Urinary Tract and Umbilical Surgery in the Horse

Can do endoscopy-> provides evaluation of the urine outflow from ureters  which should void every 20-45 seconds. Can catheterise the ureters which may provide evidence of uni/bilateral disease.

-Transrectal ultrasound for adults bladder.
-Transcutaneous ultrasound for foal bladder, kidneys and umbilicus.

Radiography may provide information about the proximal urinary tract in foals/yearlings.
Scintigraphy can be used to assess renal function.

Bladder Rupture

Usually seen in 1-5 day old foals. COLTS. Depressed, abdominal distension, colic, increased frequency, urination and small volumes of urine passed. 

Diagnosis-> HYPERK, hypochloride, sodium, metabolic acidosis and dehydration. 
With peritoneal fluid, there will be increased creatinine when compared against serum. Normal= clear fluid with a low SG. 
Stabilise-> get K+ below 5.5 before anaesthesia due to risk of arrhythmias. Rule out concurrent sepsis. Fluid therapy- IV saline/hartmanns +/- sodium bicarbonate to correct the metabolic acidosis/insulin. Use a slow abdominal drain, and check IgG statuus.

Tx- surgical repair via midline laporotomy +/- umbilicus/urachus resection. 

Urolithiasis 

Uncommon, adult male. Cystitis and obstruction. 
Can also use electrohydraulic/laster lithostripsy to remove. 

Umbilicus 

Assess if moist >24h (urine), swelling/pain or fever.

1. Patent urachus- fails to close/reopens with sepsis. Concurrent sepsis/septic arthritis/physitis. Moisture/urine dripping.
Tx- abs, topic cautery or surgical resection.
2. Sepsis- foal 1-2 weeks old. Swollen and painful. Tx- assess IgG, and concurrent conditions. Blood culture/haem etc. Surgical resect if no response to systemic abs.
3. Umbilical hernia- common. Most= small and resolve with time. Repair if LARGE or persists for >6 months, enlarges or has associated colic signs.