Case Report: Mesh repair of a urinary bladder dorsal wall defect following repeated cystorrhaphy in a warmblood foal.

Abstract

A three-day-old male Warmblood foal presented with inability to urinate. Primary diagnostic findings included abdominal distension, hyperkalemia, azotemia, and ultrasonographic evidence for free anechoic fluid in the abdominal cavity. Abdominocentesis confirmed the diagnosis of an uroperitoneum [peritoneal fluid to serum creatinine ratio (>2:1)]. Suture repair of a dorsal urinary bladder wall defect was performed, but leakage along the suture tracts resulted in recurrent uroperitoneum confirmed by computed tomographic urography after two days. Repeated cystorrhaphy was performed but uroperitoneum recurred four days later. The vesical tissue at the level of the tear appeared markedly inflamed and friable during the subsequent revision. The bladder wall defect was therefore reinforced with a monofilament (Monocryl-Prolene) composite mesh to prevent excessive bladder distension. The foal was discharged from the hospital three weeks after admission in good general condition. Telephone follow-up confirmed physiological development, urination and weight-gain of the animal. The horse deceased peracutely one year after discharge where urolith formation had caused urine leakage at the ventral aspect of the urinary bladder. The mesh was found to be integrated in the intact dorsal bladder wall without evidence for adhesion formation. This case report presents an alternative approach for managing the complication of urinary leakage associated with cystorrhaphy. Mesh repair should be considered early in cases where the vesical tissue is friable and primary suture repair at high risk of failure.