ABSTRACT

An adult female bottlenose dolphin (Tursiops truncatus) presented with acute renal insufficiency (serum potassium= 6.9 and creatinine = 8.5), due to bilaterally obstructing ureteral calculi seen on abdominal ultrasound. Temporizing management of the obstruction requires cystoscopy with ureteral stent placement. Definitive treatment includes ureteroscopy with in situ lithotripsy versus shock wave lithotripsy. In this case, the right ureteral calculus passed spontaneously but the renal failure persisted. Plans for a staged operation (cystoscopy stent placement and subsequent ureteroscopy with lithotripsy) were made. The dolphin was placed in left lateral recumbency due to a peritoneal dialysis catheter in the right retroperitoneal region. A 12Fr flexible cystoscope was inserted into the bladder via the urethra whereupon a calculus was seen obstructing the left ureteral orifice. Cystoscopy with left 4.8Fr double pigtail ureteral stent placement was performed to relieve the post renal obstruction. Inadvertent proximal migration of the left ureteral stent occurred during the case. Renal function improved (serum Cr = 5.8, K= 5.4) the following day and ureteroscopy was performed to replace the stent with a longer stent and treat the calculus. The ureteral calculus was pulverized into tiny fragments using a 6.9Fr semi-rigid ureteroscope and Holmium (Ho:YAG) laser lithotripsy. The stent was also visualized in the distal ureter and replaced with a 90 cm single pigtail ureteral stent. The distal aspect of the stent was suture secured to the skin and excess trimmed. Renal function normalized several days later and the stent was removed.

ACKNOWLEDGEMENTS

The authors would like to thank Drs. Caroline Colangelo, Ron Im, and nurse Nancy Kessler, from UCSD Division of Urology for their assistance on this case.