110.Vagina, Vestibule, Vulva

Question 1

how is the vagina formed

Answer 1

fusion of the paired paramesonephric (Mullerian ducts) to create a single tube the unites the the caudal urogenital sinus to make the vestibulovaginal jxngenital tubercle = clitoris = penis in males

Question 2

blood supply to the vagina

Answer 2

vaginal artery—from internal pudendal artery supplies vagina, urethra and vestibulevulva is supplied by branches of the external pudendal artery

Question 3

diagnostics for vaginal/vestibular disease

Answer 3

–PE–rectal—aseptic digital vulvar vaginal exam+/- culture (Pastuerella, Ecoli, B hemolytic Strep–positive contrast vaginourethrogram–vaginoscopy +/- biopsy

Question 4

two approaches to the vagina

Answer 4

1. dorsal episiotomy (through vestibular constrictor muscle and mucosa)2. ventral approach +/- pubic symphysis osteotomy +/- pubic and ischial osteotomy (caution obturator n)use urinary catheter !!

Question 5

congenital/developmental anomalies of the vestibulovaginal junction

Answer 5

VESTIBULOVAGINAL STENOTIC LESIONS1. focal hypoplasia2. imperforate hymen3. double vagina4. vertical septumpresent with recurrent vaginitis, UTI, misbreeding, hydrocolpos (fluid retention in vagina)std endoscopic scissors and/or Nd:YAG laser can resect thin septum or imperforate hymenresection, vaginoplasty (poor outcome) or complete vaginectomy needed to fix focal hypoplasia (if annular lesion)

Question 6

approaches for a vaginectomy

Answer 6

—caudal midline + pelvic osteotomy—episiotomy after OHE has been performedU cath in placeclose with Parker Kerr Oversew when done thru a caudal laparotomyclose with mucosal apposition if thru episiotomy

Question 7

rectovaginal fistulas are associated with what other congenital abnormalities

Answer 7

atresia ani!

Question 8

surgical option for recessed vulva

Answer 8

episioplasty/vulvuloplasty~50% dogs have UTI, 50% have urinary incontinence, 50% referred for vaginitis/dermatitissurgery resolved UTI in 80-100% of dogs

Question 9

ddx of soft tissue protruding from vagina

Answer 9

1. vaginal edema (mucosal swelling from E in proestrus/estrus)2. vaginal prolapse (rare)3. vaginal neoplasia4. clitoral hypertrophy

Question 10

tx for vaginal edema

Answer 10

–resolve on own with termination of estrus (keep moist, prevent licking–OHE–amputation of mucosa +/- episiotomy for exposurerecurrence is high in intact bitches

Question 11

tx for vaginal prolapse

Answer 11

—manual reduction followed by OHE—CAUTION additional organs can be prolapse with vagina may need cystopexy or colopexy

Question 12

neoplasia of the vagina/vestibule

Answer 12

mostly benign 80% (pedunculated)leiomyomas (most common), fibromas, cysts, polypsbenign masses removed with episiotomy and amputationmost common malignancy leimyosarcoma followed by others: fibrosarcoma, TVT, TCC, HSAmalignant masses removed with vulvovaginectomy with perineal urethrostomy (preserve vaginal artery and branches to urethra)