Surgical Management of Nephrolithiasis in the Bottlenose Dolphin: Collaborations Between the Urologist and Veterinarian.

Roger L Sur,Jenny M Meegan,Todd Schmitt,Dean Hendrikson,James L'Esperance,Jason R Woo,Cynthia R Smith

doi:10.1089/cren.2017.0143

Abstract

Background: Cohorts of bottlenose (Tursiops truncatus) dolphins are at significant risk for nephrolithiasis development. However, effective surgical treatment has been limited due to absence of literature and also familiarity by both veterinarians and urologists. Recently a joint veterinarian and urology team were called to treat local bottlenose dolphins in San Diego, CA, and they performed several cases. The fund of knowledge from these cases is presented for future providers who may be asked to surgically treat these animals.Case Presentation: Two surgical kidney stone cases were performed by a joint veterinarian and physician team. An effective ureteroscopic stone removal was performed on a 39-year-old female bottlenose dolphin with 9.7 mm distal ureteral calculus. The second case involved laparoscopic ureterolithotomy on a 31-year-old male bottlenose dolphin with a 6-mm right distal ureteral calculus that previously failed retrograde ureteroscopic removal. The stone was not effectively removed laparoscopically as well due to failure to progress associated with operative machinery malfunction. The dolphin was ultimately euthanized.Conclusion: Despite suboptimal outcome in one case, extremely valuable lessons were learned during both cases. We present our surgical experiences, as well as pertinent anatomical differences, in these animals with the hope that this discussion will facilitate future surgical kidney stone treatment of dolphins.

Highlights

Bottlenose dolphins, Tursiops truncatus, are prone to developing nephrolithiasis.[1]
Veterinarians with specialized equipment and expertise in endourology are not commonly available; human urologists have been consulted on several cases to jointly perform endourologic procedures in managed dolphins—that is, dolphins not living in the wild
The objective of this case report is to present our collective experiences with the hope that others will benefit and improve endourologic care of bottlenose dolphins with nephrolithiasis

Summary

Introduction

Bottlenose dolphins, Tursiops truncatus, are prone to developing nephrolithiasis.[1]. Flexible ureteroscopy and holmium laser lithotripsy were performed in a 39-year-old female bottlenose dolphin with the U.S Navy Marine Mammal Program. No ureteral stenting was performed due to atraumatic nature of the ureter The dolphin passed another ureteral calculus several days after surgery and had no other postoperative complications with resolution of hydronephrosis on ultrasound. A 31-year-old male bottlenose dolphin with the U.S Navy Marine Mammal Program with a history of chronic severe bilateral nephrolithiasis presented with azotemia and cross-sectional imaging consistent with a partially obstructing right distal ureteral stone. A flexible ureteroscope was passed into the ureter, and at least four or five intrarenal calices were visualized which were similar in internal appearance to human calices (Fig. 2). Necropsy demonstrated obstructing ureteral stone just distal to ureterotomy and numerous renal stones

Discussion and Literature

Conclusion