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Surgical Conditions of
the Ovaries.
2
Congenital Anomalies
2
Ovarian agenesis
2
Ovarian hypoplasia..........
2
Supernumerary ovaries
2
True hermaphroditism
2
Pseudohermaphroditism.....
2
Ovarian Cysts......
2
Follicular cysts...
2
Luteal cysts...
3
Parovarian cysts
3
Ovarian Neoplasia
3
Surgical Conditions of the Uterus...
4
Pyometra
4
Hydrometra/Mucometra
5
Subinvolution of Placental Sites.......
5
Metritis....
5
Uterine Torsion...
5
Uterine Prolapse.
5
Uterine Rupture...
6
Uterine Neoplasia
6
Common Surgeries of the Uterus...
6
Ovariohysterectomy (OHE or OVH).......
6
Indications..........
6
Preoperative evaluation............
6
Complications.....
7
Cesarean Section...
7
Indications..........
7
Preoperative care
7
Anesthetic protocols............
8
Surgical technique............
8
Surgical Conditions of the Vagina, Vestibule, and Vulva...........
9
Congenital Abnormalities..............
9
Segmental Vaginal Aplasia or Hypoplasia..........
9
Persistent Hymen.
9
Rectovaginal/Rectovestibular Fistula
10
Acquired Abnormalities............
10
Vaginal Edema (vaginal hyperplasia).......
10
Vaginal Prolapse..........
10
Vaginal Neoplasia..........
11
Vulvar Hypertrophy......
11
Vulvar Hypoplasia / Infantile Vulva.
11
Mammary Neoplasia.
12
List of textbook references
13
OBJECTIVES
·
Know the signs and diagnostic findings for ovarian
neoplasia
·
Know how to diagnose and treat pyometra.
·
Understand how the signs and diagnostic findings of
metritis differ from pyometra.
·
Know how to diagnose and treat uterine prolapse.
·
Know the indications for and complications of
ovariohysterectomy.
·
Know the indications for and complications of cesarean
section.
·
Understand the surgical treatment options for
persistent hymen.
·
Understand how the signs of vaginal edema, vaginal
prolapse, and vaginal neoplasia differ.
·
Be familiar with the 3 main vaginal neoplasias.
·
Understand how the behavior of
mammary neoplasia differs between the dog and cat.
·
Be familiar with the various treatment options for
mammary neoplasia.
Note: References to
textbook illustrations have been provided and are marked by “ILL”,
for those who are interested. Use of these references is optional
and only provided for your convenience. A list of textbook
references is provided at the end of these notes. If you are
planning to work with small animals, you should consider owning at
least one of these textbooks as a reference.
(uncommon)
ovaries absent unilaterally or bilaterally.
underdeveloped ovaries.
both ovarian and testicular tissue in the same
individual.
the external genitalia is of the opposite sex
as the gonads
Signs
may be no overt problems
Surgical Treatment
Remove gonads.
May do cosmetic surgery on external genitalia.
most common type. single or multiple. may
develop after incomplete removal at spay.
Signs:
persistent
heat, mammary hyperplasia, or none.
Diagnosis:
visualizing cyst at laparoscopy or laparotomy
Surgical Treatment:
excision
or rupture of cyst (or hormonal treatment) ovariohysterectomy (OHE)
release progesterone.
usually multiple
Signs:
persistent anestrus, cystic endometrial
hyperplasia, or pyometra.
Surgical Treatment:
excise cyst or ovary (or hormonal treatment)
OHE
usually an incidental finding during routine
spay.
(uncommon)
more frequent in older, nulliparous bitches.
Signs
- if increased production of progesterone result is cystic endometrial hyperplasia or
pyometra.
- if increased production of estrogen result is
persistent heat, aplastic anemia.
- enlarged abdomen due to large tumor or to
ascites from peritoneal
metastasis.
- may have neurologic abnormalities if
metastasis to CNS
Diagnosis
physical/neurologic exam (palpate mass in
abdomen), vaginal cytology (cornification due to estrogen), serum
progesterone (>2 ng/ml), CBC +/- bone marrow biopsy (anemia),
abdominal and thoracic radiographs (primary tumor and/or
metastasis), abdominal ultrasound, biopsy
Surgical Treatment
OHE.
if young, breeding dog with large calcified tumor (suspect teratoma),
you may just excise the affected ovary.
