EVALUATION OF SUPRAPUBIC CATHETERISATION OF URINARY BLADDER IN CALVES. İbrahim Canpolat * and Cihan Günay* * Department of Surgery, Veterinary Faculty, Firat University, Elazig,23119, Turkey SUMMARY In this study suprapubic bladder drainage was performed via the placement of Cistofix catheter (5 cases) and cleft-trocar and foley catheter (5 cases) to the urinary bladders of ten calves with experimentally obstructed urethra. Cistofix catheter did not reach to the urinary bladder unless it dilated enough. It was determined the complications like catheter displacement and obstruction in the cases in which the catheters were able to reach the urinary bladder. Therefore, it was suggested that the cistofix catheterization may not be a useful and practical method in calves. The catheterization with cleft-trocar and foley catheter found to be appropriate in all case no matter how much a distention the bladder wall could have. Just one case of displacement was found in the foley catheters inserted in the bladder under the guidance of the cleft-trocar. The bore of foley catheter was adequate for the urinary drainage. The foley catheterization under the guidance of cleft-trocar also provided a very satisfactory urinary drainage in the clinical cases with urolithiasis. INTRODUCTION Urethral obstruction occured in 3-10 % of male cattle (Hawkins 1965, Kimbeling and Arnold 1983). An incidence of 11.1 percent of urolithiasis in slaughtered bulls was reported by Rosmini et al. 1988). Several surgical techniques to correct the urethral obstruction had been described: Such as local stone removal, urethrostomy, penile amputation, ischial urethrotomy, fistulation of bladder, cystotomy and catheterisation of bladder (Cockroft, 1993, Gasthuys et al.,1993,haven et al.,1993, Rakestraw et al.,1995). This report describes the evaluation of suprapubic catheterisation of distended bladder by Cystofix catheter or cleft trocar with Foley catheterisation. MATERIALS AND METHODS This study was conducted on ten, 3-6 months old, crossbred male calves. Five calves (group 1) were catheterised with a catheter (CH 15) set with removable split cannula (12 cm) (Cistofix, Braun) and other five calves (group 2) were catheterised with a cleft-trocar and
Foley catheter (Fig. 1). Metal cleft-trocar (25 cm long), suitable for the passege of 18 CH Foley catheter was prepared. About 12 hrs before bladder catheterisation each calf was sedated with Xylazine hydrochloride (Rompun, Bayer) at a dose of 0.1 mg/kg. Analgesia of the surgical area and catheter region were achived by local infiltration anesthesia. In the ischial region the urethra was ligated with 2 simple interrupted pattern with nonabsorbable suture material to simulate urinary outflow obstruction in calves. After 12 hrs, distended bladder was seen, by an aid of ultrasonographic-guidence, the cistofix and cleft trocar were then introduced into the abdomen about 8 cm caudal of prepuce and 3-4 cm lateral of the linea alba and carefully extended until the tip was touching the ventral wall of the bladder. Using a thrusting action the trocar catheter was introduced into the distended bladder. The split cannula was removed and the catheter's balloon was then inflated in group 1. After cleft trocar was placed in the bladder, Foley catheter was pushed through its bore with a sterill Steinmann pin 2 mm diameter size into the lumen of the Foley catheter and than the cleft trocar were removed by gentle traction (Fig 2 and 3). The distended bladder was drained of urine through the Foley catheter in group 2. The laparotomy wound was closed and the Cistofix and Foley catheter were exteriorised through the wound and fixed in position with stay sutures. The ligation placed on the urethra was removed to terminate urethral obstruction. Sequential five-day courses of Penicillin-Streptomycin were given intramuscularly at the recommended dose rates. The catheter was removed seven days later by traction after the balloon was deflated and the animals urinated through the natural orifice. At weekly intervals, the calves returned to the hospital for ultrasonographic evaluation of urinary bladder, urine sample analysis, and physical examination. The animals recovered well three months later.
