Naga, everted urinary bladder in which Holstein cow

Naga, Ahmad, Naveed, Hossam Moneir, Haseeb Ali Tariqa,
and Nasim Ahmada


Sapphire Dairies, Raiwind, Lahore, Pakistan and aDepartment
of Theriogenology, University of Veterinary and Animal Sciences, Lahore,

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demand of milk has always been on increase. This is particularly true for
heavily populated tropical, subtropical countries including Pakistan.
Consequently, the trend of commercial dairy farming is increasing. These dairy
farms keep primarily Holstein Friesian or their crosses. Due to variation in
stress level of environment the milk production ability is generally reduced up
to 25% in these countries compared to their native areas. In addition to
provide optimal nutrition, the reproductive health of animal must be sound in
order to run the farm economically.

major reproductive issues of these dairy cows are metritis, dystocia, and
vaginal laceration at the time of parturition, embryonic or fetal losses and
repeat breeding. Prolapse of uterus, vagina and rectum is uncommon and if this
occurs usually it is post parturient. The major causes of prolapse are
genetics, feeding and management issues. However, prolapse and eversion of
urinary bladder associated with parturition is very rare but has been reported
in Holstein (1), beef cow (2) and in mare (3). In invariably all reported cases
the dam or fetus did not survive. We document here, for the first time, to the
best of our knowledge, a case of partially everted urinary bladder in which Holstein
cow that was treated successfully in which both the calf and the dam survived.

29 months old, pregnant heifer, weighing about 500 kg body weight was reported
at Sapphire dairy private limited, with protruding mass from her vagina and at
the same time for dystocia. The gestation length was xxx days. She has
been placed in maternity area with free excess to water and feed all the time.
She was on normal close up diet. Physical examination revealed a normal rectal
temperature (38.2° C), pulse rate of 80 beats per minute. The hiefer was bright
and alert.

of the protruding mass revealed the round structure to be about 18 cm in diameter.
It was severely hyperemic. On the upper aspect and anterior extremity two
nipple like projections were seen which were formed by folds of mucosal
membranes and represented the orifices of the ureters. It was confirmed by
vaginal examination that mass which was protruding was the everted urinary
bladder as it was coming out from urethral opening. There was no evidence of
tear on vaginal floor. The wall of bladder became thickened perhaps due to
exposure. Vaginal examination also revealed a live calf in normal presentation,
position and posture. At this time we decided to remove the live calf first and
then deal with everted bladder. The calf was delivered with little assistance
in about ten minutes. 

this we tried to decrease the size of thickened wall of the everted bladder
with the application of cold water, ice and Potassium Aluminum Sulfate but it
did not work. Then we performed epidural block by 8 ml of 2% lignocaine and
dose was repeated twice at interval of half hour with a total amount of local anesthetic
used was 24 ml. Diameter of urethral opening was increased by 2 cm incisions on
both left and right lateral sides of urethral orifice.  Using lubricated finger and with the help of
liquid paraffin we were able to push back the everted mass which was retained
inside well. Thereafter, the incisions were closed by placing three simple
continued sutures using catgut on both sides (). Potassium per magnate (KMNO4) was
sprayed on operated area. A combination of ampicillin (  ) as an antibiotic and flunixin meglumine (  ) as an anti-inflammatory was used for five
days. Daily cleansing of wound was done with the help of lugol’s iodine

is in stable condition. At first two to three days there is mild straining at
time of urination but from third day cow was urinating completely normal. Now
urination, defecation, feeding and milk production is completely normal.

is very important to differentiate among eversion and prolapse of urinary
bladder because method of reduction of protruded mass depends upon it. In
eversion of bladder the mucosal surface of bladder protrudes through vulva and
on its upper aspect there are two projections which represents the orifice of ureters
(6) sometime it may be referred as inversion, on the other hand in prolapse of
bladder the serosal of bladder protrude out. And protruded mass will be distended
with urine. Wound can be felt at ventral surface of vagina from which bladder
will protruded out (7).

of urinary bladder occur due to straining in cystitis (7) vaginitis, laceration
or tearing in the floor of vagina in calving. The factor which is favorable is
minimal level of weather stress in month of January for Holstein in Pakistan.

comparison with mare the size of urethral orifice is narrow in cow that’s why
reduction of protruded mass is difficult task (1) . In the present case we
decided to increase the size of orifice by giving on left and right lateral
sides of urethral orifice. If incision is given longitudinally on cranial and caudal
side of urethral orifice it will continue extending. It would be intrusting if
she became pregnant and eversion of bladder occurs or not at the time of parturition.
It is important to deal with this case as soon as possible because there is continuous
straining which may lead to herniation of other organs e.g. intestine and make
the prognosis of case unfavorable (1). In present case cow is attended without
any delay that’s why cow and fetus both survived.

are reporting this case if anyone in future come across with such an emergency he
can deal it with confidence and know that the prognosis of case will be favorable
if dealt without any delay.



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Veterinary Surgery ……………………

Diseases of cattle……………………….