48. Pathophysiology, classification, and treatment of vaginal prolapse in cows Flashcards
Ethiology?
Etiology:
- Last trimester of pregnancy
- Hormonal changes (E2, Relaxine)
- Wall of vagina protrudes through vulva
Classification of vagine prolapse?
Classification of vaginal prolapse
- Grade 1 prolapse
- Grade 2 prolapse
- Grade 3 prolapse
- Grade 4 Prolapse
Grade 1 prolapse?
Grade 1 Prolapse:
- Intermittent prolapse
- Visible when lying down, retracts when standing up
- Irritation: second phase
Grade 2 prolapse?
Grade 2 Prolapse
• Continuous prolapse without major tissue damage, urinary bladder retroflexed – urination problems
• Can be easily replaced
• Further irritation – third phase
Grade 3 prolapse?
Grade 3 Prolapse:
- Both the cervix and almost the entire vagina is prolapsed
- Major irritation, local oedema, hyperaemia, compression of blood vessels
- Difficult to replace
- If cervical seal is disturbed: danger of imminent septic abortion – elective c-section
- Signs of toxaemia indicates foetal death
Grade 4 prolapse?
Grade 4 Prolapse
- Prolonged prolapse
- Grade 2 or 3 with infection, trauma, or tissue necrosis
- Possible adhesions between perivaginal tissue and adjacent organs (bladder)
- Peritonitis: present or imminent
- Sub acute form is replaceable but chronic is irreplaceable, poor prognosis, euthanasia.
Replacement of vaginal prolpase?
Replacement of vaginal prolapse:
• Preoperative measures:
o Epidural anaesthesia
o Clean and disinfect the prolapsed vagina and the surrounding area
o Hygroscopic powder: sugar, sulpha urea – decrease local oedema
• Operation Techniques:
o Several options, depending on expected date of parturition and environmental factors
o Flessa Method
o Buhner method
o Lacing of the vulva with mattress sutures (vertical/ horizontal)
o Episioplasty (Caslick’s operation) – mainly in horses
Flessa method operation?
Operation:
• Pierce the vulva with the pins with spacers on both sides (number of pins used depends on the size of the
vulva)
- Leave the ventral third of the vulva intact to keep urination undisturbed
- Remove pins when parturition starts
Buhner method?
Buhner Method:
- Equipment: Buhner needle and antibiotic – soaked tape
- Horizontal skin incisions: dorsal and ventral commissure of the vulva
- Insertion of a loop of tape under the skin of the vulva:
o Stimulates the action of the constrictor vestibuli muscle
Buhner method technique?
Technique:
- Needle is directed through incision at ventral commissure of vulva
- Suture material is threaded through exposed eye of needle
- Second limb of suture is carried around left side of vulva
- The suture is pulled out and tied at the vulvar incision
Buhner method?
Buhner method:
- Tightened suture: enough space for 2 or 3 fingers in the vulva
- Use bow knot for maintaining the closure
- Circular constriction is formed
- Incisions: closed by interrupted suture
- Easy to open when parturition starts
- Lacing of the vulva with mattress sutures:
Lacing of the vulva with matress sutures(advantages-techniques)
Lacing of the vulva with mattress sutures
Advantages:
- Simplicity, easily removable
- No special equipment needed
- Secure
Technique:
- Widely placed mattress sutures encircle vertically placed quills of rubber tubing (infusion tube)
- Vertical or horizontal mattress sutures
- Remove when parturition starts
Caelicks operation?
Episioplasty (Caslick’s operation)
Technique:
- 1.8 cm band of the mucosa removed to about 4 cm above the ventral commissure
- Closure of the vulvar lips: vertical mattress suture, nonabsorbable material
- Parturition: open surgically
Complications?
Complications:
- Faecal contamination of pins/tape/sutures – risk of infection – inflammation, foetal death
- Lack of close observation before parturition – obstructed vulvar opening – foetal death
- Vaginal wall oedema – compression of urethra – difficult urination
- Vaginal wall oedema – stricture – dystocia – C-section
- Scar tissue formation in the vulva – dystocia – episiotomy
- Might relapse after parturition – repeat operation/cull
