How To Collect Urine From Catheter

Urine can exist collected when the horse urinates or by catheterizing the bladder or ureters.

Collecting Urine during Urination

• About horses, when approached during urination, cease urinating. A drove tube or loving cup taped to a pole, withal, oft tin be advanced into a urine stream without inhibiting the act of urination ( Fig. 14.1 ).
• Palpation of the float per rectum  may give some indication of the likelihood of obtaining voided urine inside a reasonable fourth dimension.
• Some horses can exist induced to urinate by putting them in a freshly bedded stall.
• Foals usually urinate soon after standing.
• If a catheter is not available for collecting urine, a mare can be stimulated to urinate by digitally palpating its urethra. Many mares urinate within minutes subsequently the finger has been removed from the urethra.
• A plastic gallon jug, with its bottom removed, a collection bag taped to its spout, and straps fastened to its base, or an embroidery hoop with a purse attached can be placed over the prepuce and strapped to the dorsum to collect urine from a male equus caballus ( Fig. 14.two ).
• Midstream and end-stream samples  are usually most desirable for cytological exam of urine because not-diagnostic cellular debris is flushed before drove. Cells that have settled out in the bladder, such as neoplastic cells, are constitute in an cease-stream sample . Cells indicative of upper urinary tract disease are more likely to be plant on a midstream sample, whereas cells indicative of lower urinary tract disease are more likely to be found in an end-stream sample.
• Because urine collected during spontaneous urination contains contaminating bacteria, urine to exist submitted for enumeration of pathogenic bacteria should exist collected by catheterization.

Figure fourteen.one . A collection tube or loving cup taped to a pole often can be avant-garde into a urine stream without inhibiting the act of urination.

Figure 14.2 . A plastic gallon jug, with its bottom removed, a collection bag taped to its spout, and straps fastened to its base of operations (A) or an embroidery loop with a bag attached (B), can be placed over the prepuce and strapped to the dorsum for collection of urine.

Drove of Urine past Catheterization of the Bladder (Male)

Materials

• Having an assistant facilitates catheterization of the male.
• Acepromazine maleate (0.04 mg/kg). Tranquilization facilitates and enhances the safety of the process past decreasing resentment of urethral catheterization and past causing relaxation of the retractor penis muscles. When acepromazine is used in stallions (and, rarely, geldings) in that location is a take a chance of priapism or penile paralysis that can be minimized by preventing sexual arousal during tranquilization. Sedation using xylazine (0.ii mg/kg) causes diuresis and glucosuria and and so may bear upon results of urinalysis. Although potentially dangerous, urethral catheterization of some horses can be performed without tranquilization.
• The procedure is more safely performed with the horse restrained in stocks.
• A commercially available stallion catheter; or a foal nasogastric tube; or a thirty- French, 150-cm long canine feeding tube; or a human enteral feeding tube; or a 100-cm long, 12-mm (or less) diameter endoscope
• A suitable container or a plain drinking glass tube to collect urine
• A sterile, water-soluble lubricant
• Sterile surgical gloves
• Materials for scrubbing the glans penis

Process

• The horse is administered a tranquilizer to cause penile protrusion, or alternatively, a hand is inserted through the preputial orifice and the penis is grasped and extracted from the preputial cavity using steady traction.
• An assistant holds and washes the glans with a disinfectant soap.
• The tip of a sterile catheter, dressed with sterile lubricant, is inserted into the urethra, taking care non to insert the catheter tip in the glans fossa. Increased effort may be required to advance the catheter past the ischial arch. As the catheter passes the ischial curvation, the horse may raise its tail (i.eastward., flag) ( Fig. 14.iii ). The catheter is inserted almost 60 cm to reach the bladder.
• Urine may flow spontaneously from the catheter, simply if not:

• A 60-ml catheter tip syringe tin exist used to apply suction to the tube or to force air through the tube to stimulate the bladder to contract.
• A hand can exist placed in the rectum to compress the bladder.
• The equus caballus'due south abdomen tin can be slapped to cause an intestinal contraction that may cause urine to flow (this, yet, may non be a safe method of promoting urine period from some horses).

Figure 14.3 . As the catheter passes the ischial arch, the horse may heighten its tail (i.e., flag).

Collection of Urine by Catheterization of the Float (Female)

Materials

• Tranquilization or sedation is optional.
• Tail wrap
• Sterile, h2o-soluble lubricant
• A rigid, 10- to fourteen-mm diameter metal or plastic catheter is easiest to pass, just even a flexible Foley or stallion catheter suffices.
• Sterile surgical gloves
• Materials for scrubbing the perineal region

Process

• The perineal region is cleaned with a disinfectant soap.
• A lubricated mitt is passed into the foyer, and the urethral opening is identified virtually x-cm (knuckle depth) from the labia. A finger is inserted into the urethral opening, and the catheter is advanced beneath the finger Or  the labia can exist spread with fingers, and a lubricated catheter blindly passed along the floor of the vestibule, through the urethra and into the bladder.
• If urine does not flow from the catheter, a paw can be advanced into the vagina, or withdrawn from the anteroom and placed into the rectum, to apply pressure to the float.

Complications

• Cystitis is a rare complication, and when it occurs, it is well-nigh likely acquired by irritation of the bladder mucosa by the catheter during repeated catheterization.
• The urinary catheter may enter an ampulla in a male person equus caballus. During palpation of the abdomen per rectum , the catheter is felt outside the bladder and is perceived to be free within the abdominal cavity.

Collection of Urine from the Ureters

Indication

• To localize disease of the urinary tract to one or both kidneys.

