Urogenital - Ch 109, 110 Flashcards
Yong Vet Surg 2019
Survey of instructor and student impressions of a high-fidelity model in canine ovariohysterectomy surgical training
What is objective and results, clinical significance
Objective:
To evaluate the usefulness of a high-fidelity model for teaching ovariohysterectomy (OHE) to veterinary students.
Results:
Evaluators rated the high-fidelity model as moderate-to-highly realistic.Time to complete the OHE on the model (mean ± SD,73.4 ± 27.1 minutes) and live dogs (83.0 ± 24.7 minutes) did not differ (P = .20). Frequency of hemorrhagic events (P = .77) and accidental visceral injury (P = .30) did not differ between the model and live dogs.
However, fewer loose ligatures were placed in live dogs (23/64) compared with the model (22/37; P = .02).
Conclusion: The high-fidelity model improved the confidence of sophomore students. The duration of OHE did not differ between the model and live dogs.
Clinical impact: The high-fidelity model is valuable for improving confidence in veterinary students prior to live-dog OHE.
Zhu JAVMA 2024
Resource setting impacts neonatal but not maternal survival in bitches treated for dystocia: 243 cases (2015–2020)
OBJECTIVE To compare maternal and fetal outcomes of dystocia managed surgically and nonsurgically at referral hospitals (RHs) versus community medicine clinics (CMCs), determine the rate of C-section, and evaluate the incidence of hypoglycemia and hypocalcemia in bitches presented with dystocia.
RESULTS
183 (75%) dystocia episodes treated at an RH and 60 (25%) at a CMC.
There was a low incidence of hypoglycemia (5% [9/178]) and ionized hypocalcemia (1% [2/164]).
Seventy-three percent (177/243) of bitches underwent surgical intervention, 25% (61/243) received nonsurgical management, and 2% (5/243) transferred to their primary veterinarian.
There was no difference in survival for bitches operated at an RH compared with a CMC.
However, bitches operated at an RH were more likely (P = .04) to be discharged with at least 1 live neonate.
CLINICAL RELEVANCE In bitches diagnosed with dystocia, hypoglycemia and hypocalcemia were rare. The majority of bitches underwent a C-section. The setting where the C-section was performed did not impact maternal survival but did impact neonatal survival
Bruckner JAVMA 2023
Advantages of laparoscopic-assisted ovariohysterectomy versus open ovariohysterectomy for dogs with pyometra not detected in randomized clinical trial
OBJECTIVE To compare results for surgery time, perioperative pain, need for rescue analgesia, variables, serum C-reactive protein concentration, and postoperative complications for dogs with pyometra treated with laparoscopic-assisted ovariohysterectomy (LaOVH) versus open-surgery (OS) ovariohysterectomy.
ANIMALS 12 client-owned dogs with pyometra between June 1, 2016, and December 31, 2019.
RESULTS 6 dogs were recruited in each group; results for 1 dog in the LaOVH group were excluded from further analysis due to free abdominal fluid detected during surgery. Median surgery time was significantly shorter and median total incision length was longer for the OS group (23 minutes; 106 mm), compared to the LaOVH group (37 minutes; 38 mm). No other results differed significantly between groups.
CLINICAL RELEVANCE Although fewer patients in the LaOVH group required rescue analgesia, this was not statistically significant.
Therefore, our results could not prove previously suggested advantages of LaOVH (eg, less perioperative pain or faster recovery) in dogs with pyometra. Additionally, for the LaOVH group, the median surgical time was approximately 50% longer, an assistant was needed, and specialized equipment was required.
Owen JAVMA 2023
Canine laparoscopic-assisted ovary-sparing hysterectomy does not increase risk of stump pyometra
OBJECTIVE To evaluate incidences of pyometra and orthopedic, behavioral, urinary/reproductive, neoplastic, or atopic disease processes as outcomes for dogs undergoing either a laparoscopic-assisted ovary-sparing spay/hysterectomy (LapOSS) or a laparoscopic ovariectomy (LapOVE).
ANIMALS 33 client-owned dogs.
