Endoscopic-assisted electrohydraulic shockwave lithotripsy in standing sedated horses.
Authors: Röcken Michael, Fürst Anton, Kummer Martin, Mosel Gesine, Tschanz Theo, Lischer Christoph J
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Endoscopic-assisted electrohydraulic shockwave lithotripsy in standing sedated horses Electrohydraulic shockwave lithotripsy represents a significant advancement in managing urinary calculi in horses, offering a minimally invasive alternative to traditional surgical approaches. Röcken and colleagues treated 21 male horses with cystic stones (median diameter 6 cm) using a fibre-optic lithotripsy device passed through the working channel of a transurethral endoscope whilst horses remained standing under sedation; the shockwave energy fragmented calculi into pieces smaller than 1 cm, which were then flushed from the bladder via repeated saline lavage. Complete calculus removal succeeded in 20 of 21 horses (95%), with most cases requiring 1–6 treatment sessions and a mean operative time of 168.6 minutes, and notably, fragmented material was excreted naturally through the urethra in all but one case. Postoperative complications were minor in most horses (mild haematuria, dysuria, or urinary debris), though one horse developed bladder rupture requiring euthanasia; follow-up at a mean of 18.8 months confirmed all surviving horses returned to normal activity without recurrent calculi. For equine practitioners managing urolithiasis, this technique offers a standing-sedation option that avoids general anaesthesia and major surgery, though careful case selection for low-density calcium carbonate stones and awareness of potential urethral fragment impaction remain important considerations.
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Practical Takeaways
- •Electrohydraulic lithotripsy in standing sedated horses offers a minimally invasive alternative to traditional surgical approaches for bladder calculi, with high success rates (95%) and good long-term outcomes
- •The procedure requires specialized endoscopic equipment and expertise but avoids major surgery; most horses tolerate standing sedation well and return to normal activity
- •Complications are generally manageable (hematuria, dysuria, trapped fragments) with low mortality risk, though patient selection for low-density calcium carbonate calculi is important for success
Key Findings
- •Complete calculus removal achieved in 20 of 21 horses (95%) using transendoscopic electrohydraulic lithotripsy in standing sedated horses
- •Median calculus diameter was 6 cm (range 4-11 cm) and required 1-6 sessions to completely fragment into <1 cm pieces
- •Mean total surgical time was 168.6 minutes (range 45-450 minutes) with fragmented calculi successfully excreted via urethra in 19 of 20 horses
- •Long-term follow-up at mean 18.8 months showed horses returned to previous activity levels without recurrence of clinical signs