Equine Female Urogenital Sx 1

Question 1

Episioplasty: Three surgical options from this approach?

Answer 1

1. Caslick’s procedure
2. Perineal body reconstruction
3. Perineal body transection

Question 2

Caslick’s Operation
1. aka ____

2. Goal?

Answer 2

1. Vulvoplasty

2. Tx pneumovagina by preventing aspiration of air into vagina

Question 3

Caslick’s Procedure allows us to prevent:

1.
2.
3.
4.
5.

Answer 3

1. Vaginitis
2. Cervicitis
3. Metritis
4. Infertility
5. Noise production

Question 4

Preparation for Caslick’s Procedure:

1. What position should horse be in?
2. Drugs?

Answer 4

1. Standing in stocks

2. Sedation / Local anesthetic / epidural anesthesia

Question 5

Preparation for Caslick’s Procedure:

Cleaning / Site preparation?

Answer 5

Manually remove feces, bandage tail, scrub + Disinfect

Question 6

Describe the Step-by-Step of Caslick’s procedure:

1.

2.

Answer 6

1. remove ~ 3 mm of tissue of vulva

2. Vertical mattress suture, starting dorsally

Question 7

Aftercare for Caslick’s Procedure?

Answer 7

Reopen before foaling via episiotomy!

Question 8

Indications for Perineal body reconstruction:

1.
2.
3.

Answer 8

1. Ineffective vulvar/vestibular seal
2. Failed caslick’s procedure
3. Rectovestibular injuries

Question 9

Describe the steps of a perineal body reconstruction:

4.

Answer 9

1. Incision at mucocutaneous junction of labium

2, Submucosal dissection of triangular section, removing a thin sliver of mucosa

3. Retraction and suturing, starting cranially. Creating apposition of submucosal tissue
4. Skin closure via deep horizontal mattress suture

Question 10

Perineal body reconstruction: Aftercare:

1.
2.

Answer 10

1. 4-6 weeks sexual rest

2. Episiotomy at foaling

Question 11

Indications for Perineal Body Transection:

1.

2.

Answer 11

1. Forward sloping of vulva

2. No decrease in vulvar and vaginal opening

Question 12

What is a common cause of forward sloping of vulva that would require Perineal Body transection?

Answer 12

weight of uterus and fetus pulling cranially for years via multiple pregnancies/deliveries

Question 13

Perineal Body transection:

Goal?

Answer 13

Break down tissue so we don’t have the step/sloping affect.

Question 14

Two options for closure of Perineal body transection:

1.
2.

Answer 14

1. Suture

2. Second intention healing

Question 15

Urovagina: Two clinical presenations?

1.
2.

Answer 15

1. Vesicovaginal reflux

2. Urine pooling

Question 16

Urovagina: CxS:

1.
2.
3.
4.

Answer 16

1. Vaginitis
2. cervicitis
3. endometritis
4. Decreased conception rates

Question 17

Three potential causes of Urovagina?

1.
2.
3.

Answer 17

1. Pneumovagina
2. Ectopic ureter
3. Excessive closure of Caslick’s

Question 18

Surgery options to Tx Urovagina?

1.
2.

Answer 18

1. Caudal relocation of transverse fold aka Vaginoplasty

2. Caudal urethral extension (urethroplasty)

Question 19

Caudal Relocation of Transverse Fold aka Vaginoplasty:

Surgical Steps:

1.

2.

3.

Answer 19

1. Incision in transverse fold
2. Incision in vestibule wall
3. Suture em together to create a more narrow vaginal opening

Question 20

Caudal Urethral Extension aka Urethroplasty:

Surgical Techniques:

1.
2.
3.
4.

Answer 20

1. Brown
2. McKinnon
3. Shires
4. Monin

Question 21

First step of Caudal Urethral extension aka urethroplasty?

Answer 21

Inserting catheter by guiding into along the floor into the urethral orifice

Question 22

Caudal Urethral extension aka urethroplasty

What do you do after you insert the catheter into the urethral orifice?

Answer 22

Suture the ventral shelf and create apposition, than repeat with the dorsal shelf

This creates an elongated urethra

Question 23

Describe the Shires technique for Caudal Urethral extension aka urethroplasty

Answer 23

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

Question 24

Common Foaling Injuries:

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Answer 24

1. Perineal Lacerations
2. Rectovestibular fistulae
3. Vaginal contusions
4. Vaginal rupture
5. Cervical lacerations
6. Uterine rupture
7. Uterine hemorrhage
8. Uterine prolapse
9. Uterine bladder eversion/prolapse/rupture
10. GIT injuries

Question 25

Perineal laceration classifications: 1. 2. 3.

Answer 25

1. First degree = only mucosa vestibule, vulva 2. Second Degree = Mucosa + submucosa 2. Third Degree = Perineal body, anal sphincter, floor of rectum

Question 26

What kind of perineal laceration is most common in younger mares?

Answer 26

3rd degree due to it being their first time foaling

Question 27

3 Main causes of Perineal laceration: 1. 2. 3.

Answer 27

1. Primiparous mares 2. Fetal malposition 3. Nose or foot catches vulvovaginal fold

Question 28

Repair of 3rd Degree Perineal Lacerations: 1. Technique? What position should horse be in? 2. ____ prophylaxis. 3. Repair when? 4. Aftercare?

Answer 28

1. Local debridement in standing horse. 2. Tetanus 3. 4-6 weeks post-partum, after weaning 4. Diet change to create softer feces

Question 29

4 Basic Surgical Principles for Repair of 3rd Degree Perineal Laceration: 1. 2. 3. 4.

Answer 29

1. Minimum tension on suture line 2. Broad contact of wound surfaces 3. Strong suture material 4. Reduce amount of feces

Question 30

Two methods for Rectovestibular Repair and when to use them? 1. 2.

Answer 30

1. Aanes method = for second stage of repair | 2. Goetze or Vaughan Method = single stage repair

Question 31

Rectovestibular Repair: First Stage Repair: 1. Goal? 2. Broads steps?

Answer 31

1. Recreate rectum floor | 2. Incise, suture with simple interrupted to appose submucosal tissue and invert vestibular mucosa

Question 32

Rectovestibular Fistula: 1. Definition?

Answer 32

Laceration of dorsal vestibula into rectum WITHOUT disruption of perineal body or anal sphincter

Question 33

T/F: It is always recommended to repair a rectovestibular fistula surgically

Answer 33

F, small ones can close spontaneously

Question 34

Two APPROACHES to repair of Rectovestibular Fistula: 1. 2.

Answer 34

1. Via rectum | 2. Via vestibula/perineal body

Question 35

Two TECHNIQUES of Rectovestibular fistula repair 1. 2.

Answer 35

1. Direct closure of fistula | 2. Via creation of third-degree laceration, and than repairing that

Question 36

Describe the rectal approach to repair of rectovestibular fistula

Answer 36

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

Question 37

Describe the incision to create a third degree perineal laceration as treatment for Rectovestibular fistula

Answer 37

A midline longitudinal incision in the vaginal shelf