MANAGEMENT OF CONGENITAL URINARY OBSTRUCTION IN NEWBORN CALVES

Congenital urinary tract obstruction is a developmental anomaly which may persist after birth in new born calves. To determine the occurrence of congenital urinary obstruction and to evaluate tube cystostomy for the management of congenital urinary obstruction in neonatal calves two studies were conducted. A retrospective study was performed to observe the occurrence of congenital urinary obstruction in neonatal ruminants from January 2005 to November 2014. Occurrence of congenital urinary obstruction in neonatal calves was also studied in respect to age, sex, breed and season. During the period of 10 years, a total of 42 cases of congenital urinary obstruction were recorded, which constituted an incidence of 2.0%. In this study, maximum incidence was recorded in bovine is 38 (90%). Maximum number of cases (45%) of congenital urinary obstruction in ruminants was recorded from March to June, July to October and November to February as 19 (45%), 9 (22%) and 14 (33%) respectively. Among affected animals, 31 were cross breed (74%) and 11 were local breed (26%). Number of affected males was 29 (69%) clearly ahead than affected female 13 (31%). In another study, tube cystostomy with infusion set was performed in eleven neonatal calves aged 1-6 days old and observed for 1 month. Among 11 calves, 2 died due to severe infection and septicemia and 2 calves needed repeated operation. Seven calves got uneventful recovery and the cured animal showed satisfactory results. Overall successful rate was 63.6%. The results revealed that tube cystostomy seemed to be an effective method. In addition, this study will help not only veterinarian to make them aware about the occurrence of congenital urinary obstruction but also to solve the problem by saving the life of neonatal calves.


INTRODUCTION
Bangladesh is an agricultural country where livestock plays an important role in its national economy with a direct contribution of around 3% to the agricultural GDP (Bangladesh Economic Review, 2014).About 75% people rely on livestock to some extent for their livelihood, which clearly indicate this poverty reduction potential of the livestock sub sector is high (National livestock development policy, 2007).Livestock production is contributing not only to food but also provide hides, fibers, fertilizer and fuel, as well as a modest, interest-producing capital that can easily be mobile when unforeseen needs arise (Samad, 1998).Agro-climatic condition, religious point of view, social practices and technological aspects support the prospects and potentials of raising animal.
Calf mortality is the major causes of economic losses in livestock production.Calf diseases that cause morbidity and mortality are the results of complex interaction of the management practices and environment, infectious agents and the calf itself.Neonatal calf mortality varied from 8.7-64% throughout the world and the mortality in the first month of age was account to be 84% of total mortality (Jenny et al., 1981).The predominant causes of calf mortality were pneumonia 14.8%, foot and mouth diseases 12.3%, dystocia 11.7%, calf scour 8.6, diarrhea 1.9% and some congenital diseases (Islam et al., 2005).Some reports on the etiology of calf diseases with especial emphasis to parasites (Samad et al., 1977), microbes (Debnath et al., 1987), pathological diseases and conditions and congenital malformation (Hossain et al., 2002) associated with calf morbidity and mortality have been done in Bangladesh.Congenital defects are those with a fetus in born.Major congenital defects affecting calves in Bangladesh are congenital urinary obstruction, umbilical hernia, atresia ani, dermoid cysts, nonfunctional limb joints, embryonic duplications etc. (Hossain et al., 1986;Newman et al., 1999).
Congenital defects, structural or functional abnormalities presented at birth (Nesbitt, 1954) are one of the most challenges facing the clinician in the field because of their nature of complexity (Samad and Hoque, 1986;Rousseaux and Ribbl, 1988).Urethral obstruction in calves is a fatal disease that predisposes to high mortality rate unless the animal is subjected to emergency surgical treatment for correction of the obstruction (Rahman et al., 1972).It appears uncommon in the general population but with a relatively high incidence in certain cross-breeds (Oehme and Perior, 1974;Das and Hashim, 1996).
In Bangladesh most of the farmers have no facility for modem treatment for their livestock.
Moreover, many farmers cannot afford the cost of treatment.So before taking the animal to the veterinarian, the owners try to treat their animals with various local remedies.When choosing a treatment modality, the patient's intended use should be taken into consideration.
All treatment modalities have benefits and complications associated with them, so selection is based on long term goals for the individual patient and the owner's ability and willingness to finance and provide after care for the treatment.Surgical tube cystostomy the most commonly used treatment for long term management of obstructive urolithiasis in animals.It redirects urine through a catheter placed from urinary bladder with an exit through the abdominal wall.The success rate of this technique has been reported to be 80% (Fazili et al., 2012).It is important that a hypothetical survey is necessary to bring basic data for further study of surgical affections and thereby solve the problem of ruminant in Bangladesh.A few clinical works on congenital urinary obstruction in ruminants are done in Bangladesh (Samad et al., 2002).This study has been carried out to find out the occurrence of congenital urinary obstruction of animals in Veterinary Teaching Hospital at Mymensingh, to study the relationship of different factors such as species, age, sex and seasons with the occurrence of congenital urinary obstruction in animals in this area and to evaluate tube cystostomy for the management of congenital urinary obstruction to save newborn calves.

