EXPERIMENTAL EVALUATION OF URINARY BLADDER MARSUPIALIZATION IN THE MALE LAMBS AND CALVES. İbrahim Canpolat 1 Sait Bulut 1

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1 EXPERIMENTAL EVALUATION OF URINARY BLADDER MARSUPIALIZATION IN THE MALE LAMBS AND CALVES İbrahim Canpolat 1 Sait Bulut 1 1 Department of Surgery, Veterinary Faculty, Firat University, Elazig, 23119, Turkey SUMMARY In this study, marsupialization was performed experimentally in six male lambs and six calves. The male lambs were found to be anatomically more suitable to marsupialization. In calves, the unsuccessful results with an incidence of death were recorded. As the calves had anatomically a stretched abdominal wall this increased a tension on the sutures that fixed the urinary vesicle to the abdominal wall and finally resulted in the rupture of the sutures and leakage of the urine in the abdominal cavity. In male lambs, it was found that the situation of abdominal walls was suitable for suturing the urinary bladder to it. Therefore, the operation become successful and the fistula established during this operation remained patent during 6 months. The prolonged complications of marsupialization was dermatitis due to continuing urinary leakage and gradual stenosis of the fistula hole. It was determined that erytema and scald dermatitis began to occur in the skin one month after surgery and these lesions increased and associated with wound in the abdominal regions in 3-6 months. The performed marsupialization opening gradually narrowed and finally obliterated in 6 months. It was concluded that marsupialization technique could be used as an treatment means in the male lambs with uretral obstruction INTRODUCTION Urethral obstruction occured up to 10 % of male sheep (Hay 1990) and 3-10 % of male cattle (Hawkins 1965, Kimbeling and Arnold 1983). Mortality rates in untreated cases may be 100 % (Hay 1990). Several surgical techniques to correct the urethral obstruction had been described such as local stone removal, urethrostomy, penile amputation, ischial urethrotomy, fistulation and catheterisation of bladder (Cockroft, 1993, Gasthuys et al., 1993, Haven et al., 1993, Rakestraw et al.1995). In a retrospective study, bladder marsupialization was evaluated as a primary prodecure to study the long-term outcome when compered to other surgical procedures or when financial consideration dictated selection of a more economical procedure (May et al., 1998, May et al.,2002). The purpose of the study reported

2 here was to provide a clinical evaluation of the effects of urinary bladder marsupialization in the male lamb and calf. MATERIALS AND METHODS In this study, six male Akkaraman bred, 3-6 month old lambs and six male crossbred 3-6 month old calves were used. About 12 hrs before bladder marsupialization, each lamb and calf were anesthetized with Xylazine hydrochloride (Rompun, Bayer) at the dose of 0.1 mg/kg bodyweight was administereted by intramuscular route to obtain adequate sedation. The urethral process in the lambs and the ischial portion of the urethra in calves were ligated with nonabsorbable suture material to simulate urinary outflow obstruction. After Xylazine hydrochloride sedation and local anesthesia (Prilocaine hydrochlorur, Citanest, AstraZeneca), the lambs and calves were positioned in dorsal recumbency for abdominal surgery. A 8-10 cm paramedian laparatomy incision was made in the caudoventral abdomen approximately 3 cm lateral and parallel to the prepuce. The apex of the urinary bladder was identified and exterioized. Bladder decompression was performed using a 18 gauge needle. The seromuscular layer of the bladder was circumferentially sutured to the rectus abdominis fascia with interrupted horizontal mattress sutures of 2-0 chromic catgut after placement of anchoring sutures at the most lateral, medial, cranial, and caudal aspects of the bladder. The margins of the cystotomy incision were sutured to the abdominal skin with simple interrupted sutures using 2-0 polydioxanone. The laparotomy opening was closed in three layers, with closure of abdominal fascia and subcutaneous tissue with simple continous patterns and the skin with simple interrupted suture pattern (Fig.1). The lengths of all incisions and the final stomal diameter were measured and recorded. Postoperative administrations of Penicilline- Streptomycine and Flunixin meglumine were continued for 7 and 3 days respectively. Physical examination was performed daily for 7 days. At weekly intervals, the lambs and calves were brought to the hospital for evaluation of marsupialization area, ultrasonographic and physical examination. Stomal diamater measurements were recorded and a subjective score for urine scald dermatitis was made as described by May et al. After 180 days, all animals were euthanized and necropsied.

3 Fig 1. Urinary bladder marsupialization using a single-incision technique. RESULTS A median weight loss of 1.5 kg occurred between days 0-60 and median weight gains occurred at other intervals in lambs. Ligation of the urethral process successfully stimulated acute, short-term urinary outflow obstruction. Clinical signs of urinary tract obstruction and bladder rupture were not observed. Surgical time ranged from min (median, 37 min) in single incision technique. Subjectively, marsupialization was simple and required minimal surgical instrumentation. The ultrasonographic appearence of kidneys at the preoperative examination unchanged in all animals. Five of the 6 lambs survived to day 180. Lamb 3 was found dead on day 20 and suppurative cytitis and peritonitis were observed during necropsy. No lambs had complete stomal stricture on 180th day. Mild urine scald dermatitis appeared in all lambs after a month, moderate scald between days(fig 2), marked scald between days, severe scald between days(fig 3). No sign of cytitis or ascending urinary tract infection were observed in any lambs. Suturing of the bladder to abdominal wall was diffucult due to severe tension in calves. Calf 4 died due to peritonitis and uremia at day 10. It was observed presence of urine discharge passed through the suture opening. In all other calves, the stricture was developed and the stomal opening completely closed in three weeks. On necropsy examination after 180 days, the bladder had become tubular in shape in all the lambs (Fig 4). The omentum adhered to laparotomy incisional line in all animals. All

4 urinary tract organs were grossly normal. Stomal diamater decreased (P<0.001) significantly from day 0 to day 180. Mean stomal diamater was 3 cm on day 0 and 0.65 cm on day 180. Fig 2: The modarate scald dermatitis appeared around stoma at 90 days in lamb 4 Fig 3: The severe scald dermatitis appeared around stoma at 180 days in lamb 4

5 Fig 4: The bladder had become tubular in shape in the lamb 2 DISCUSSION Urinary bladder marsupialization caused no adverse effect to the overall health of the lambs. On the other hand, the procedure was not recommended in calves. The use of urinary bladder marsupialization ha been adopted for the treatment of obtructive urolithiasis in 9 cattle. Seven animals died or were euthanatized because of progresive uremia within 14 days of surgery (Gasthuys et al., 1993). The use of urinary bladder marsupialization had been reported for the treatment of obtructive urolithiasis in 19 goat with satisfactory result in 15 cases (May et al., 1998). The use of urinary bladder marsupialization had been reported in 6 goats with experimentally induced urethral obstruction, stomal stricture occured only in a goat at 120 days and all other goats had mild urine scald dermatitis (May et al, 2002). In this study, stomal stricture was not observed but progressive urine scald dermatitis was found in all the animals. Urinary bladder marsupialization by a single-incision technique in 2 bucks and 2 rams resulted in 3 animals recovering succesfully (Helminen 1986). This technique was used in the present study with the success of 5 out of 6 male lambs. But not useful in calves. The surgical time of urinary bladder marsupialization by a double-incision technique in goats was median 57 min (May et all., 2002). In this study with a single-incision technique in lambs, the duration was calculated as median 37 min. The single-incision technique was more easy and taken less time to perform. Urinary bladder marsupialization had a good prognosis for long-time (150 days) resolution of distended bladder in lambs, but this procedure was unacceptable for calves.

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