Materials

• For male horses, a 100-cm, or longer, endoscope with an outside diameter no greater than 12-mm
• Sterile, polyethylene tubing (Intramedic Polyethylene Tubing, Dirt Adams, Becton Dickinson & Co, Parsippany NJ 07054) to fit the accessory channel of the endoscope (e.yard., PE 190 tubing for a ix-mm endoscope). Ureteral catheters, to insert into the accompaniment aqueduct of an endoscope, are commercially bachelor. (Bard USCI polyurethane ureteral catheter, olive tip 5Fr, CR Bard Inc, Murray Hill, NJ; Endoscopic Flushing Catheter, SurgiVet, Waukesha, WI).
• A ten-mL syringe and a hypodermic needle that tightly fits the PE tubing for drove of urine. Sterile, edgeless needles that are less likely to cut the PE tubing are commercially available (Monoject Blunt Needles, Sherwood Medical, St. Louis MO 63103).
• Sterile, water-soluble lubricant
• Sterile surgical gloves
• For female person horses, a shorter endoscope is adequate. The ureters of mares can also be catheterized blindly using a adequately rigid eight- to 10-Fr polypropylene catheter.
• Materials for scrubbing of the glans penis or perineal region

Drove of Ureteral Urine Using an Endoscope

Procedure

• The insertion tube of the endoscope is passed into the float and then withdrawn until the tip of the endoscope lies inside the cervix of the bladder. The ureteral openings are observed in the dorsal aspect of the trigone region at the x and 2 o'clock positions. (The endoscopic view is oriented past observing a puddle of urine that is obviously on the flooring of the bladder.) Polyethylene tubing is advanced from the biopsy port of the endoscope through the ureteral opening, and urine is aspirated through the tubing ( Fig. fourteen.four ).
• The ureters of mares can be catheterized blindly, past digitally dilating the urethral orifice to allow introduction of two fingers. The projection of the ureteral orifice is identified past palpation with a fingertip. The finger is withdrawn, and the polyethylene tubing is placed between 2 fingers, which are reinserted. The urethral orifice is again palpated, and the tubing is threaded into the ureter.

Figure xiv.4 . To collect urine from a ureter, polyethylene tubing is advanced from the biopsy port of the endoscope through the ureteral opening.

Complications

A ureteral orifice can be difficult to locate. The ureteral openings can be institute past watching for dilation of the ureteral orifice equally a spurt of urine is discharged. Spurts of urine are discharged almost in one case every infinitesimal ( Fig. 14.5 ). A ureteral orifice may be easier to see if the bladder is partially distended with air, but too much distention may make an orifice more hard to see.

Figure 14.5 . The ureteral openings can be found by watching for a spurt of urine that is discharged about once every minute.

Urinalysis

Interpretation

• If urine cannot be examined within 30 minutes, it should exist refrigerated to avoid changes in pH, cellular degeneration, and bacterial growth.
• Urine is first examined for gross appearance, specific gravity, and dipstick reactions, and then centrifuged for microscopic examination of sediment.
• Normal urine is yellowish to most colorless. Aberrant colors are:

• Red to reddish brown : Normal urine contains oxidizing  agents that tin cause a reddish or brown discoloration of urine when urine is left standing. This is specially evident when urine contacts snowfall. This color is also acquired by hematuria , hemoglobinuria , myoglobinurea , and some drugs . Centrifugation causes urine to clear when hematuria is the cause of red or brown discoloration. Plasma and urine are both discolored crimson when hemoglobinurea is the cause of reddish discoloration of urine, and concentration of serum creatinine kinase is markedly elevated when myoglobinurea is the cause of discoloration.
• Clear : Indicates dilute urine. Dilute urine is caused by psychogenic h2o drinking, polydipsia associated with diabetes insipidus or mellitus, fluid therapy, or chronic renal illness.

• Specific gravity is usually greater than i.035  (range, 1.020 to 1.060). Urine of foals is very dilute (range, 1.006 or greater). Urinary specific gravity <one.020 in horses with clinical dehydration or azotemia is highly suggestive of renal disease.
• The pH of urine of adult horses is unremarkably greater than  8.v, only foals tend to have acidic urine. Prolonged anorexia or a high-grain nutrition causes the urinary pH to subtract.
• Urine is usually gummy because of mucus-secreting cells in the renal pelvis.
• Suspended calcium carbonate crystals cause opacity (particularly obvious for horses fed a legume hay).
• Modest numbers of cerise claret cells, white blood cells, and leaner tin can normally exist establish in urine sediment. More 5 RBCs or 5 WBCs per loftier ability field of urine collected midstream during urination or by catheterization is prove of hemorrhage and inflammation, respectively.
• Recovery of more than ten,000 colony-forming units per ml of urine nerveless past catheterization is diagnostic of urinary tract infection.
• Dipstick measurement may falsely point the presence of poly peptide in highly element of group i urine.
• Granular, cellular, or leukocyte casts signal renal illness. Hyaline casts can normally exist plant, especially in urine of exercised horses.
• An increase in urinary concentration of gamma glutamyltranferase  (UGGT) indicates tubular epithelial necrosis. Comparing the concentration of this urinary enzyme to the concentration of urinary creatinine (Ucr) accounts for the effect of differences in urinary concentration. UGGT/Ucr >l is evidence of tubular epithelial necrosis.

Suggested Readings

Schott HC, Hodgson DR, Bayly WM. Ureteral catheterization in the horse. Equine Veterinary Education two:140-143, 1990.

Kohn CW, Chew DJ. Laboratory diagnosis and label of renal disease in horses. The Veterinary Clinics of North America: Equine Practice 3:585-615, 1987.  - PubMed  -

Source: https://www.ivis.org/library/manual-of-equine-diagnostic-procedures/collecting-urine

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