Urethral hemorrhage in a gelding.
Keywords: hemorrhage, urethra, gelding, blood
A seven year old Icelandic gelding was presented with a history of severe but sporadic hemorrhage from his urethra. An episode of hemorrhage also occurred during
examination.
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The owners reported that large volumes of "pure blood" had been discharged from the penis, not associated with urination. Dried blood was also present on both hind legs, suggesting that more hemorrhage may have occurred than that seen by the owners.
The owners reported that large volumes of "pure blood" had been discharged from the penis, not associated with urination. Dried blood was also present on both hind legs, suggesting that more hemorrhage may have occurred than that seen by the owners.
Endoscopic examination revealed the presence of blood in the
urethra (subset image 1) close to the ischial arch. Shortly after the first image was obtained, a column
of blood was projected toward the endoscope (subset image 2). Advancing in the
direction of the bladder, the urethra was flushed with saline and group of
varicose veins was seen (subset image 3 on the left side of the image). No points of hemorrhage could be
demonstrated on the surface of these veins, therefore it was impossible to
state unequivocally that they were the source of hemorrhage. Just caudal to the
bladder (subset image 4) pooled blood was seen ventral to the colliculus seminalis.
Hemorrhage can occur from many sources in the proximal genital
tract. These include mucosal tears in the urethra, urethritis, inflammation and
neoplasia of the accessory glands and so on. Circumstantially however we concluded that
fragility of urethral varicose veins was the source of hemorrhage.
It was with some reservation that yunnan baiyao; a chinese
herbal remedy was used to treat this horse. The usual dose recommended for
exercise induced pulmonary hemorrhage is “one bottle of powder in the morning
and one in the evening”. This is clearly unscientific because the powder has
more than 20 ingredients and standardization is therefore virtually impossible. Only a single treatment was used.
Recent contact with the owner revealed that sporadic
hemorrhagic episodes occur at three to five day intervals but the gelding
remains bright, alert and responsive.
The condition may remain untreated. In similar cases in mares where
vaginal varicosities have bled intermittently, the author has recommended
ligation or cautery of the vessels but surgical intervention is neither safe
nor feasible in this case.
Note: Fatal air embolism has recently been linked with urethral endoscopy. The chance for this is thought to be remote. However, because of this possibility, urethral endoscopy should probably be done only if there are strong indications to do so.
Note: Fatal air embolism has recently been linked with urethral endoscopy. The chance for this is thought to be remote. However, because of this possibility, urethral endoscopy should probably be done only if there are strong indications to do so.