RESULTS 17 of the 33 dogs were in the LapOSS group, and 16 of 33 dogs were in the LapOVE group. Of the 17 dogs undergoing LapOSS, 5 of 17 (29%) underwent an elective OVE at a later date. The mean follow-up time was 4.2 ± 1.8 years for the LapOSS group and 4.3 ± 2.0 years for the LapOVE group. No dogs developed stump pyometra.
One LapOSS dog developed mammary tumor, and 2 others developed nonreproductive malignant neoplasia while 2 of the LapOVE dogs developed malignant neoplasia. One of the LapOSS dogs with malignant neoplasia had an ovariectomy prior to development of disease.
CLINICAL RELEVANCE Laparoscopic-assisted ovary-sparing spay appears to provide a safe and reliable method of sterilization, with no observable increased risk of pyometra with hysterectomy. Owners must be counseled prior to surgery regarding the consequences of gonadal hormone retention and multiple heat cycles.
Guest JAVMA 2023
Performing an ovariohysterectomy at the time of c-section does not pose an increase in risk of mortality, intra- or postoperative complications, or decreased mothering ability of the bitch
OBJECTIVE Ovariohysterectomy (OVH) is frequently recommended at the time of c-section in canines, yet prior literature suggests poor mothering ability and increased morbidity to the bitch with c-section with concurrent OVH (CSOVH). The study objective was to compare maternal survival, complications, and mothering ability between bitches that underwent c-section alone (CS) or CSOVH. ANIMALS 125 bitches.
RESULTS 80 bitches undergoing CS and 45 bitches undergoing CSOVH were identified. There was no difference in anesthesia duration, intraoperative complications, postoperative complications, mothering ability, puppy survival to weaning, or other variables compared between groups.
CSOVH bitches had longer surgery times (P = .045; 54.4 ± 20.7 min vs 46.9 ± 16.6 min) and longer time from delivery to nursing (P = .028; 75.4 ± 22.3 min vs 65.2 ± 19.5 min).
Ninety (72%) owners responded to the survey. All 90 bitches survived until puppy weaning.
CSOVH bitches were more frequently perceived as painful postoperatively (P = .015).
CLINICAL RELEVANCE Performing an OVH at the time of c-section does not pose a significant increase in risk of mortality, intraoperative complications, postoperative complications, or decreased mothering ability of the bitch. The increased duration of surgery and increased time from delivery to nursing in the CSOVH group were clinically insignificant. Appropriate postoperative pain management should be emphasized post-CSOVH. Based on these results, OVH should be performed concurrently with c-section if indicated.
Ogden Vet Surg 2020
Outcomes associated with vaginectomy and vulvovaginectomy in 21 dogs
Objective: To report the outcomes of dogs with lesions of the genitourinary tract treated by vaginectomy or vulvovaginectomy.
Study design: Multi-institutional retrospective study.
Results: This study included 21 dogs. Four dogs had vulvovaginectomy, six had complete vaginectomy, and 11 had a subtotal vaginectomy performed. The mean age at surgery was 9.2 years (SD, 3.3). Thirteen dogs were intact at presentation.
Smooth muscle tumors were diagnosed most commonly (10 leiomyomata, three leiomyosarcomas, two leiomyofibromas). The median duration of follow-up was 520 days (range, 71-1955).
Major complications requiring revision surgery were recorded in two dogs. Postoperative UIC occurred in six of 21 dogs, resolving spontaneously within 60 days in three dogs. Dogs with malignant tumors (n = 6) survived at least 71 days (median, 626; 95% CI, 71-1245), and recurrence of disease occurred in two dogs. In dogs with benign tumors (n = 15), the median survival time was not reached. These dogs survived at least 104 days and had no recurrence of the disease.
Conclusion: Vaginectomy and vulvovaginectomy resulted in prolonged survival and low rates of major complications and UIC. Clinical significance: This study provides evidence to recommend that the risks of this procedure and expectations should be discussed with clients.
