulled back out through the urethra.

Using the endoscope to look at the stone

Passing the pouch into the bladder

Bladder stones in horses can be very challenging to remove. In other species, they can be removed surgically by making an incision into the abdomen, and then cutting into the bladder and removing the stone. This procedure is very difficult in horses because of their size and because the bladder is located within the pelvic cavity. Thus to get to the bladder and the stone, the bladder has to be pulled and stretched until the surgeon can actually visualize it in the abdomen. This is pretty physically challenging as well as traumatic to the bladder. Recovery from abdominal surgery also takes about 3 months before the horse can return to training. With smaller stones in mares, we can sometimes remove them through the urethra using instruments or in older mares, sometimes a vet with a very small hand can actually reach their hand into the bladder through the urethra to grasp and remove the stone.

Picture of the stone, successfully captured in the pouch within the bladder prior to removal

Final product, the bladder stone in the pouch. You can see how rough the surface of the stone is.

Some celebratory hugs were definitely in order when Dr Scott and Dr Smith successfully extracted the stone!

When you do something this cool, you have to share it with all of your colleagues!

Bladder stones in horses are typically made up of calcium and the stones tend to be very rough and spiculated, as well as fairly fragile. Thus when we remove them, they can create a lot of damage and irritation to the urethra if they scrape along the lining of it. Additionally, the stones can break apart and retrieving crumbled pieces of stone can be very difficult.
The advantages of this new technique are many: 1) because the bag is smooth we avoid injuring the lining of the urethra as the stone is pulled out. 2)The entire procedure is done with the horse awake and standing with just an epidural so the recovery time is minimal. 3) With the stone in the sack, if it does break apart during removal, all of the pieces are contained and thus won’t be left behind in the bladder.

So you might think we are a little silly to be so excited about a bladder stone, but after struggling with how to deal with these without creating damage during removal for a long time, we are happy to have a better way to deal with them!!

Dr Avellar was super pumped to get to use the specimen retrieval pouch!

At this time, we have only used this technique in mares. Obviously, because of differences in anatomy, removal of bladder stones in geldings presents different challenges, but we are tickled to have had such great success with it in Reyna.
Below are several pictures from the procedure and the equipment that we used.

Such a beautiful little mare. So happy that her procedure was a success!!!

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