Surgery of the female reproductive tract

Question 1

What are the indication for an ovariohysterectomy?

Answer 1

Eliminates unwanted pregnancies
Eliminates inconvenience of oestrus
Decreased risk of mammary neoplasia

Question 2

Ovariohysterectomy prevents the treatment of which diseases?

Answer 2

• Pyometra
• Metritis
• Ovarian / Uterine neoplasia
• Subinvolution of placental sites (sign: haemorrhagic vaginal discharge)
• Vaginal hyperplasia
• Vaginal prolapse
• Uterine torsion or prolapse (rare)

Question 3

What are the advantages of spaying before the 1st season?

Answer 3

Reduced risk of mammary neoplasia
Uterine and ovarian vessels small > less haemorrhage
Reduced surgical / annaesthesia time?
Reduced inconvenience to owner

Question 4

What are the disadvantages of spaying before the 1st season?

Answer 4

Anaesthesia ?
Juvenile behaviour?
Juvelin/hypoplastic vulva?
Obesity?

Question 5

When is ovariohysterectomy before the 1st season contraindicated?

Answer 5

Juvenile vaginitis
Juvenile Urethral Sphincter Mechanism Incompetence (USMI)

Question 6

When should ovariohysterectomy be performed?

Answer 6

In anoestrus - between seasons = 3 months after oestrus

Question 7

How many weeks post partum should a bitch be spayed?

Answer 7

More than 6-8 weeks

Question 8

Why should neutering be avoided whilst in season?

Answer 8

Increased size of uterine vessels
Uterine turgidity
Increased risk of haemorrhage

Question 9

Cystic endometria hyperplasia is also known as?

Answer 9

Pyometra

Question 10

When does Cystic endometria hyperplasia occur in the reproductive cycle?

Answer 10

Luteal phase

Question 11

Which dogs are most affected by pyometra

Answer 11

Middle aged, intact females

Question 12

What are the clinical signs of a pyometra?

Answer 12

Polyuria – polydipsia
Lethargy
Inappetence
Vomiting
Pyrexia
Dehydration
Abdominal pain
Vaginal discharge
Gait abnormalities
SIRS

Question 13

How do the haematology results indicate a pyometra?

Answer 13

Inflammatory leukogram, leukocytosis in most cases, anaemia due to erythrocyte loss in uterine exudate

Question 14

How is a pyometra diagnosed?

Answer 14

Abdominal radiography
Abdominal ultrasound

Question 15

Describe pyometra treatment

Answer 15

• Prompt and aggressive : Stabilise first if needed
• IVFT to correct dehydration and acid-base status
• Broad spectrum antimicrobials: cefuroxime or amoxicillin/clavulanic acid
• Treatment of choice: ovariohysterectomy
• Continue with antimicrobials if systemically ill, uti, intraoperative contamination

Question 16

When would medical management of a pyometra be acceptable?

Answer 16

Not recommended as a routine
Could consider if open pyometra, bitch of high breeding value
Risk of recurrence
‘Uterine emptying’ and antimicrobials for at least 14 days

Question 17

How is a pyometra medically managed?

Answer 17

PGF2a ; side effects.. Pain, vomiting, hypersalivation, fever, dyspnoea, panting
If medical management successful can breed at next cycle

Question 18

What is ovarian remnant sydrome?

Answer 18

• Signs of recurrent oestrus
• Diagnosis: history, vaginal cytology, hormone assays
• Exploratory coeliotomy; preferably if in oestrus
• Excise tissue from ovarian pedicles and submit for histopathology

Question 19

What is the cause of a uterine stump granuloma?

Answer 19

Poor aspect technique
Use of non- absorbable suture material for ligatures
Excessive remaining uterine body

Question 20

How does vaginal hyperplasia/prolapse present?

Answer 20

Oedematous enlargement of vagina during proestrus/oestrus under the influence of oestrogen

Question 21

How is vaginal hyperplasia/prolapse treated?

Answer 21

• Mild cases can be treated conservatively
• Apply lubricant
• Prevent self-trauma (use of Elizabethan collar)
• Reduction of prolapse and purse string around vulva?
• Large masses/non-viable prolapsed tissue requires resection (episiotomy)

Question 22

What is an episiotomy?

Answer 22

Incision of the vulva orifice to approach vaginal and vestibular lesions

Question 23

When is an episiotomy indicated?

Answer 23

• Surgical exploration of the vagina
• Excision of vaginal masses
• Repair of vaginal lacerations post-mating
• Treatment of strictures/congenital defects
• Exposure of the urethral papilla
• Facilitation of manual foetal extraction

Question 24

What is an episioplasty?

Answer 24

Reconstructive procedure to remove excess skin folds around the vulva
Excess skin folds > peri-vulvar dermatitis; rare consequence of early spay

Question 25

Name some ovarian neoplasia

Answer 25

Teratomas, teratocarcinomas, dysgerminomas
Adenoma, adenocarcinoma
Granulosa cell tumours

Question 26

How do dogs with ovarian neoplasia present?

Answer 26

Persistent proestrus/oestrus, cystic endometric hyperplasia, pyometra

Question 27

Name the most common uterine neoplasia of dogs

Answer 27

Mesenchymal origin
Leiomyomas (90%)
Leiomyosarcoma

Question 28

Name the most common uterine neoplasia of cats

Answer 28

Adenocarcinoma

Question 29

What is the most common tumour of intact females?

Answer 29

Mammary neoplasia

Question 30

Describe the main features of inflammatory carcinomas

Answer 30

• May affect multiple glands, both chains
• Signs similar to mastitis, dermatitis; poor demarcation, oedema, inflammation
• Short median survival times – poor prognosis
• Surgery not usually recommended

Question 31

What % of mammary neoplasia are malignant in 1. dogs, 2. cats

Answer 31

Dogs - more than 50% are benign
Cats - 90% malignant