Nicoli JSAP 2022
Resection of vaginal septum using endoscopic-guided sealing devices in female dogs: 8 cases (2015–2018)
Objectives: Vestibulovaginal septal remnants are congenital anomalies that are often concurrent with ectopic ureters in bitches. During endoscopic laser ablation of the ectopic ureter, the vaginal septum should be cut in the same surgical session. However, sometimes, the septal length and thickness make the procedure extremely long and challenging with lasers. This study aimed to describe the use of sealing devices for septal cuts.
Materials and Methods: We searched medical records for female dogs presented for ectopic ureters with endoscopic laser ablation that had a vaginal septum equal or longer than 4 cm in length that were treated using vesseal-sealing devices.
Results: 8 patients were eligible for inclusion in the case series. Weight of included dogs ranged from 10 to 27 kg, and age ranged from 3 to 60 months.
Three of these patients had the septum resected using the LigaSure™ device, and five of them using the ENSEAL® device.
The median time of septum resection using the vessel-sealing devices was 100 seconds (range 60 to 130s). No obvious complications were detected when using the described technique.
Clinical Significance: The sealing devices used by the authors allowed a rapid and uneventful resection of the vaginal septum in the cases described herein.
Pegram JSAP 2019
Associations between neutering and early-onset urinary incontinence in UK bitches under primary veterinary care
Objectives: To investigate association between neutering and early-onset urinary incontinence in bitches under primary veterinary care in the UK.
Materials and Methods: A retrospective cohort study of bitches within VetCompass born between January 1, 2010 and December 31, 2012 that were followed until March 31, 2018. The clinical records were automatically searched and manually validated for incontinence cases. Incidence risk and rate over the study period were calculated. Cox regression modelling separately evaluated the hazard of urinary incontinence and association with neutering: (1) from the date of birth for all bitches, both neutered and entire; and, (2) from the date of neutering for the neutered subset. Other variables considered included breed, bodyweight and veterinary practice group.
Results: Overall, 492 bitches were identified with early-onset urinary incontinence from a total of 72,971 included in the study period.
Incidence risk was 0.68% (95% confidence intervals 0.62 to 0.74), while incidence rate increased with age.
After accounting for confounding factors, increased hazard of early-onset urinary incontinence was identified in: (1) neutered bitches, with the effect increasing with age; and, (2) bitches neutered before 6 months, within the first 2 years following neutering.
In both models, increased hazard was additionally associated with increasing bodyweight and breed.
Clinical Significance: Neutering itself and early-age neutering (<6 months) are major risk factors for early-onset urinary incontinence. These results should be taken into account in making evidence-based recommendations on neutering and its timing.
Pailler JAVMA 2022
Owner-reported long-term outcomes, quality of life, and longevity after hospital discharge following surgical treatment of pyometra in bitches and queens
OBJECTIVE Investigate long-term complications, survival times, general health and quality of life (QoL) outcomes, and longevity in female dogs and cats (bitches and queens, respectively) following hospital discharge after ovariohysterectomy (OHE) for pyometra.
ANIMALS 306 pet-owner–completed surveys and corresponding medical records for 234 bitches and 72 queens treated with OHE for pyometra at the American Society for the Prevention of Cruelty to Animals Animal Hospital between January 1, 2017, and December 31, 2019.
PROCEDURES A telephone and online survey was conducted to gather data about pet owners’ perception of pet health and QoL following OHE for pyometra, and potential associations between survey results and medical record data were evaluated. Median survival time at a given age at OHE for pyometra was calculated with the use of maximum likelihood estimation of a survival-time regression model.
RESULTS 72 of the 121 (60%) eligible owners of queens and 234 of the 390 (60%) eligible owners of bitches completed the survey. Most owners reported that at the time of the survey, their pet’s health and QoL were better or the same as before pyometra. Reported health and QoL outcomes were similar for pets > 8 versus ≤ 8 years of age.
CLINICAL RELEVANCE Our findings indicated that bitches and queens undergoing OHE for pyometra at older ages and without other severe health issues can expect to live their full life span. Veterinarians in private practice could expect similar outcomes.
