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Small animal surgery I > Surgery of the vagina and vulva > Flashcards

Surgery of the vagina and vulva Flashcards

1
Q

Why is vaginoscopy most useful for diagnostics?

A
  • Direct visualization of stenosis
  • Can evaluate repro and urinary tract together
  • Can rule out ureteral abnormalities (e.g. ectopic ureter)
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2
Q

Anatomy

A
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3
Q

Is a bacterial culture of the lower reproductive tract helpful? Why/why not?

A

Rarely

  • Limited value
    • Caudal repro tract not sterile
    • Indicated for resistant infection
    • May detect specific pathogens (Brucella)
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4
Q

What are the anatomical indications for an episiotomy approach?

A
  • Used for vestibular and vaginal lesions
  • Access up to just cranial to urethral opening
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5
Q

What is the proper positioning for an episiotomy approach?

A
  • Position for perineal sx
    • Tail looped up and over
    • Be sure to provide padding to prevent sores on the ventrum
  • Incise on midline from vulvar opening
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6
Q

What are the anatomical indications for a ventral approach to the lower repro tract?

A

For intrapelvic and abdominal lesions

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7
Q

What are the differences between a caudal approach and transpelvic approach?

A
  • Ventral midline abdominal incision
    • Limited access to lesions caudal to cervix
    • Rarely sufficient exposure by itself
  • Transpelvic
    • Req. muscle elevation, osteotomy
    • Significant morbidity
    • Risks
      • Obturator nerve
      • Complex blood supply to intrapelvic viscera
      • Avoid damaging urethra
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8
Q

What is the etiology of vestibulovaginal stenosis?

A
  • Developmental anomalies
  • No basis for genetic transmission
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9
Q

What are the various forms vestibulovaginal stenosis can take?

A
  • Retained embryonic epithelial tissue–3 types of lesions
    • Vertical septum–generally have vertical band in the center dividing vagina
    • Annular fibrotic stenosis–ring lesion; usually toward cranial aspect
    • Hypoplastic region–narrow area that resembles stricture
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10
Q

What clinical signs are associated with stenosis?

A
  • Recurrent vaginitis
  • Recurrent UTI
  • Difficulty or pain with breeding
  • Urinary incontinence often reported due to ectopic ureters
    • Usually due to other causes
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11
Q

What is the significance of urinary incontinence related to stenosis?

A

Repair of stenosis will NOT fix incontinence

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12
Q

How can a contrast vaginourethrogram be used to diagnose stenosis?

A
  • Iodinated contrast
  • Measure max and min diameter
  • Calculate ratio B:A
  • < 0.2 indicates severe stenosis
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13
Q

What are the indications for treatment of stenosis?

A

Breeding dogs

Spayed dogs with clinical signs

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14
Q

What criteria is used to determine stenosis treatment decisions?

A
  • Lesion type: septum vs. annulus vs. hypoplasia
  • Location: caudal vs. cranial
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15
Q

What are the two treatment options for a simple septal lesion?

A

Episiotomy or endoscopic treatment

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16
Q

How is an episiotomy used to treat a simple septal lesion?

A
  • Limited access cranial to urethral opening
  • Mucosal resection at lesion attachments–cut out the band
  • Appose mucosa
  • Some lesions retracted caudally to expose
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17
Q

Explain endoscopic treatment of a simple septal lesion

A
  • Laser ablation
  • Endoscopic scissor resection
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18
Q

T/F: Mucosal resection for an annular lesion is prone to stricture

A

TRUE

19
Q

What does the technique for resection of mucosa for an annular lesion depend on?

A

Location

20
Q

Explain the caudal to pelvis technique for an annular lesion resection

A
  • Vaginal resection and anastamosis
  • Dorsal approach–similar to episiotomy but you don’t go into the lumen of the vestibule; doesn’t enter lumen of vaginal vault
  • Incise skin over vestibule, incise stenotic area and then anastamose
21
Q

Explain the intrapelvic technique for resection of mucosa of an annular lesion

A
  • Vaginectomy–cervix to urethral opening
  • Ventral abdominal + transpelvic approach
  • Include OHE if not already spayed
22
Q

What is the etiology of a recessed vulva?

