Ruptured bladders – ruminants

Ruminants with obstructed urethras may rupture either the bladder or the urethra. When the bladder ruptures, the fluid leaks into the peritoneal cavity. Over time, the abdomen becomes distended a fluid wave can be detected.

Animals become less colicky and more depressed and anorexic after the rupture. The penile urethra may continue to pulsate or it may stop pulsating. Animals may or may not be febrile but are usually dehydrated, tachycardic and tachypneic.

Hyperkalemia is possible but generally serum electrolytes are not significantly deranged. Animals are generally dehydrated.

Diagnosis is confirmed with ultrasound and/or abdominocentesis. Comparison of peritoneal and serum creatinine levels is useful.

Abdominal fluid drainage is ideal but often challenging. Removing the fluid improves ventilation. If it cannot be removed, preoxygenation is useful. Animals are given antibiotics and NSAIDs.

Small ruminants and breeding animals undergo general anesthesia for management of the urolithiasis (tube cystotomy) and repair of the bladder. Any tears are repaired using 2-0 or 3-0 absorbable suture in an inverting pattern. Many surgeons do a two layer closure of the bladder.  The abdomen is lavaged and any abdominal fluid is removed via suction.

In beef cattle with ruptured bladder secondary to urolithiasis, the bladder is left to heal by second intention. Urine is diverted via a urinary catheter placed via urethrotomy; this keep the bladder empty and allows healing.

Animals do need postoperative analgesics and antibiotics in most cases. Feedlot steers do not usually require antibiotics since secondary infections are unlikely due to the short time line.

Prognosis is guarded due to the urolithiasis and uremia. Usually the obstruction needs to be fixed as well as the bladder.  Large ruminants are generally managed conservatively until slaughter is possible. Steers with a serum phosphate >2.9 mmol/L are associated with longer duration ruptures and have poorer prognosis.