Pailler JAVMA 2022
Findings and prognostic indicators of outcomes for queens with pyometra treated surgically in a nonspecialized hospital setting
OBJECTIVE To describe findings, determine the rate of survival to hospital discharge, and identify prognostic indicators of poor outcomes for female cats (queens) with pyometra treated with ovariohysterectomy (OHE) in a nonspecialized setting.
ANIMALS 134 queens with pyometra diagnosed between January 1, 2017, and December 31, 2019.
PROCEDURES The medical records were retrospectively searched and data including patient history, clinical signs, blood work results, and outcome (survival to hospital discharge, length of hospitalization, and uterine rupture) were collected from medical records. Logistic regression models were used to assess potential predictors of outcomes.
RESULTS Dehydration (69% [83/121]) and absolute neutrophilia (83% [52/63]) were commonly reported. The rate of survival to hospital discharge was 100% (126/126; 95% CI, 97% to 100%) for queens treated with OHE; 33% (41/126) were hospitalized ≥ 2 nights, and 4% (5/120) had uterine rupture.
Queens with abnormal serum ionized calcium concentration or signs of depressed mentation had greater odds (OR of 4.64 and 2.26, respectively) of ≥ 2 nights’ hospitalization.
Queens with high rectal temperature, closed pyometra, or heart murmur had greater odds (OR of 35.66, 17.37, or 16.06, respectively) of uterine rupture.
CLINICAL RELEVANCE Our findings indicated that OHE for pyometra in queens was highly successful even when performed in a nonspecialty hospital with high-quality basic supportive care, and we believe most general practitioners who offer OHE could expect to see similar outcomes. With more general-practice veterinarians comfortable treating pyometra in their clinics, OHE for pyometra will be available to more pets, ultimately saving more lives.
Pailler JAVMA 2022
Findings and prognostic indicators of outcomes for bitches with pyometra treated surgically in a nonspecialized setting
OBJECTIVE To determine the rate of survival to hospital discharge and identify indicators associated with poor outcomes among female dogs (bitches) with pyometra treated with ovariohysterectomy (OHE) in a nonspecialized setting. ANIMALS 405 bitches diagnosed with pyometra at the American Society for the Prevention of Cruelty to Animals Animal Hospital from January 1, 2017, to February 8, 2019.
PROCEDURES For this retrospective study, medical records were searched and data collected including patient history, clinical signs, serum biochemical analyses results, and outcome (survival to hospital discharge, length of hospital stay, and uterine rupture). Logistic regression models were used to assess multivariable associations and identify potential predictive variables.
RESULTS The rate of survival to hospital discharge for bitches with pyometra treated with OHE was 97% (394/405); 44% (174/394) stayed in the hospital ≥ 2 nights, and 3% (11/390) had a ruptured uterus. Bitches with a high BUN concentration or heart murmur had greater odds of death after OHE; however, the model had low predictive power. Those with uterine rupture, inappetence, high concentrations of BUN or serum creatinine, low PCV, or dehydration had greater odds of hospitalization ≥ 2 nights. There were no significant predictors of uterine rupture.
CLINICAL RELEVANCE The rate of survival to hospital discharge was high for bitches with pyometra treated with OHE in a nonspecialized setting; therefore, general practitioners could expect similar outcomes. With this important procedure widely available in general practices, more pets can receive treatment for this life-threatening disease.
McCobb JAVMA 2022
Surgery in a veterinary outpatient community medicine setting has a good outcome for dogs with pyometra
OBJECTIVE To compare the outcome of canine pyometra surgeries performed at referral hospitals with those performed at community clinics (outpatient settings), and to evaluate factors that impact outcome.
RESULTS Eighty-three dogs were treated at referral hospitals; 50 dogs were treated at community clinics. Survival to hospital discharge for all dogs was 97% (129/133) and did not differ between treatment facility type. Dogs treated at both types of facilities were similar in age, body weight, and clinical signs. Median duration between diagnosis and OHE was significantly shorter for dogs treated at referral hospitals (0 day; range, 0 to 0.7 days) versus community clinics (1.0 day; range, 0 to 14.0 days); however, delay was not related to survival to hospital discharge. Duration of hospitalization did not impact survival to hospital discharge nor survival for at least 1 week after surgery.
