Genital Surgery - Female

Question 1

What is a perineoplasty?

Answer 1

Surgical reconstruction of the perineum (area between vagina opening and the anus)

Question 2

What is a vaginoplasty?

Answer 2

Surgical reconstruction of the vagina

Question 3

What is an episoplasty?

Answer 3

Surgical repair of vulva

Question 4

What are the indications for an ovariectomy in a mare?

Answer 4

Neoplasia / hematoma
Genetic control
Prevention of estrus

Question 5

What is the most common ovarian tumor of the horse?

Answer 5

Granuloma theca cell tumor

Question 6

What are the clinical signs of a granulosa theca cell tumor?

Answer 6

Anestrus, intermittent/continued estrus
Nymphomania, stallion behavior
Elevated testosterone +/- inhibin
+/- hemoperitoneum
+/- adhesions to adjacent organs; small colon strangulation (requires ovariectomy)

All ages
Unilateral > bilateral (rare)
Benign > metastatic

Question 7

What are the surgical approaches and prognosis for an ovariectomy?

Answer 7

Colpotomy
Paramedian oblique/flank/central midline
Laparoscopy

Prognosis is good, even if drop ovary and leave it in the body it may get walled off

Risk of metastasis post morcellation not reported in horses

Question 8

How do you perform a colpotomy?

Answer 8

Enter vagina and incise cervix and into body cavity
Take ecraseur and blindly lop around ovary to tighten and crush off ovary

Question 9

What are the types of perineal body injury?

Answer 9

1st degree: skin and mucous membranes
2nd degree: + constrictor vulvae m.
3rd degree: complete disruption of perineal body (one opening - rare to salvage EAS)

Rectovaginal fistula: full thickness - does NOT involve vulvar cleft

Question 10

What three layers are you reconstructing after a perineal injury?

Answer 10

Rectal mucosa
Perineal body
Vaginal mucosa

Question 11

What structure can you never reconstruct when dealing with perineal injuries?

Answer 11

Rectal muscle/anal sphincter

Question 12

What causes urovagina?

Answer 12

Cranioventral slope of urogenital tract

Question 13

How do you surgically repair a urovagina?

Answer 13

Caudal retraction of transverse fold
Caudal vaginal relocation
Urethral extension - urethroplasty - definitive surgery for those with >20 degree slope

Question 14

What is pneumovagina and what causes it?

Answer 14

Involuntary aspiration of air into the vagina resulting in chronic distention

Secondary to perineal conformation or a result of injury racing

Question 15

How do you surgically treat a pneumovagina?

Answer 15

Caslick’s operation
Reduction of the mucocutaneous junction of the vulva to prevent aspiration of air

Question 16

How do you perform a 3rd degree perineal repair?

Answer 16

Delayed repair -> plastic surgery repair/reconstruction
Wait weeks to months to heal and re-epithelialize after healing

1. Caudal epidural - between Cd1-2; 18-gauge 1.5 inch, 1mL Xylazine + 3-4 mL mepivicaine, anus should be flaccid
2. Dissect along dotted lines to make three different planes; rectal mucosa, perineal body, vaginal mucosa
3. Little incisions around is where vulva will be aligned - never full thickness