Introduction
Haematuria refers to the presence of red blood cells into the urine, and can be macroscopic or microscopic (Schumacher 2007). Specific data on the incidence of haematuria in equine practice are lacking. However, based on the available evidence, pathologic haematuria is considered uncommon (Duesterdieck-Zellmer 2007; Smith et al. 2018). With macroscopic haematuria, urine is red or brown. Discriminating haematuria from pigmenturia (presence of haemoglobin, myoglobin, or pigments in urine) may be challenging and requires laboratory analyses to be performed (Delvescovo 2022). The most common problems associated with haematuria are, in a putative order of frequency: urethral rents, urethritis, urolithiasis, trauma and neoplastic masses, pyelonephritis, cystitis, chronic administration of non-steroidal anti-inflammatory drugs and clotting disorders. Urethral infestation by Habronema spp. and Draschia spp. larvae, cantharidin toxicosis, renal failure with intravascular haemolysis, and vascular anomalies are other pathological conditions occasionally associated with haematuria (Schumacher 2007). Primary haemorrhagic cystitis is a further idiopathic condition resulting in haematuria. Exercise-related haematuria is also repoted, most often microscopic in nature (Schott et al. 1995).
Bladder mucosa has a remarkable regenerative capacity which allows a rapid return to urothelial integrity and function (Saulez et al.2005). Bladder haemorrhage often due to cystitis (either infectious, inflammatory, or idiopathic), neoplasia, or trauma. Bacterial cystitis requires mid- to long-term antibiotic treatment and might relapse, depending on the inciting cause. In a previous report on idiopathic haemorrhagic cystitis, most cases resolved completely or almost so in 3 weeks (Smith et al. 2018), following prolonged treatment with antimicrobials and anti-inflammatory therapies, despite no bacteria were cultured or identified. These data overall agree with experimental evidence gathered in other species supporting a minimum of 4 weeks for complete healing of damaged bladder mucosa (Hans et al. 2019). In spite of the reported positive outcome of prolonged treatment, it is sometimes advisable for the clinician to gain haemorrhage control rapidly, because of the presence of significant anaemia, coagulation disturbances, or because it might also reduce healing time and antimicrobial treatment duration. Urothelium damage can in fact become an entrance port for bacteria into the systemic circulation (Smithet al. 2018). On top of this, some horse owners have a strong emotional attitude towards their animal, and will more easily accept therapeutic interventions that control or at least improve the clinical sign(s) for which they looked for veterinary attention in the short-term, joined to other required long-term therapies effective for treating the primary problem.
This report proposes an easy-to-apply topical treatment for rapid bladder bleeding control in two adult geldings diagnosed with haemorrhagic cystitis. The product used is a carboxymethyl-starch powdera (CSP) employed in human surgery for blood loss control (Bracey et al. 2017). Haemostatic supplements like the one we describe were first used in human medicine in the 40’s, and since then their efficacy has constantly improved (Vecchio et al.2016). To the best of the Authors’ knowledge, this is the first report of trans-endoscopic or trans-catheter application of a haemostatic powder in a hollow organ in equine practice.