MATERIALS AND METHODS
Two studies were conducted at Veterinary Teaching Hospital and the Department of Surgery & Obstetrics, Bangladesh Agricultural University (BAU), Mymensingh, from June 2013 to November, 2014.

Study 1
A retrospective study was carried out on the cases presented with the history and clinical signs suggestive of urinary obstruction in ruminants at Veterinary Teaching Hospital, Faculty of Veterinary Sciences, BAU from January 2005 to November 2014.Cases were recorded and calculated to determine the occurrence of congenital urinary obstruction in neonatal ruminants in that period.The occurrence of congenital urinary obstruction was calculated according to species, age, sex, breed and season.

Study 2
This study was performed to assess tube cystostomy in neonatal calves for the management of congenital urinary obstruction.Surgical intervention was performed in Eleven calves presented to the Veterinary Teaching Hospital, BAU, Mymensingh, with congenital urinary obstruction and distended abdomen (Figure 1 and 2).Age of calves ranged from 1 to 6 days with body weight 10-15 kg.Among 11 calves, 2 were females and 9 were males.All newborn calves were free from other concurrent neurologic, metabolic or infectious diseases.showed that the occurrence is increasing day by day (Figure 6).

Occurrence in different species
We observed that occurrence of congenital cases was higher in calves in comparison to kids.
We found 38 cases (90%) in calves and 4 cases (10%) in kids.In 2005, we found that three calves and one kid were affected.In 2006-2009, the calf was solely affected.We found no record of congenital urinary obstruction in goat.In 2010, 4 cases were observed in 3 calves and1 kid.In 2011 and 2012, there was no record of congenital urinary obstruction in goat.
Seven calves and two kids were affected in 2013.In 2014, only 4 calves were affected.These data are shown in figure 7.

Occurrence in breed
Among the affected animals 31 was cross breed (74%) and 11 was local breed (26%).Result is presented in Figure 9.

Occurrence in respect to sex of the animal
The occurrence of congenital urinary obstruction in respect to sex is shown in Figure 10.It was recorded that the number of affected male is 29 (69%) is clearly ahead than affected female 13 (31%).1.
During the study period, all the cases attained adequate analgesia at surgical site, there was no complication encountered.Catheterization of urinary bladder and positioning of tube were achieved without any difficulties.Continuous flows of urination were noticed immediately after the surgical correction in all the cases.Among 11 calves, 2 died due to severe infection and septicemia.Moreover, 2 calves returned to Veterinary Teaching hospital after 10 days of operation due to dislodgement of the catheter and were subjected to perform tube cystostomy again.Seven calves got uneventful recovery and the cured animal showed satisfactory results.
There is no inflammation, no dehiscence, no maggot infestation in the operative area and gradual decreasing wound area.No exudation was observed at surgical site in any animals during removal of suture.The animal can move freely and urinate continuously without any 69% 31% Male ( 29) Female ( 13) disruption.All calves showed good prognosis and performance in the immediate postoperative period.Severe pain was noticed for first 2 postoperative days in all animals, which gradually lessened and subsided by 14 th postoperative day in almost all calves alive.Among 7 calves, 3 calves resumed normal urination through the natural opening on 15 -21 postoperative days.Tube was removed after resuming normal urination through the external urethral orifice.Owner complained about tube blockage due to urinary cast.They were advised to make suction of the tube with 10 ml syringe and then urination through catheter was normal.
Overall successful rate was 63.6%.The results showed tube cystostomy as an effective method for the management of congenital urinary obstruction in neonates.