Prognosis
good if benign and no aplastic anemia.
poor if metastasis or bone marrow suppression.
Adenoma/Cystadenoma
- may cause increased progesterone
Adenocarcinoma/Cystadenocarcinoma
- most common ovarian tumor in bitches.
may have metastasis to abdominal organs and lungs causing ascites
and hydrothorax
Granulosa cell tumor
- increased estrogen or progesterone. most common ovarian tumor
in queens.
may metastasize to abdominal organs or CNS. tends to be
benign in bitch and malignant in queen.
Dysgerminoma - rarely cause signs. may metastasize to adjacent
organs.
Teratoma
(Dermoid cyst) - may be asymptomatic or present for suspected
pregnancy.
may be calcified.
Teratocarcinoma
- often calcified. metastasizes regionally to bone so may be lame.
Pyometra is inflammation of the uterus.
Etiopathogenesis is not clear, but progesterone plays a key
role by increasing uterine secretions, decreasing contractions, and
closing the cervix.
(Repeated estrous cycles can lead to cystic endometrial
hyperplasia (CEH). However, pyometra can occur without CEH.)The
uterus becomes more susceptible to infection -
E. coli the most common, but other aerobes and anaerobes can
also be isolated.
Signs
anorexia,
PU/PD, depression, +/- vaginal discharge, vomiting, diarrhea,
shock.
Diagnosis
Signalment and history - usually occurs in bitches >6 yrs old,
and usually within
8 weeks of estrus.
Physical
exam - temperature may be normal. purulent or sanguineous
vaginal discharge if cervix is open (open pyometra), no discharge if
cervix is closed (closed pyometra).
+/- palpate enlarged uterus.
Lab data
– may be normal, but usually have
leukocytosis +/- left shift and
hyperglobulinemia
which indicate inflammation.
may have hypoalbuminemia due to decreased production, decreased
intake, or loss in utero.
may have nonregenerative anemia due to loss of RBC's into lumen and toxic
depression of production. may have prerenal azotemia. may have low urine specific gravity - (how pyometra affects
the kidneys is not clear.
one theory is that E. coli endotoxin or other toxins affect the
ability of the renal tubules to reabsorb water. Antigen-antibody
complex glomerulopathy? Direct effect of endotoxins?).
may
have urinary tract infection.
SAP can be elevated. can have metabolic acidosis.
Diagnostic imaging
- may see tubular soft
tissue density on survey abdominal films.
radiographs may be nondiagnostic, but can usually identify fluid-filled tubular structure on abdominal ultrasound.
[ILL. Hedlund (2002) Fig 28-15 radiograph]
Surgical Treatment
Ovariohysterectomy
- Same as a routine OHE but the uterus is more friable (and may
be filled with pus), so pack it off with laparotomy sponges to
prevent contamination.
Culture the uterus!
Don't leave any uterine body in the dog.
Lavage the uterine stump with sterile saline and consider oversewing
the end of the stump if mucosa is protruding - this can be done with
interrupted Lembert sutures or a Parker-Kerr oversew. Disadvantages
of oversewing are the potential for uterine stump granuloma or
abscess.
Post op care:
Continue antibiotics for 7-10 days based on culture and sensitivity
results.
Prognosis
usually good.
If death occurs, it is usually due to septicemia.
Medical Treatment
Not
recommended.
Can be attempted if cervix is open and dog is a valuable
breeding bitch.
Use antibiotics and PGF2a (not approved for use in dogs) to
contract the myometrium, relax the cervix, and lyse the CL.
(antibiotics can resolve bacterial infection, but medication does
not alter any underlying CEH.)
Potential side effects include restlessness, salivation,
vomiting, defecation, forcing pus through the oviducts into the
peritoneal cavity, and uterine rupture.
Recurrence of pyometra is likely so she should be bred at the next
estrus.
accumulation of sterile fluid in the uterus -
uncommon and usually an incidental finding.
Placental
sites do not degenerate and serosanguineous drainage is noted 7-12
weeks post partum. It
usually occurs in dogs <2 1/2 yrs old, with first or second litter.
Signs
anemia due to hemorrhage, palpate enlarged
uterine horns. R/O metritis, vaginitis, neoplasia.
