Figure 20.2 Subcutaneous peripenile swelling typically extends from the base of the scrotum cranially and involves the entire ventrum.

Diagnosis

      Urolithiasis can typically be diagnosed utilizing historical data and clinical signs. Additionally, rectal palpation and careful palpation of the penis can typically locate the site of obstruction and the presence or absence of a urethral or bladder rupture. For feedlot steers or economically constrained cases, treatment is implemented based on physical examination. However, for valuable individuals a complete diagnostic picture includes a complete blood count (CBC), biochemistry profile, and ultrasound.

      The abnormalities observed with a CBC will typically coincide with the severity and duration of disease. Typical findings include a neutrophilia and possible hemoconcentration depending on the degree of dehydration. Cases with urethral rupture may have increased fibrinogen with excessive subcutaneous tissue necrosis. Common biochemical abnormalities include azotemia, hyponatremia, and hypochloremia. In ruminants, potassium can be normal or elevated in individuals with obstructive urolithiasis. When hyperkalemia is present, the degree of elevation is typically mild. One study experimentally induced uroabdomen and demonstrated increased salivary potassium excretion, possibly explaining the less severe hyperkalemia observed in ruminants with urolithiasis [11]. In small ruminants, Ewoldt et al. found individuals with no free abdominal fluid and a serum potassium less than 5.2 meq/l more likely to survive [12]. Individuals with urolithiasis may have a metabolic alkalosis, acidosis, or normal blood pH. When acidosis occurs, individuals are often severely dehydrated and suffering from lactic acidosis [13]. With prolonged obstructions, hyperphosphatemia and hypomagnesemia can occur and concerns of secondary renal failure should be considered. One study stated the best prognostic indicator was excessive serum phosphate being associated with increased likelihood of death [14]. In absence of hydronephrosis, 48 hours of fluid diuresis should be administered before diagnosing an individual in secondary renal failure. In individuals with uroabdomen, the degree of azotemia, hyponatremia, hypochloremia, and hyperkalemia can be severe due to the osmotic gradient across the abdominal wall pulling sodium and chloride into the abdomen, potassium and blood urea nitrogen intravascularly, with creatinine staying mostly intra‐abdominally, since it diffuses at a slower rate being a larger molecule.

If available, ultrasound can be used to assist with assessment of the urinary tract. Ultrasonography can be used transcutaneously or transrectally to assess the integrity and location of uroliths. Additionally, ultrasonography can assist with diagnosing the presence of cystoliths, ureteroliths, or nephroliths. Cystoliths usually have a sandy debris appearance that is hyperechoic with a rough, irregular surface that casts acoustic shadows [15]. Ureteroliths and nephroliths are often difficult to diagnose antemortem, but are hyperechoic half‐moon‐shaped or round calculi that cast acoustic shadows through deeper tissues [15]. Ureteroliths may also be diagnosed via rectal examination if hydroureter is associated with the condition. Prior to surgical intervention, presence of hydronephrosis and/or hydroureter should be investigated. The right kidney extends from the 13th rib to the third lumbar vertebrae with the cranial pole in the renal impression of the liver in the 12tth intercostal space [15]. The left kidney can be imaged from the right paralumbar fossa caudal and is found slightly ventral to the right kidney from the 2nd to 5th lumbar vertebrae [15]. The left kidney can also be evaluated with transrectal ultrasound. If severe hydronephrosis is present, humane euthanasia is recommended (Figure 20.3). Presence of peripenile subcutaneous edema is suggestive of a urethral rupture and poor prognosis for returning to breeding soundness. Significant diffuse hypoechoic free fluid in the abdominal area is generally suggestive of uroabdomen. However, definitive diagnosis of uroabdomen is done by performing an abdominocentesis in either the flank fold of the abdomen or at the location of the fluid found ultrasonographically with an 18‐gauge, 3.8‐cm (1.5‐inch) needle after surgical prep. An abdominal fluid creatinine to serum creatinine ratio of 2 : 1 or greater confirms the diagnosis of uroabdomen [11, 16].