New Procedure at TVFS Helps Nigerian Dwarf Goat

Tufts Veterinary Field Service (TVFS) recently introduced a new surgery at the practice to treat urinary blockage, a potentially fatal condition frequently seen in male goats. The first TVFS patient to undergo minimally invasive tube cystotomy (MITC) was a four-month-old Nigerian Dwarf goat named Casper.

When Kevin O’Donnell brought Casper and his twin brother Chestnut home to his farm in Massachusetts, the goats fit right in with the family’s pot-bellied pigs, horses, emus, sheep, hens, ducks, and turkeys.

“Casper’s precocious. He’s out all day long, hanging out with the sheep or ponies. The kids love him,” says O’Donnell.

Soon after arriving at the farm, Casper was up through the night screaming in pain. The following day, the kid was quiet and lethargic, not eating and struggling to urinate. O’Donnell brought Casper to TVFS in Woodstock, Connecticut. Part of the Department of Large Animal Clinical Sciences (LACS) at Cummings School of Veterinary Medicine at Tufts University, TVFS provides primary and emergency care and specialty reproductive services for large animals. Patients are treated at TVFS’s haul-in service or on the farm.

The team at TVFS diagnosed Casper with urinary blockage, caused by the formation of urinary crystals and stones, which inhibited his ability to urinate. This painful condition mainly afflicts male goats, sheep, and feedlot steers. Grain in the diet can lead to urinary blockage in male goats.

Dr. Jacquelin Graber, clinical assistant professor in the LACS Department at Cummings School, explains, “It is exceptionally important to manage the diet of male goats closely to prevent urinary stone formation and subsequent blockages. The primary nutritional cause is directly related to grain feeding, which alters the concentrations of calcium and phosphorus in the body, promoting stone formation. Certain forages, such as alfalfa, have a higher content of calcium and may also contribute to urinary blockages. Male goats should only be fed grass hay and a trace mineral supplement intended for goats. Owners should minimize any feeding of treats as well.”

The cause in Casper’s case is difficult to pinpoint. He may have been fed grain during his first few months of life, and the goat food recommended to O’Donnell contained grain. Other factors could be stress from a new place or castration banding. Genetics can also predispose goats to this condition.

If caught early enough, urinary blockage can be treated with dietary changes, medication, or supplements to dissolve the stones. In many cases, like Casper’s, blockage progresses to a point where the patient needs surgical intervention, typically classic tube cystotomy, a surgery that requires an extended hospital stay and can be financially prohibitive. As an ambulatory outpatient practice, not a hospital, TVFS does not offer this type of surgery.

To address this condition seen often in patients, Graber introduced the MITC procedure to TVFS, offering patients an option that’s less invasive and recovery-intensive than classic tube cystotomy. MITC patients can return home the day of surgery and be managed on an outpatient basis, with a much-reduced financial burden for owners. According to a study published in JAVMA, MITC patients have experienced positive outcomes. In classic tube cystotomy, the patient’s bladder is exteriorized to flush out urinary crystals and stones while the animal is intubated. Patients typically stay in the hospital for 10 days to recover. With MITC, the surgeon inserts a special cannula, or tube, in the bladder through a small incision to establish urine flow from the bladder while the stones are dissolved with time and medication.

“The MITC procedure has many benefits over other surgical options, which directly benefit the welfare of patients,” says Graber. “The procedure does not require a full general anesthetic, only sedation, performed under regional local anesthesia. The procedure itself is also rather brief and only requires a single, keyhole-sized incision into the abdomen. Patients experience a shorter recovery time and potentially less pain with a minimally invasive procedure.”

Dr. Adam Ward, assistant clinical professor in the LACS Department, was the first to perform the procedure at TVFS, and the first MITC patient was Casper.

“Case selection is key—Casper is a very healthy little Nigerian dwarf kid,” says Ward on recommending MITC for Casper. “There may be times when the classic surgery or a different type of surgery is a better choice, but this one is a viable option for a lot of cases.”

After sedating Casper, Ward and the TVFS team removed the urethral process at the tip of the goat’s penis, where crystals and stones can get caught. This can sometimes relieve the blockage, along with dietary changes, though in Casper’s case, the blockage was more proximal, so it did not have any effect. The team moved on to MITC.

The surgery went smoothly and took about half an hour. Casper began walking around as soon as the anesthesia wore off.

“When he woke up, he was back to his old self, better than he had been. I could tell almost immediately he was feeling better,” says O’Donnell.

Casper spent less than two hours at TVFS. He went home with a catheter to drain his bladder and medications for pain and to break up any remaining crystals. He returned to TVFS twice for rechecks and to have the catheter removed when he could urinate on his own again.

“Almost as soon as we got him home, he was trying to get into trouble, keeping up with his brother, and hanging out with the other animals,” says O’Donnell. “There’s always a risk that it could come back. He’s staying on medication, and we’re keeping a close eye on him.”

“Casper has had a good outcome so far, because he was a good candidate,” says Ward. “Good outcomes are related to good starts. He’s young and hasn't been blocked very long. If he had gone another day or two, it would have been another story.”

Ward notes that urinary blockage can be fatal if not treated, and even with treatment, blockage recurs in about half the cases. Aftercare is essential to the patient’s recovery. Owners must closely monitor the goat’s eating and drinking, and ensure the catheter remains in place and the incision stays clean.

Attributing much of Casper’s return to health to O’Donnell, Ward says, “Kevin realized it was happening and also took really good care of him. Kevin did all the right things for the aftercare.”

As for TVFS’s first MITC procedure, Graber says, “I am thrilled that Casper had such a successful outcome. His presentation was the best-case scenario, being a young, otherwise healthy male goat with an intact urinary bladder and a ‘first-time offender,’ meaning that he hadn’t had a previous episode of urinary blockages. These are all things we consider in determining if a goat is eligible for MITC. His owner was also particularly diligent in his monitoring of Casper at home, as well as bringing Casper in for his recheck appointments. Both are absolutely critical on the client-side of case management to have a successful outcome.”