Treatment
OHE to stop blood loss. Spontaneous recovery is
common.
Medical management may be tried using ergonovine, but success
varies.
Similar
to pyometra but metritis usually occurs postpartum and is associated
with dystocia, obstetrical manipulation, or retained fetus or
placenta.
Signs
anorexia, depression, vomiting, vaginal
discharge, fever, mastitis.
(Differs from pyometra in that there is no PU/PD.)
Diagnosis
Signalment and history - usually occurs
immediately postpartum.
Physical
exam - fever. malodorous, mucopurulent vaginal discharge
Lab data
- usually have leukocytosis
with degenerative left shift.
see degenerate PMNs and bacteria on cytology of the discharge.
Surgical Treatment
OHE is recommended if not a breeding animal or
if she has severe systemic signs. Perform surgery and post op care
as for pyometra.
Medical Treatment
consider
if she is not too sick and is a breeding animal. Use systemic
antibiotics and drain the uterus daily.
A soft rubber catheter can be passed if the cervix is dilated.
If a catheter cannot be passed, the uterus can be drained by
laparotomy and hysterotomy.
You can also use ergonovine maleate or PGF2α as for pyometra.
Usually occurs in a gravid uterus, etiology
unknown.
Signs
acute abdominal pain, vomiting, severe
depression and collapse, shock.
Diagnosis
supposedly can feel rotation on vaginal exam,
but more likely to be diagnosed on exploratory.
Treatment
OHE +/- cesarean section.
Do not derotate the uterus.
Prognosis
High mortality, especially if in DIC or
peritonitis due to rupture.
rare
Usually occurs at labor or within 48 hrs.
Signs
one or two tubular masses protruding from
vulva. May be in shock if intra-abdominal bleeding.
Treatment
- If uterus looks healthy, flush with warm
saline and lubricate with a water soluble jelly.
Gently manipulate uterus to manually reduce. Recurrence is rare.
- If manual reduction fails or the uterus is
necrotic, amputate the uterus.
A smooth, cylindrical object is placed in the uterine lumen and 4
stay sutures are placed at equidistant points around the prolapsed
uterus. Incise through all layers to the inserted object, one
quadrant at a time.
Immediately after incising one quadrant, anastomose the inner and
outer layers of the prolapsed uterus with simple interrupted
absorbable suture before incising the next quadrant.
- If uterus is replaced but uterine tissue is
damaged or there is internal bleeding, may need OHE.
May occur secondary to pregnancy or pyometra.
Can cause peritonitis.
If the tear is sutured, it may recur or fibrose, so do OHE or
unilateral OHE.
(rare)
Leiomyoma is the most common canine uterine
neoplasia.
Adenocarcinoma is the most common feline uterine tumor. It
may metastasis regionally, or to lungs, brain, or eyes.
Signs
depends on tumor type, size and pattern of
metastasis.
Illness is usually related to metastatic disease.
Diagnosis
usually at OHE or necropsy.
May find in patient suspected of having pyometra.
Treatment
OHE after checking for metastasis. Can try chemotherapy
for metastatic dz.
Prognosis
good for benign tumors.
poor for malignant tumors.
·
elective sterilization. This is recommended before 1st
estrus to reduce risk of mammary neoplasia. May be done as early as
7 weeks in spay-neuter programs designed to reduce pet
overpopulation problems. Main points to remember for early spay are
to avoid hypothermia and hypoglycemia.
·
ovarian dz (cysts or neoplasia)
·
uterine disease (pyometra, subinvolution, metritis,
torsion, rupture, neoplasia)
·
diseases related to hormone production (prevent
mammary tumors, prevent vaginal edema, vaginal prolapse, help
control unregulated diabetics)
·
physical exam
·
extent of diagnostic evaluation is related to animal's
age and reason for surgery
Hemorrhage
during surgery or post operative (bleed into
abdomen or vagina). More potential problems if OHE performed during
estrus.
Recurrent estrus
due to incomplete ovary removal – e.g. if
ligature placement is incorrect. If ovarian tissue is accidentally
dropped into the abdomen it can revascularize or reimplant and be
functional. Can diagnose by identifying cornified vaginal epithelial
cells and/or increased serum progesterone (>2 ng/ml). Explore while
there are signs of estrus when the tissue is enlarged and easier to
find.