A
  • Conformational abnormality
  • Medium to large breed dogs
  • AKA “hooded vulva”
23
Q

T/F: There is no relationship between age at OHE and incidence of recessed vulva

A

TRUE

24
Q

Does obesity have an impact on incidence of recessed vulvas?

A

Nope–no data to support it

25
Q

What are the clinical signs associated with a recessed vulva?

A
  • Skin fold dermatitis or vaginitis
  • Urine pooling
    • Recurrent UTI
    • Apparent incontinence
      • Urine is trapped and can be dribbling
26
Q

What are the indications for surgical treatment of a recessed vulva?

A
  • Recurrent UTI
  • Significant skin fold dermatitis
  • Urine pooling/leakage
27
Q

What is the recommended procedure for recessed vulva?

A
  • Episioplasty–vulvar reconstruction to remove the skin fold
    • Straightforward
    • Outline area, resect to expose vulva
28
Q

Are complications of episioplasty for treatment of recessed vulva common?

A

No–rare

Recurrent signs almost always resolve

29
Q

What is the prognosis for treatment of a recessed vulva?

A

Good prognosis

30
Q

When does vaginal edema resolve?

A

End of cycle

31
Q

What is the history/signalment of vaginal edema?

A
  • Young dogs
  • One of the first proestrus/estrus cycles
  • Mucosa becomes edematous
  • Edematous mucosa protrudes from vulva
  • Tissue subject to drying/trauma
32
Q

What is the etiology of vaginal edema?

A

We don’t really know why, but the tissue becomes edematous

33
Q

How is vaginal edema usually treated?

A
  • Manual reduction of tissue
    • If significant will likely recur
  • OHE is recommended to prevent recurrence and injury to everted mucosa
  • Episiotomy likely required
34
Q

When treating vaginal edema, why is resecting the protruding tissue without an OHE not recommended?

A

The procedure is associated with significant hemorrhage and does not prevent recurrence during subsequent estrus cycles

35
Q

How do you differentiate vaginal prolapse from vaginal edema and neoplasia?

A
  • Vaginal prolapse–entire circumference of vagina prolapses and creates a ‘doughnut-shaped’ prolapse
  • Edema/neoplasia–only part of the vagina prolapses and it looks like a lump of tissue instead of a doughnut shape
36
Q

What are the etiologies of vaginal prolapse?

A

Secondary to dystocia, constipation, or forced separation

37
Q

How is vaginal prolapse typically treated?

A
  • Manual reduction + OHE
  • Bladder, colon may herniate as well (possible referral)
  • Hysteropexy (tack uterus to rim of pelvis to keep it from collapsing)
    • Breeding animals
38
Q

What is the typical signalment associated with reproductive neoplasia?

A

Older, intact female dogs > 10yrs old

(Suggests hormonal influence)

39
Q

What is the relative likelihood of benign vs. malignant neoplasia?

A
  • Most masses (80%) are benign
    • Leiomyoma most common
    • Fibroma, polyp, cyst
40
Q

What staging workup is necessary for reproductive neoplasia?

A
  • Pre-op staging workup
    • CBC/chem/UA
    • Thoracic rads
    • Abdominal U/S
41
Q

How is benign disease typically treated?

A
  • Excisional biopsy via episiotomy
  • Full-thickness resection at base
    • If only resect to the mucosa, probably won’t get entire mass (often come from the smooth muscle wall of vagina)
  • Electrocautery highly recommended
42
Q

What is the most common malignancy?

A

Leiomyosarcoma

43
Q

What are the characteristics of leiomyosarcomas?

A
  • Relatively low risk of metastasis
  • Locally invasive
  • Survival can be good with local control of tumor
44
Q

What is involved in the surgical treatment of malignant reproductive tumors?

A
  • Aggressive resection is necessary!
    • Transpelvic approach likely necessary
    • Remove entire repro tract + opening of urethra
  • Vulvovaginectomy
  • Also requires perineal urethrostomy

Small animal surgery I (25 decks)

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