My horse has problems urinating—could urinary stones be the cause?

Urolithiasis, colloquially referred to as urinary stone disease, refers to the formation and deposition of various concretions in the urinary tract of horses. Although this disease occurs sporadically in horses, it can lead to serious symptoms and significant impairments. The deposits can occur in the form of crystals, grit, sand, or stones and are most commonly found (approx. 60%) in the urinary bladder. Geldings are more severely affected than stallions or mares.

INHALT
Cause and origin Symptoms Diagnosis Treatment Forecast Prophylaxis
Cause and origin

The exact causes of urinary stone formation remain unclear. The main component of urinary stones is calcium carbonate, which is why an excess of calcium and phosphorus in the body is suspected to be the trigger. However, it is known that certain factors promote the formation of urinary stones. These include urinary tract infections, urinary retention or tissue damage leading to a shift in pH, an excess of certain minerals in the urine, and mucus and dead cells that serve as crystallization nuclei. Bladder paralysis or bladder emptying disorders can lead to an excessive accumulation of sandy-loamy urinary gravel. This is referred to as sabulous (= sandy) cystitis.

Symptoms

Clear signs of illness are usually only observed once the urinary stones have reached a certain size and significant tissue damage has occurred. Affected horses exhibit increased and painful urination, bloody urine, dribbling urine, and in some cases mild colic symptoms.

In rare cases, large stones can completely block the urethra, preventing urination. The affected animals show severe colic symptoms and the increased pressure can ultimately lead to a rupture of the bladder or urethra. The symptoms stop abruptly, urine accumulates in the abdominal cavity and the animals become apathetic. Both the severe colic symptoms and the sudden change always constitute an acute emergency and require immediate veterinary treatment.

Diagnosis

After a detailed preliminary report and a general clinical examination, the veterinarian can already make a tentative diagnosis. This suspicion is usually confirmed by a rectal examination, as a bladder stone can be clearly felt by the veterinarian in the emptied bladder due to its size. A complete examination of the entire urinary tract should always be performed to detect any further stones or grit.

The exact diagnosis and precise visualization of the urinary stone(s) can finally be made with the help of transrectal ultrasound and endoscopic examination of the urethra and bladder (cystoscopy). Additional blood and urine tests can be used to determine the parameters of inflammation, the severity of the disease, possible bacterial involvement, and impairment of kidney function.

Urine stick test
A urine test can provide information about a urinary tract infection
Treatment

Sandy-loamy urinary gravel can be softened and flushed out by bladder irrigation. To date, there is no known drug therapy that dissolves calcium-containing urinary stones. The treatment of choice is therefore always surgical removal of the urinary stones. Various surgical methods are now available to veterinarians for this purpose. Once the horse has been anesthetized and laid down, conventional surgery or minimally invasive laparocystotomy (keyhole surgery) can be performed. Both of these methods always require general anesthesia and at least two weeks of box rest for the patient after the operation.

With the help of modern shock wave techniques, urinary stones can now also be broken up and removed endoscopically via the urethra in standing horses. Although this procedure should always be performed in a clinic, it only requires sedation of the horse and leaves no surgical scars that take a long time to heal.

In the rare cases where kidney stones are diagnosed, they can only be treated by surgical removal of the kidney. This difficult procedure should be reserved for absolute specialists. Please consult your veterinarian in individual cases to find out where such a procedure can be performed.

Forecast

The chances of recovery depend on the location and size of the urinary stones and the success of the surgical treatment. If bladder or urethral stones are completely removed by laparoscopy or conventional surgical techniques, there is only a very low risk of recurrence and therefore a good prognosis. In the case of ureteral or kidney stones, the prognosis is only cautious due to the much more difficult surgical procedure.

Depending on the duration and severity of the disease, bladder emptying disorders may still occur after treatment. Due to inflammation of the mucous membrane and mechanical irritation of the bladder, the affected horses are unable to urinate in a targeted and controlled manner even after the stones have been removed. The affected horses have a permanently overfilled bladder, which can lead to recurrent colic. If this problem proves to be irreversible, it may be necessary to euthanize the horse.

Prophylaxis

To prevent the formation of urinary stones, the composition of both roughage and concentrated feed should be discussed in detail with the veterinarian and adjusted if necessary. It is advisable to have a roughage analysis carried out and to check the ingredients of all feed supplements. Since stones in horses are primarily composed of calcium carbonate, calcium-containing feed should be avoided as far as possible to prevent excessive intake.