DISCUSSION
The most appropriate information regarding congenital urinary obstruction in animal is very scanty.Therefore, a retrospective study was done in ruminants and to determine the occurrence of congenital urinary obstruction in animals.We found that the occurrence of congenital urinary obstruction in animal is 2% in comparison with other surgical disease.
Moreover, occurrence was higher (90%) in calves in comparison to kids.Study showed that the congenital urinary obstruction incidence highest during March-June (45%) where temperature and relative humidity were optimum.In hot and cold seasons the rate is comparatively low (22% and 33%, respectively).Crossbred animal had greater risk of occurrence of congenital deformities, because proper rules are not followed during artificial insemination.Genetics and environmental factors are recognized as major causes (Binns et al., 1972;Hartley et al., 1974;Dennis, 1975).Abnormal development is usually caused either by genotypic or environmental factors, in addition to failure to meet the temporal-spatial requirements (overwhelmed fetal compensatory mechanisms) of development (Bai et al., 2004).It is worthy to point out that autosomal recessive gene has an effect on crossbred animal and animal born with congenital malformation (Samad, 2008).
To date, very little information is available regarding the relative frequency of congenital urinary obstruction in calves and successful rates of treatment.Therefore, the present study was planned with the objectives to evaluate recovery rate after surgical treatment of congenital urinary obstruction cases.Surgical correction is the only way to restore normal function in the urinary system.The aim of the operation was to make the animal urinate in this study.We performed cystostomy with easily available (in sterile pack) and cheap infusion set tubing.Fazili et al, (2010) have also reported the use of infusion set for tube cystostomy for treatment of obstructive urolithiasis in small ruminants.
Urinary catheters are one of the most frequently used tools in the diagnosis and management of urinary tract disorders.Using of catheter facilities the alternative and continuous flow of urination in animal.It maintains the constant and controlled bladder drainage in recumbent, non-ambulatory and incontinent patients.Urinary catheterization is used in the animal emergency setting and critical care for diagnostic, treatment, and monitoring purposes.
Important factor for recovery of diseases includes appropriate surgical approach, proper placement of catheter and post-operative care.Tube cystostomy using infusion set tubing was found to be a useful, easy, quick, cheap, and field-applicable technique for managing tube cystostomy in the neonatal calves.Surgical tube cystostomy is the most promising procedure for obstructive urolithiasis in small ruminants intended for use as breeding animals.The procedure is relatively simple, requiring a short duration of anesthesia and resulting in restoration of full urethral patency in successful cases (Fortier et al., 2004;Ewoldt et al., 2008).Moreover, the incision site healed uneventfully and the cutaneous sutures were removed on the day of catheter withdrawal.During the follow-up period of 1 month in live animal, no complication was reported.The bladder is considered to have a high regenerative capacity and heals readily (Rasmussen, 1967).
Calves presented with the history of no urination and clinical signs suggestive of congenital urinary obstruction were subjected to detailed physical and ultrasonographic examination to confirm congenital urinary obstruction.Sonography is a non-invasive reproducible and inexpensive method for diagnosis of urolithiasis, localization urethral calculi and rupture of urethra or the urinary bladder (Braun, 1993).It is safer for both patient and the operator as it does not involve the use of ionizing radiation.The volume, size and shape of the urinary bladder can be detected by cystosonography (Khan et al., 2011), besides changes in the wall thickness, intraluminal defects and seat of calculi lodgment can be detected.Abdominal sonography is useful to evaluate the bladder but is unrewarding for evaluation of the entire length of the urethra.Scanning of bladder revels rounded to unevenly hyperechoic shadows with multiple spread tiny hyperechoic patterns (Janene et al., 1995).
In the current study, one animal was found dead after few days of tube cystostomy placement.The cause of death may be attributed to urine leakage, Uroperitoneum, peritonitis and uremia.Ewoldt et al. (2008) have revealed that the most common cause of death shortly following the tube cystostomy placement is urine leakage.Fortier et al., (2004) described the catheter obstruction as a common and serious complication requiring careful management to avoid the need for repeat surgery.Tube cystostomy is not free from complications and some complications involved are urine leakage, wound infection or dehiscence problems with the tube itself such as irritation at the stoma site, obstruction or accidental dislodgment and problems related to ascending infection due to presence of the tube (Bhokre et al., 1985).
In our study, there was no major complication such as significant wound infection, complete dehiscence of sutures, and no obstruction in the artificial opening.Nylon sutures were removed 12-14 days after operation and Chromic acid suture (e.g.catgut) were left in the surgical site (Bjorling, 2003).The kind of suture materials had no significant effects on occurrence of postoperative complications.Slatter (1985) opined that before specific surgical or medical treatment, the general condition of the patient must be assessed.Shock, anuria, dysuria, uremia, dehydration, electrolyte imbalances and anorexia must be recognized and corrected prior to definitive repair of the urethra or urinary tract.
We could not perform haemato-biochemical study which could be indicative of electrolyte and acid-base abnormalities due retention of urine.Moreover, further study should be directed to implement and evaluate this technique in a sufficient number of cases before recommending its adoption.However, the data collected from this study could help the veterinarian to treat and prevent the affection.Such cheap techniques are particularly advantageous in developing countries.The knowledge derived from this study will increase clinicians understanding about the congenital cases related urinary system of ruminants and identification of risk factors of the cases subsequently will help to take necessary preventive measures of the disorders.Moreover, attempts should be made to save neonatal animals in order to give maximum economic benefit to the farmers of this country.

CONCLUSIONS
Occurrence of congenital urinary obstruction cases was higher in calves and in the season of March-June.The male calves were more affected than female calves.Tube cystostomy with infusion set seemed to be an effective method for the management of congenital urinary obstruction in calves.This technique was the rapid, simple and cost effective.Proper wound management and routine check-up is important for the success of treatment performed with tube cystostomy.

Figure 1 .
Figure 1.Animal having no opening for urination.

Figure 4
Figure 4(a).Exteriorization and incision on the urinary bladder.

Figure 4
Figure 4(b).Placement of catheter into bladder with purse-string suture.

Figure 4
Figure 4(c).Closure of abdominal muscle and securing of catheter.

Figure 4
Figure 4(d).Animal immediately after the operation.

Figure 6 :
Figure 6: Occurrence of congenital urinary obstruction in different years.

Figure 7 :Figure 8
Figure 7: Occurrence of disease in different species.

Figure 8 :
Figure 8: Effects of season on the occurrence of congenital urinary Obstruction.

Table 1 :
The characteristics of congenital cases in calves treated by tube cystostomy and postoperative observation up to one month