Fig 1: Cistofix catheter (up), Cleft-trocar and Foley catheter (down)
Fig 2: Placement of Foley catheter in urinary bladder via cleft-trocar under ultrasonographic guidence. Fig 3: Appearance of inplaced catheter and removed cleft-trocar
RESULTS AND DISCUSSİON The trocar was inserted with difficulty into the bladders of Cistofix administered cases. It was dislodged in three cases on the following day of the surgery and the foley catheter was replaced after cystotomy. In another case, the catheter was found to had been occluded at the 5th day of the surgery. The occluded catheter was cleared by infusing, normal saline solution with pressure. The cistofix remained in place in two cases for a week. In the second group, the cleft trocar was easily inserted in the distended bladder under the ultrasonographic guidance and through which the foley catheter was passed. In case of this group, the Foley catheter dislodged due to the deflation of its balloon and and it was replaced via cystotomy. The Foley catheter remained in place in the remaining cases during a week with no sign of complications. During the introduction of trocar and catheters, no traumatic effect occured in any abdominal organs. Additionaly, urinary tract infection was not noticed in both the groups. Suprapubic bladder drainage with Cystofix had been used for a long time in man (Bauer and Hartel 1978). The principal advantages of suprapubic drainage of the bladder compared with the transurethral indwelling catheter were holding back ascending infection of the urinary tract and avoidance of urethral trauma (Marx and Schmedt 1979). Complications did not occur if bladder distension was well ascertained, the catheter was accurately inserted and stringent aseptic precations were taken (Feiber 1983, Arvis et al 1982) Assesing the effectiviness of different urinary catheters in emptying the bladder, suprapubic catheter was found to drain the bladder relativelly well (Haylen et al.,1989). Comparison of suprapubic versus urethral catheters in the treatment of acute urinary retention in man concluded that patients presenting with acute urinary retention should be routinely treated by drainage using suprapubic catheters (Ichsan and Hunt 1987). Urinary tract infection and urethral stricture were seen with indwelling urethral catheters in dogs and cats. (Barsanti et al.,1985). Placement of a permanent cystotomy catheter should be considered in cases transitional cell carsinoma associated with urine outflow obstruction in dogs with good condition (Smith et al.,1995) In this study; the placement of Cistofix catheter in the calves to relieve urine outflow obstruction was found to be unsuitable because catheter displacement occured in three cases and catheter obstruction in one case. The later condition was belived to occur easily in the case with urolithiasis. The cleft-metal trocar readily reached and entered the distended bladder. The Foley catheter was inserted through the bore of the cleft trocar with an aid of pin and its balloon was inflated for this purpose. 18 CH catheter was found to be appropriate to
drain the urine with the no occurence of obstruction in any case. In just one case, the catheter was displaced as a result of balloon rotation. The technique described here for insertion of a Foley catheter through abdominal and bladder wall facilitates the catheterisation and avoids a big incision of the bladder and contamination of the peritoneum. This method of catheterisation in calves appeared to preserve the natural reproductive capacity of the calves. REFERENCES Arvis G,Constancis P,Perniceni T and Paoli D(1982)...Nouv Presse Med 11,20:1565 Barsanti JA, Blue J and Edmunds J(1985)...J Am Vet Med Assoc 187,4: 384 Bauer H and Hartel U(1978)...Anaesthesist 27,9:443 Cockroft,P.D.(1993)... Vet.Rec.132,486. Feiber H (1983)...Urologe 22,4:195 Gasthuys,F.,Steenhaut.M.,Moor,A. and Sarcu,K.(1993)... Vet.Rec. 133,522. Hawkins WW (1965)... J Am Vet Med Assoc 147,1321 Haven,MC,Bowman,KF,Engelbert,T.A and Blikslager,AT(1993)... Cornel Vet. Jan. 83(1)47. Haylen BT,Frazer MI and MacDonald JH(1989)...Br J Urol, 64,4:353 Ichsan J and Hunt DR (1987)...Aust NZJ Surg 57,1:33 Kimbeling,C.V and Arnold,K.S.(1983)...Vet. Clin.North Am. Larg. Ani.Prac. 5,637-655. Marx FJ and Schmedt E(1979)...Munch Med Wochenschr 121,49:1649 Rakestraw,P.C.,Fubini,S.C.,Gilbert,O.R. and Ward,J.O.(1995)...Vet. Surg. 24,498-505. Rosmini R, Morocchio L and Morelli A(1988)...Practisch Tierarzt 7,14. Smith JD, Stone EA, and Gilson SD(1995)... J Am Vet Med Assoc. 206,4:496-9