Uterine stump infection
especially if progesterone is present from
ovary or exogenous source
Uterine or ovarian stump granuloma with or without fistulous
tracts
may
occur secondary to braided nonabsorbable suture (Vetafil, silk)
Ligation of ureter
will develop unilateral hydronephrosis.
If you ligate both ureters, the dog will go into anuric renal
failure.
The ureters are usually damaged so they must be transected
and reimplanted into the bladder.
Urinary incontinence
estrogen responsive incontinence may occur and
can be treated with diethlystilbesterol or phenylpropanolamine. No
difference in incidence of this between animals spayed in an early
spay-neuter program as compared to those spayed later.
Eunuchoid syndrome
decreased aggression and stamina.? Not proven
Weight gain
not a problem if diet and exercise are
regulated.
Infantile vulva
Can occur
for animals who have surgery at 7 weeks of age, but generally has no
clinical significance. (Males castrated young will also have smaller
penis than those castrated later.)
·
complete primary uterine inertia (dachshunds and
Scotties)
·
incomplete primary uterine inertia refractory to
medical therapy
·
secondary uterine inertia (St. Bernards)
·
relative or absolute fetal oversize (brachycephalic
fetus tend to have large head/shoulders)
·
anatomic abnormalities of pelvic canal (old pelvic
fractures)
·
uncorrectable fetal malpresentation (transverse
presentation)
·
fetal death with putrefaction (greyhounds)
·
toxemia (fetal death, uterine torsion, uterine
rupture)
warm IV fluids - correct any deficits prior to anesthesia, if
possible (hypoglycemia, hypocalcemia)
antibiotics - if
uterine infection, dead fetus, or manual manipulation
steroids - if septic shock
clip and scrub surgical site prior to anesthesia
- if possible without exciting bitch.
surgery table should be warm and level
(doesn't need to be tilted)
final scrub under anesthesia
want optimum analgesia and immobilization of
bitch with minimal compromise of fetuses.
Check your anesthesia notes for details on
this. From a surgical standpoint, you want to be very efficient – so
plan ahead and keep moving!
approach:
ventral midline abdominal.
(can also use flank approach to avoid mammary glands, but is
more vascular, less familiar, and less exposure.)
pack off uterus with laparotomy sponges.
hysterotomy:
longitudinal incision through avascular region
of uterine body. Gently
advance fetus to incision, open amniotic sac, pull out puppy, clamp
umbilical cord, place puppy on sterile towel and hand to nonsterile
assistant.
Use gentle traction to remove placenta.
If it's firmly adhered, leave it.
Check to be sure uterus is empty of fetuses and placentas.
Can give oxytocin to stimulate uterine contractions and to
help control bleeding.
close uterus with 1 or 2 layers, using continuous inverting suture
pattern (Cushings or Lembert) with absorbable suture.
[ILL. Hedlund (2002) Fig
28-7 and 28-8 photos]
[ILL. Gilson (2003) Fig
101-1, 101-2, 101-3 drawings]
[ILL. Probst (1998) Fig
30-9 thru 30-13 drawings]
en bloc ovariohysterectomy:
This is an alternative to hysterotomy if the
animal is to be spayed as well. Isolate the ovarian pedicles. break
down the broad ligament between the ovary and cervix on both sides
of the uterus. manipulate any fetuses from the cervix and vagina
into the uterine body. Double clamp both ovarian pedicles and the
uterus just cranial to the cervix. cut between the clamps and pass
the ovaries and uterus to a team of nonsterile assistants, who can
immediately open the uterus and resuscitate the neonates. double
ligate the pedicles. The advantages of this procedure are that there
is less chance for contamination by the uterine fluids, and it
shortens the anesthesia time. A potential disadvantage is that you
need enough assistants to resuscitate the entire litter at once.