CLINICAL RELEVANCE Results indicated that OHE for pyometra in dogs has a good outcome and that, although prompt surgical treatment remains a goal, in cases where limitations to performing surgery exist, a delay until surgery or discharging patients the same day is still associated with a high degree of success.
Rigdon-Brestle JAVMA 2022
Retrospective review reveals few complications of ovarian pedicle tie in 15,927 cats undergoing ovariohysterectomy at a large HQHVSN clinic and training facility in the United States: 2017–2018
RESULTS A pedicle drop or tear occurred in 0.3% (n = 49) of cats and was significantly more likely among veterinary students. Most (41/49 [84%]) pedicle drops and tears did not result in hemorrhage. Only 19 of 15,927 (0.12%) cats had pedicle- related hemorrhage, and in all instances, hemorrhage was corrected intraoperatively without serious complication or death. Cat characteristics and surgeon experience level were not related to pedicle hemorrhage.
CLINICAL RELEVANCE Results support previous evidence that the ovarian pedicle tie procedure is safe in cats undergoing ovariohysterectomy when performed by experienced surgeons or novice surgeons under supervision. Given the reduced anesthetic time associated with the procedure, the ovarian pedicle tie should be considered an acceptable standard practice in all practice settings.
Place JAVMA 2019
Evaluation of combined assessments of serum anti-Müllerian hormone and progesterone concentrations for the diagnosis of ovarian remnant syndrome in dogs
To determine the usefulness of combined assessments of serum anti-Müllerian hormone (AMH) and progesterone (P4) concentrations for diagnosis of ovarian remnant syndrome (ORS) in dogs.
DESIGN Prospective case series.
ANIMALS 602 bitches that had previously undergone ovariohysterectomy or ovariectomy without hysterectomy and that were being evaluated for ORS.
PROCEDURES Serum AMH and P4 concentrations were measured in a single serum sample obtained from each of the 602 dogs; results were classified as positive, negative, or inconclusive. Following AMH testing, submitting veterinarians were offered reimbursement for shipping and histologic evaluation of any tissue removed during treatment of dogs for which serum samples had been assessed.
RESULTS Tissue samples were provided from 53 of 55 dogs that underwent surgical abdominal exploration. Of 48 dogs with histologically confirmed ORS, 25 were positive for both AMH and P4 and 23 were positive for AMH or P4 or test results were inconclusive. No dogs with histologically confirmed ORS were negative for both AMH and P4.
Tissue samples that included no ovarian tissue were obtained from 5 dogs that were positive for both AMH and P4. In 2 dogs that were negative for both AMH and P4, no ovarian remnant was identified and no tissue was removed at the time of exploratory surgery.
CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that combined determination of AMH and P4 concentrations in a single serum sample can be an effective diagnostic test for spayed dogs suspected to have ORS. Histologic analysis of excised tissues to assess the completeness of surgical treatment in dogs with ORS is warranted
Adams Vet Surg 2022
Risk factors for neonatal mortality prior to hospital discharge in brachycephalic and nonbrachycephalic dogs undergoing cesarean section
Results: Overall neonatal survival to discharge was 93.1% (447/480); survival was similar between brachycephalic and nonbrachycephalic breeds (p = .221, 202/213 [94.8%] brachycephalic survival, 245/267 [91.8%] nonbrachycephalic survival).
Puppies delivered via elective c-section were more likely to survive compared to emergency c-section (p < .001, 238/240 [99.2%] elective survival, 209/240 [87.1%] emergency survival).
Puppies delivered in larger c-section litters were more likely to survive (p < .004) compared to smaller litters. Total litter size had no effect on survival.
Conclusion: Brachycephalism had no effect on neonatal survival. Puppies delivered via elective c-section were more likely to survive compared to puppies delivered via emergency c-section.
Clinical significance: Outcomes following c-section are similar between brachycephalic and nonbrachycephalic breeds. While it is preferable to encourage selective breeding for bitches that are able to whelp naturally, elective c-section should be considered in bitches at high risk for dystocia to maximize neonatal survival.
