Treatment and additional findings:
The gelding was hospitalized for observation and during the night no dysuria was observed. Rectal palpation was repeated next day and revealed no abnormalities. A cystoscopy was performed which revealed the presence of 2 urethral diverticula dorsal to the entrance of the bladder, lined with normal epithelium (figure 1 and 2). The mucosa of the bladder, the urethra and the two diverticula were hyperaemic with evidence of urine accumulation in both diverticula. No ectopic ureter was identified. There was normal voiding of urine from the ureters and presence of sediment in the bladder. After cystoscopy, the rectal palpation was repeated and revealed a gas distended structure dorsal to the bladder. Transrectal ultrasound showed a gas distended structure and a diffuse thickening of the bladder wall. The gas distended structure was suspected to be the urethral diverticula filled with gas, however, the extent of the diverticula could not be estimated. The complete blood count was repeated and showed a moderate neutrophilic leucocytosis (WBC: 14,14 x 10^9/L; neutrophiles: 11,2 x 10^9/L) and the blood gas analysis confirmed the slight hypokalaemia (2,8 mmol/L). Treatment was initiated with broad spectrum antibiotics (trimethoprim-sulfamides, 25 mg/kg PO BID) and anti-inflammatories (meloxicam, 0,6 mg/kg PO SID) to treat the present urinary infection. No further dysuria was observed and next day the repeat transrectal palpation and transrectal ultrasound didn’t allow identification of the diverticula No abnormalities of both kidneys were identified during transabdominal ultrasound. On day 2 of hospitalisation, the cystoscopy was repeated. The mucosa of the bladder, the urethra and the two diverticula were less hyperaemic (figure 3 and 4) but urine accumulation in the diverticula was still present. Sediment in the bladder was also still present and a lavage with an isotonic polyionic solution (lactated Ringer) was performed. Surgical exploration of the diverticula was declined by the owner due to financial restraints. One day later, the gelding was discharged from the hospital with systemic treatment.