[ILL. Mullen (1998) Fig
30-14 thru 30-17 drawings]
closure:
obtain sample for culture and sensitivity
followed by abdominal lavage if any spillage from uterus.
routine abdominal closure.
neonatal resuscitation:
clean membranes and fluid from oral cavity and
nostrils by swab or suction. can swing body and head in downward arc
to clear fluid from airway. rub neonate with towel to stimulate
respiration and to
dry. check for heartbeat and breathing (can give atropine or
doxapram sublingual or by umbilical vein). give few drops of 50%
glucose if not responding well. can give naloxone if bitch had
narcotics. ligate umbilical cord if it bleeds when clamp is removed.
keep warm. check for congenital defects.
post operative care:
clean incision. observe for hypothermia,
depression, shock, excess vaginal bleeding. put puppies with bitch
as soon as she is awake and watch for behavioral problems. puppies
need colostrum and nursing stimulates oxytocin to promote uterine
contraction. send home ASAP.
complications:
hypovolemia/hypotension
- due to blood loss, shock, anesthesia. treat with fluids and
transfusions as needed.
uterine
hemorrhage
- check for coagulopathies. control with oxytocin or ergonovine
maleate. transfuse if necessary.
may need OHE.
peritonitis - due to break in
technique or sepsis
metritis
uterine
scarring and adhesions - by third C sect may have decreased
litter size and difficult to exteriorize the uterus. if the horn was
incised, it may scar and prevent further placentation or cause
abnormal fetal development.
agalactia - usually milk within 24 hrs.
oxytocin will stimulate milk let-down but not milk production.
prolapsed uterus
mastitis
- enlarged, hot, painful mammary gland, fever, anorexia. Tx warm
soaks.
retained
placenta
- will usually come out on its own. if not, may lead to septic
metritis.
eclampsia - see trembling, weakness, convulsions, fever 2-4 wks
post partum. usually small breeds with large litters. Tx Ca
gluconate and vitamin D
subinvolution of placental sites - serosanguineous discharge.
treat as for hemorrhage.
segmental vaginal aplasia - complete occlusion
and retention of uterine fluids
vaginal hypoplasia - partial occlusion
Signs
asymptomatic, vaginitis, inability to tie
Diagnosis
digital palpation, vaginoscopy, vaginography
Treatment options
- breeding bitch- can resect caudal and
midvaginal strictures. incise longitudinally and suture
transversely.
- nonbreeding symptomatic - OHE or vaginectomy
- nonbreeding asymptomatic - no Tx
vertical septum or annular stricture at
vestibulovaginal junction
Signs
difficulty breeding, chronic vaginitis, urine
pooling, mucometra
Diagnosis
palpation, vaginogram, vaginoscopy
Treatment
- episiotomy - incise from dorsal vulvar
commissure toward anus along median raphe. incise fascia and vulvar
muscles, then mucosa. place urinary catheter.
resect septum.
close episiotomy in 3 layers.
- abdominal approach is needed if septum is > 2
cm cranial.
- vaginectomy is indicated if the stricture is
cranial, if urine pools after the septum has been removed, or if
surgical relief of the stricture was unsuccessful.
Prognosis
guarded if surgery site strictures post
operatively
[ILL. Hedlund (2002) Fig
28-9 drawing of episiotomy]
[ILL. Manfra Marretta
(1998) Fig 31-8 thru 31-11drawing of episiotomy]
[ILL. Wykes (2003) Fig
99-2 photo of persistent hymen]
often associated with imperforate anus. if
large fistula - do okay until start on solid food, then may develop
megacolon.
Signs
feces from vulva or urine from anus. vaginitis,
cystitis, frequent urination
Diagnosis
barium enema or barium in vagina
Treatment
ligate or oversew fistula. reconstruct wall.
Complications
incontinence. especially if had imperforate
anus.
[ILL. Wykes (2003) Fig
99-5 drawing]
occurs during follicular phase, usually during
first estrus and may recur. may also recur at parturition and cause
problems.
brachycephalics are predisposed.
Signs
mass cranial to urethral papilla, may protrude
through vulvar labia. can desiccate or become traumatized. urethra
is easily catheterized.
Treatment options
-
if mild, keep moist with soluble jelly until it reduces during
diestrus. megestrol acetate (progesterone) to prevent, but also
prevents ovulation.
- GnRH - can cause cysts.
