Surgery of the equine female reproductive tract

Question 1

What are the anatomical barriers in a female horse?

Answer 1

• Vulva
• Vestibulovaginal fold
• Cervix

Question 2

What occurs with failure of the anatomical barriers?

Answer 2

• Contamination + reduced fertility

Question 3

What cab cause poor conformation of the vulva?

Answer 3

• Injury
• Age
• Parity
• Body condition

Question 4

What are conformation problems that contribute to poor reproductive performances?
What can be done to help?

Answer 4

• Pneumovagina - Caslicks, perineal reconstruction
• Urovagina - urethral extension
• Cervical incompetency - cervical repair
• Delayed uterine clearance - uterine suspension
• Oviduct blockage - oviduct lavage, prostaglandin

Question 5

What is a caslicks procedure?

Answer 5

• Improve vulvar competence
• using stocks, tail bandaged + held out of the way
• wash perineum + local anaesthesia
• Excise thin band of mucosa each side (3-4mm)
• Include dorsal commissure
• Level with the ischiatic tuber
• Do not oversuture
• Usually 0USP (3.5M) non-absorbable monofilament suture
• Remove sutures 10-14 days later
• Remove Caslick before foaling

Question 6

When would you do perineal body reconstruction?

Answer 6

• More severe cases of pneumovagina
• Second degree perineal lacerations

Question 7

How would you confirm urovagina? Tx? Ddx?

Answer 7

• Cytology
• Tx = improve body condition or surgery
• Ddx = ectopic ureter

Question 8

What is surgical management of urovagina?

Answer 8

• Caudal relocation of transverse fold
• Urethral extension

Question 9

When would you do surgery to cervical lacerations?
What are post-op complications?

Answer 9

• Dioesturs - >3weeks post paetum
• Post op complications = adhesions + incompetence

Question 10

What can delayed uterine clearance lead to?

Answer 10

• Endometritis
• Post mating persistent endometritis

Question 11

What is treatment of delayed uterine clearance?

Answer 11

• Uterine suspension - UTEROPLEXY
• Restoration of horizontal orientation of uterine horns
• Improves uterine clearance
• Improves perineal conformation
• May reduce urine pooling

Question 12

How would you treat oviduct blockages?
What does it do?

Answer 12

• Laparoscopic injection of prostaglandin =
• Relaxes smooth muscle of oviduct
• Modulates oviductal transport

Question 13

What is + what is done with first degree perineal laceration?

Answer 13

• Mucosal damage
• Caslick/no surgery required

Question 14

What is + what is done with second degree perineal laceration?

Answer 14

• Mucosa, submucosa & perineal muscles
• Caslick’s procedure & reconstruction of the perineal
  body

Question 15

What is + what is done with third degree perineal laceration?

Answer 15

• Complete disruption of rectovestibular shelf, perineal body & anus
• Requires surgical repair
• Delay repair for 4-6 weeks
• One and two stage procedures described

Question 16

What causes rectovestibular fistulas?

Answer 16

• Penetration of foals foot into rectum without progression to 3rd degree perineal laceration
• Unsuccessful repair of 3rd degree laceration

Question 17

What is the prognosis of squamous cell carcinoma?
Where are they seen?

Answer 17

• Poor prognosis
• Seen on vulva + clitoris

Question 18

What is seen with varicosities?

Answer 18

• Intermittent vulvar bleeding
• Blood pooling
• Worst at oestrus

Question 19

HOw would you treat varicosities?

Answer 19

• Not always necessary
• Topical treatment with astringent creams
• Ligation
• Cautery
• Laser photocoagulation

Question 20

What is the most common ovarian disorder?

Answer 20

• Granulosa (theca) cell tumour
• unilateral, rarely metastasise
• good prognosis
• anoestrus/ continuous oestrus signs
• stallion like behaviour / aggression

Question 21

How is a granulosa cell tumour diagnosed? Tx?

Answer 21

• Rectal examination
• Enlarged ovary on affected side
• Contralateral ovary usually small
• Transrectal ultrasonography
• Distinctive honeycomb like appearance
• Endocrinology
• ↑Testosterone in 50%
• ↑Inhibin in 85%
• ↑ Anti-Müllerian Hormone (AMH) in 98%
• Tx = Standing laparoscopy - ovarectomy

Question 22

What can be done if dystocia?

Answer 22

• Controlled vaginal delivery
• Caesarean section - 1 wk post-op hospital
• Terminal c-section - save foal (if mare has chronic problem)
• Foetotomy - only if confident with technique

Question 23

What are complications following dystocia / parturition?

Answer 23

• Uterine prolapse
• Uterine rupture
• Uterine haemorrhage
• Invagination / retroflexion of the uterine horn
• Retained foetal membranes
• Cervical tears
• Perineal lacerations / rectovaginal tears

Question 24

What are different uterine disorders?

Answer 24

• Uterine prolapse - Post dystocia, Replacement under standing sedation / GA
• Uterine artery haemorrhage - Older mares, Colic & evidence of haemorrhagic shock
• Uterine torsion - diagnosed on rectal palpation, Last 2 months gestation / at parturition, Colic / dystocia, Correction: surgical / rolling
• Uterine rupture - Clinical signs evident 24 – 72 days post foaling, Colic, Peritonitis
• Uterine neoplasia - Partial / total ovariohysterectomy
• Pyometra - Drainage of uterine contents pre-surgery + Ovariohysterectomy

Question 25

What are mammary disorders?

Answer 25

• Neoplasia
• Mastitis