Equine Female Urogenital Sx 1 Flashcards
Episioplasty: Three surgical options from this approach?
- Caslick’s procedure
- Perineal body reconstruction
- Perineal body transection
Caslick’s Operation
1. aka ____
- Goal?
- Vulvoplasty
2. Tx pneumovagina by preventing aspiration of air into vagina
Caslick’s Procedure allows us to prevent:
1. 2. 3. 4. 5.
- Vaginitis
- Cervicitis
- Metritis
- Infertility
- Noise production
Preparation for Caslick’s Procedure:
- What position should horse be in?
- Drugs?
- Standing in stocks
2. Sedation / Local anesthetic / epidural anesthesia
Preparation for Caslick’s Procedure:
Cleaning / Site preparation?
Manually remove feces, bandage tail, scrub + Disinfect
Describe the Step-by-Step of Caslick’s procedure:
1.
2.
- remove ~ 3 mm of tissue of vulva
2. Vertical mattress suture, starting dorsally
Aftercare for Caslick’s Procedure?
Reopen before foaling via episiotomy!
Indications for Perineal body reconstruction:
1.
2.
3.
- Ineffective vulvar/vestibular seal
- Failed caslick’s procedure
- Rectovestibular injuries
Describe the steps of a perineal body reconstruction:
4.
- Incision at mucocutaneous junction of labium
2, Submucosal dissection of triangular section, removing a thin sliver of mucosa
- Retraction and suturing, starting cranially. Creating apposition of submucosal tissue
- Skin closure via deep horizontal mattress suture
Perineal body reconstruction: Aftercare:
1.
2.
- 4-6 weeks sexual rest
2. Episiotomy at foaling
Indications for Perineal Body Transection:
1.
2.
- Forward sloping of vulva
2. No decrease in vulvar and vaginal opening
What is a common cause of forward sloping of vulva that would require Perineal Body transection?
weight of uterus and fetus pulling cranially for years via multiple pregnancies/deliveries
Perineal Body transection:
Goal?
Break down tissue so we don’t have the step/sloping affect.
Two options for closure of Perineal body transection:
1.
2.
- Suture
2. Second intention healing
Urovagina: Two clinical presenations?
1.
2.
- Vesicovaginal reflux
2. Urine pooling
Urovagina: CxS:
1.
2.
3.
4.
- Vaginitis
- cervicitis
- endometritis
- Decreased conception rates
Three potential causes of Urovagina?
1.
2.
3.
- Pneumovagina
- Ectopic ureter
- Excessive closure of Caslick’s
Surgery options to Tx Urovagina?
1.
2.
- Caudal relocation of transverse fold aka Vaginoplasty
2. Caudal urethral extension (urethroplasty)
Caudal Relocation of Transverse Fold aka Vaginoplasty:
Surgical Steps:
1.
2.
3.
- Incision in transverse fold
- Incision in vestibule wall
- Suture em together to create a more narrow vaginal opening
Caudal Urethral Extension aka Urethroplasty:
Surgical Techniques:
1.
2.
3.
4.
- Brown
- McKinnon
- Shires
- Monin
First step of Caudal Urethral extension aka urethroplasty?
Inserting catheter by guiding into along the floor into the urethral orifice
Caudal Urethral extension aka urethroplasty
What do you do after you insert the catheter into the urethral orifice?
Suture the ventral shelf and create apposition, than repeat with the dorsal shelf
This creates an elongated urethra
Describe the Shires technique for Caudal Urethral extension aka urethroplasty
After placing catheter, place a horizontal mattress suture through the mucosa on the left and another on the right side. Go from cranial to caudal for both patterns.
Take a sliver off the dorsal part to make it an open wound, suture that new wound closed, and leave the catheter in there for 3 days
Common Foaling Injuries:
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
- Perineal Lacerations
- Rectovestibular fistulae
- Vaginal contusions
- Vaginal rupture
- Cervical lacerations
- Uterine rupture
- Uterine hemorrhage
- Uterine prolapse
- Uterine bladder eversion/prolapse/rupture
- GIT injuries
Perineal laceration classifications:
1.
2.
3.
- First degree = only mucosa vestibule, vulva
- Second Degree = Mucosa + submucosa
- Third Degree = Perineal body, anal sphincter, floor of rectum
What kind of perineal laceration is most common in younger mares?
3rd degree due to it being their first time foaling
3 Main causes of Perineal laceration:
1.
2.
3.
- Primiparous mares
- Fetal malposition
- Nose or foot catches vulvovaginal fold
Repair of 3rd Degree Perineal Lacerations:
- Technique? What position should horse be in?
- ____ prophylaxis.
- Repair when?
- Aftercare?
- Local debridement in standing horse.
- Tetanus
- 4-6 weeks post-partum, after weaning
- Diet change to create softer feces
4 Basic Surgical Principles for Repair of 3rd Degree Perineal Laceration:
1.
2.
3.
4.
- Minimum tension on suture line
- Broad contact of wound surfaces
- Strong suture material
- Reduce amount of feces
Two methods for Rectovestibular Repair and when to use them?
1.
2.
- Aanes method = for second stage of repair
2. Goetze or Vaughan Method = single stage repair
Rectovestibular Repair: First Stage Repair:
- Goal?
- Broads steps?
- Recreate rectum floor
2. Incise, suture with simple interrupted to appose submucosal tissue and invert vestibular mucosa
Rectovestibular Fistula:
- Definition?
Laceration of dorsal vestibula into rectum WITHOUT disruption of perineal body or anal sphincter
T/F: It is always recommended to repair a rectovestibular fistula surgically
F, small ones can close spontaneously
Two APPROACHES to repair of Rectovestibular Fistula:
- 2.
- Via rectum
2. Via vestibula/perineal body
Two TECHNIQUES of Rectovestibular fistula repair
1.
2.
- Direct closure of fistula
2. Via creation of third-degree laceration, and than repairing that
Describe the rectal approach to repair of rectovestibular fistula
Incise into margin of fistula, and trim a little sliver off.
Place a continous suture pattern to disperse tension along the suture evenly.
It may tear, but every time you re-suture it, it should get smaller
Describe the incision to create a third degree perineal laceration as treatment for Rectovestibular fistula
A midline longitudinal incision in the vaginal shelf