-
surgical resection - episiotomy and resect at base, close vaginal
mucosa. may recur at next heat
- OHE - Tx of choice if not a breeding bitch
[ILL. Wykes (2003) Fig
99-6 drawing]
[ILL. Pettit (1998) Fig
31-1 drawing]
(uncommon)
may be hereditary. brachycephalics are
predisposed. may precede uterine prolapse. occurs during periods of
increased estrogen. rare during pregnancy
Diagnosis
donut shaped eversion of vagina, may see
urethral papilla
Treatment options
-
if mild, will spontaneously regress during diestrus - keep moist
- replace. may suture uterus or broad ligament
to abdominal wall, or suture labia
- resect devitalized tissue (first do
episiotomy and place urinary catheter)
- OHE is curative - will cause regression if
not a chronic prolapse.
[ILL. Wykes (2003) Fig
99-7 drawing]
[ILL. Pettit (1998) Fig
31-2 drawing]
Most common location for female (intact or
spayed) reproductive tract tumors.
Predisposition for boxer, poodle, and German shepherd.
Most are leiomyoma or transmissible venereal tumor (TVT).
Signs
bulging of perineum, vaginal prolapse,
tenesmus, dysuria, urinary incontinence, difficulty copulating,
sanguinous or purulent discharge
Diagnosis
vaginoscopy, digital vaginal exam, rectal
palpation in small dogs, cytology.
Abdominal and thoracic radiographs.
Treatment
Surgical excision - usually easy to remove with
episiotomy.
Prognosis
good for completely removed leiomyoma or for
TVT
Leiomyoma - often multiparous bitches.
Tumor is slow growing and associated with tenesmus and dysuria.
usually completely encapsulated and can be excised. Sessile or
pedunculated. Often reported with chronic estrogen (ovarian tumor or
follicular cyst). do not usually metastasize.
Leiomyosarcoma - metastasize to lymph nodes, spleen, lungs, or
cervical spinal cord and may recur without metastasis
Transmissible Venereal Tumor (TVT) - transmission, growth, and
metastasis depends on immune status of recipient.
May regress or grow slowly in normal animal, may grow quickly and
metastasize in immunosuppressed animal.
Treatment for TVT depends on tumor location, presence of metastasis,
and availability of treatment modalities.
Sx excision of TVT is associated with high rate of recurrence.
Chemotherapy using vincristine has a high cure rate and is useful
for metastatic disease.
Orthovoltage radiation therapy works for local tumors.
may persist with prolonged estrogen due to
cystic ovaries, granulosa cell tumor
Treatment
OHE
(recessed vulva, vulvar inversion)
may be more common in dogs that are spayed at
an early age, but not proven. Has also been described in intact
females. Obesity may also be a factor.
Signs
vulva is hidden into folds of adjacent skin,
perivulvar dermatitis. Has also been associated with chronic urinary
tract infections, urinary incontinence, and vaginitis.
Treatment
weight loss is indicated if the animal is
obese.
local cleaning of the skin.
episioplasty - crescent shaped bilateral piece
of skin removed dorsal and lateral to vulva. remove underlying fat.
close subcutaneous tissue and skin.
[ILL. Hedlund (2002) Fig
28-10 drawing of episioplasty]
[ILL. Manfra Marretta
(1998) Fig 31-4 thru 31-7drawing of episioplasty]
Incidence
dogs:
most common neoplasia. most commonly in caudal 2 glands.
intact females have 3-7 x increased risk compared to spayed.
spaying has no protective effect after 2.5 yrs or 4 estrus
cycles.
[ILL. Hedlund (2002) Fig 28-13 photo]
cats: 3rd most common neoplasia. all glands at
equal risk.
intact female has 7x increased risk as compared to spayed.
Siamese cats are predisposed.
Tumor type and Metastasis
dogs:
about 50% benign. (fibroadenoma) most malignant are adenocarcinoma
and have mets
to lungs or lymph nodes.
cats: 90% are malignant (adenocarcinoma, also
sarcoma and inflammatory carcinoma) and most have mets - lungs and
regional nodes.
Influence of Reproductive Hormones on
Occurrence
estrogen and progesterone have role in
etiology. bind protein receptors in target tissue. patients with
receptor rich tumors have greater survival than patients with
receptor poor tumors.
