Local anesthesia and hydro-distension to facilitate cystic calculus removal in horses.
Authors: Russell Tom, Pollock Patrick J
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Cystic calculi in male horses present a surgical challenge because accessing the bladder through a small abdominal incision can be difficult, particularly when stones are large. Russell and Pollock describe a straightforward technique combining local anaesthetic instillation with controlled hydro-distension to improve surgical exposure: after catheterising the bladder transurethral, 100 mL of 2% lidocaine was introduced and allowed to work for 10 minutes, followed by gravity-fed infusion of warmed Hartmann's solution to approximately 40 cm H₂O pressure, which remained in place until the surgeon could access and siphon it away. In their series of eight geldings with calculi ranging from 3–11 cm (median 6 cm), bladder exteriorisation from initial abdominal incision to surgically accessible position took less than five minutes regardless of stone size. The technique proved consistently effective and offers practical advantages: the local anaesthetic reduces bladder irritability and straining during manipulation, whilst the controlled distension creates space and makes the organ easier to locate and bring through the incision. For practitioners managing cystic calculi cases, this method represents a reproducible approach that can reduce operative time and improve visualisation, potentially decreasing tissue trauma and improving surgical outcomes.
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Practical Takeaways
- •Use intra-catheter lidocaine instillation (100 mL, 2%) followed by gravity-fed warm Hartmann's solution distension to improve bladder positioning during cystic calculus surgery
- •This technique reduces surgical time for bladder exteriorization to under 5 minutes, minimizing anesthesia duration and improving surgical efficiency
- •Consider this approach as a practical refinement for any colic surgery involving bladder access in male horses
Key Findings
- •Local anesthesia with 100 mL of 2% lidocaine combined with hydro-distension to 40 cm H₂O pressure enabled bladder exteriorization in <5 minutes
- •Technique successfully facilitated surgical access for cystic calculus removal in 8 geldings with stones ranging 3-11 cm diameter
- •Bladder capacity ranged from 1.4-2.5 L (median 1.8 L) across the case series