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Urolithiasis​ ​in​ ​a​ ​25​ ​Year​ ​Old​ ​Sulcata​ ​Tortoise

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dc.contributor.authorWagoner, Chyna
dc.date.accessioned2018-11-19T16:51:14Z
dc.date.available2018-11-19T16:51:14Z
dc.date.issued2017-10-18
dc.description.abstractA​ ​25​ ​year​ ​old​ ​male​ ​Sulcata​ ​tortoise​ ​(​Geochelone​ ​sulcata​)​ ​was​ ​presented​ ​to​ ​the​ ​Cornell​ ​University​ ​Hospital​ ​for Animals​ ​(CUHA)​ ​Exotics​ ​Service​ ​on​ ​08/03/2017​ ​for​ ​evaluation​ ​and​ ​removal​ ​of​ ​​ ​a​ ​large​ ​urolith​ ​(bladder​ ​stone).​ ​On 05/17/2017​ ​the​ ​patient​ ​passed​ ​a​ ​2.5​ ​inch​ ​(6.4​ ​centimeter)​ ​diameter​ ​stone,​ ​through​ ​his​ ​cloaca​ ​and​ ​phallus.​ ​He​ ​was taken​ ​to​ ​his​ ​primary​ ​veterinarian​ ​who​ ​performed​ ​radiographic​ ​evaluation​ ​of​ ​the​ ​patient’s​ ​coelomic​ ​cavity,​ ​revealing​ ​a second,​ ​larger​ ​stone​ ​(approximately​ ​3​ ​inches​ ​or​ ​8​ ​centimeters​ ​in​ ​diameter),​ ​sitting​ ​within​ ​the​ ​right​ ​lobe​ ​of​ ​his​ ​bladder. Analysis​ ​of​ ​the​ ​passed​ ​stone​ ​revealed​ ​a​ ​uric​ ​acid​ ​composition,​ ​which​ ​is​ ​the​ ​most​ ​common​ ​urolith​ ​of​ ​chelonians. On​ ​presentation​ ​to​ ​the​ ​CUHA​ ​Exotics​ ​Service,​ ​methods​ ​of​ ​stone​ ​removal​ ​were​ ​discussed​ ​with​ ​the​ ​owner​ ​including breaking​ ​down​ ​the​ ​stone​ ​via​ ​endoscopy​ ​or,​ ​should​ ​that​ ​method​ ​be​ ​ineffective,​ ​surgical​ ​removal.​ ​The​ ​patient’s​ ​physical exam​ ​was​ ​unremarkable​ ​except​ ​for​ ​moderate​ ​pyramiding​ ​of​ ​his​ ​shell​ ​and​ ​overgrowth​ ​of​ ​his​ ​caudal​ ​scute. The​ ​patient​ ​was​ ​sedated​ ​with​ ​an​ ​intramuscular​ ​injection​ ​of​ ​ketamine​ ​and​ ​dexmedetomidine,​ ​then​ ​intubated​ ​and maintained​ ​under​ ​anesthesia​ ​with​ ​isoflurane.​ ​Complete​ ​blood​ ​count​ ​and​ ​chemistry​ ​panels​ ​returned​ ​with​ ​no​ ​significant abnormalities.​ ​His​ ​caudal​ ​scute​ ​was​ ​cleaned​ ​and​ ​prepped​ ​in​ ​a​ ​sterile​ ​fashion,​ ​then​ ​trimmed​ ​and​ ​filed​ ​with​ ​a​ ​Dremel​ ​in order​ ​to​ ​give​ ​more​ ​access​ ​to​ ​his​ ​cloacal​ ​opening.​ ​On​ ​endoscopic​ ​exam,​ ​a​ ​small​ ​area​ ​of​ ​inflamed​ ​tissue​ ​was​ ​noted which​ ​could​ ​have​ ​been​ ​due​ ​to​ ​irritation​ ​caused​ ​by​ ​the​ ​stone,​ ​or​ ​by​ ​movement​ ​of​ ​the​ ​endoscopy​ ​equipment.​ ​Neither the​ ​opening​ ​into​ ​the​ ​bladder,​ ​nor​ ​the​ ​stone​ ​itself,​ ​could​ ​be​ ​well​ ​visualized​ ​so​ ​the​ ​procedure​ ​was​ ​discontinued​ ​and​ ​the patient​ ​recovered​ ​from​ ​anesthesia.​ ​Recovery​ ​was​ ​long,​ ​but​ ​not​ ​uncommon​ ​for​ ​reptile​ ​patients.​ ​During​ ​the​ ​procedure, there​ ​were​ ​some​ ​concerns​ ​regarding​ ​the​ ​patient’s​ ​cardiac​ ​stability​ ​while​ ​under​ ​anesthesia,​ ​so​ ​caution​ ​was recommended​ ​for​ ​any​ ​future​ ​anesthetic​ ​events.​ ​The​ ​owner​ ​chose​ ​to​ ​monitor​ ​the​ ​patient​ ​rather​ ​than​ ​pursue​ ​further endoscopic​ ​or​ ​surgical​ ​treatment. Uric​ ​acid​ ​urolithiasis​ ​in​ ​reptiles,​ ​including​ ​chelonians,​ ​is​ ​common​ ​and​ ​well​ ​described​ ​in​ ​the​ ​literature.​ ​Tortoises​ ​usually form​ ​uric​ ​acid​ ​stones,​ ​which​ ​can​ ​occur​ ​if​ ​their​ ​urine​ ​is​ ​supersaturated​ ​with​ ​uric​ ​acid,​ ​which​ ​then​ ​begins​ ​to​ ​crystalize. Many​ ​small​ ​crystals​ ​form,​ ​then​ ​clump​ ​and​ ​stick​ ​together,​ ​continuing​ ​to​ ​grow​ ​until​ ​the​ ​concentration​ ​of​ ​uric​ ​acid decreases​ ​to​ ​the​ ​point​ ​that​ ​no​ ​more​ ​crystals​ ​can​ ​form.​ ​Uroliths​ ​can​ ​form​ ​in​ ​the​ ​bladder,​ ​ureters,​ ​and/or​ ​cloaca.​ ​The formation​ ​of​ ​these​ ​stones​ ​is​ ​multifactorial,​ ​including​ ​genetic​ ​predisposition,​ ​variations​ ​in​ ​the​ ​structure​ ​of​ ​the​ ​urogenital organs,​ ​and​ ​nutrition. This​ ​report​ ​will​ ​discuss​ ​chelonian​ ​urogenital​ ​anatomy,​ ​the​ ​mechanism​ ​of​ ​the​ ​formation​ ​of​ ​uric​ ​acid​ ​uroliths​ ​in chelonians,​ ​the​ ​complications​ ​that​ ​uroliths​ ​can​ ​pose,​ ​as​ ​well​ ​as​ ​surgical​ ​and​ ​endoscopic​ ​treatment​ ​options.en_US
dc.identifier.urihttps://hdl.handle.net/1813/60303
dc.language.isoen_USen_US
dc.subjectSulcata​ ​tortoise -- Urolithiasis​en_US
dc.titleUrolithiasis​ ​in​ ​a​ ​25​ ​Year​ ​Old​ ​Sulcata​ ​Tortoiseen_US
dc.typecase studyen_US

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