Diagnosis
history, signalment, physical exam
cytology
abdominal and thoracic radiographs and
abdominal ultrasound
histopathology
Treatment Options
Surgical excision
lumpectomy - remove tumor
simple mastectomy
(mammectomy)
- remove affected gland
en bloc resection -
remove affected gland, regional LN, and all glands in between
unilateral mastectomy
- remove all glands on affected side and associated LN
bilateral mastectomy
[ILL. Hedlund (2002) Fig
28-14 drawing]
Use an elliptical incision, as for any mass
removal. Be careful not to get too wide or may have trouble closing.
Depth of excision should be to pectoral muscles/abdominal wall
fascia. Use good hemostatis and use walking sutures to eliminate
dead space and tension. Bilateral mastectomies may need to be
staged, removing the second mammary chain 2-4 weeks after the first.
Type of surgery does not affect survival time
or cancer free time, so lumpectomy or simple mastectomy of affected
glands may be Tx of choice. The most important thing is to get clean
margins. 44% of dogs have receptor rich malignant tumors and
concurrent OHE of these bitches will increase survival time. (OHE is
cheaper than steroid receptor assay.)
cats- unilateral mastectomy have better disease
free interval than simple mastectomy but
no difference in survival. OHE is not indicated because cat mammary
tumors are receptor poor.
Other therapy:
-Chemotherapy
-Radiation therapy
-Immuinotherapy
Prognosis
dogs: depends on tumor size, type, mode of
growth and clinical stage. < 5 cm diameter, no invasion or mets -
survival same as for benign.
75% of dogs with simple mastectomy
or enbloc did not survive >2 yrs
cats:
average survival 1 year
either species: tumors with lymphatic
infiltration, metastasis, body wall invasion, rapid growth, or
recurrence have a
poor prognosis
Gilson SD.
Cesarean section In: D. Slatter, ed.
Textbook of Small Animal Surgery. 3rd ed. Philadelphia:
Saunders, 2003;1517-1520.
Hedlund CS.
Surgery of the reproductive and genital systems In: T. W. Fossum,
ed. Small Animal Surgery. 2nd ed. St Louis: Mosby, 2002;610-674.
Manfra Marretta
S. Episioplasty In: M. J. Bojrab, ed.
Current Techniques in Small Animal Surgery. 4 ed. Baltimore:
Williams and Wilkins, 1998;506-508.
Manfra Marretta
S. Episiotomy In: M. J. Bojrab, ed.
Current Techniques in Small Animal Surgery. 4 ed. Baltimore:
Williams and Wilkins, 1998;508-510.
Mullen HS.
Cesarean section by ovariohysterectomy In: M. J. Bojrab, ed.
Current Techniques in Veterinary Surgery. 4 ed. Baltimore:
Williams and Wilkins, 1998;500-502.
Pettit GD.
Surgical treatment of vaginal and vulvar masses In: M. J. Bojrab,
ed. Current Techniques in Small Animal Surgery. 4 ed. Baltimore:
Williams and Wilkins, 1998;503-506.
Probst CW.
Cesarean section In: M. J. Bojrab, ed.
Current Techniques in Small Animal Surgery. 4 ed. Baltimore:
Williams and Wilkins, 1998;496-500.
Wykes PM, Olson
PN. Vagina, vestibule, and vulva In: D. Slatter, ed.
Textbook of Small Animal Surgery. 3rd ed. Philadelphia:
Saunders, 2003;1502-1510.
Theriogenology VMED 5361
SURGERY OF THE MALE REPRODUCTIVE SYSTEM
Fall 2002
Dr. J. Davidson
OUTLINE
SURGICAL CONDITIONS
OF THE PROSTATE.
2
General Evaluation of Prostatic Disorders.
2
Benign Prostatic Hyperplasia and Cystic Hyperplasia.
3
Suppurative Prostatitis and Prostatic Abscessation.
3
Prostatic Cysts and Paraprostatic Cysts.
4
Prostatic Neoplasia.
5
TECHNIQUES FOR SURGERY OF THE PROSTATE.
6
General Considerations for Prostatic Surgery.
6
Prostatic Biopsy.
6
Prostatic Drainage.
6
Marsupialization.
6
Prostatic Omentalization.
7
Partial Prostatectomy.
7
Complete Prostatectomy.
7
SURGICAL CONDITIONS OF THE TESTES.
7
Testicular Hypoplasia.
7
Cryptorchidism..
7
Orchitis.
8
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