Surgical Correction of Abnormalities of the Female Reproductive Organs

CHAPTER 28 Surgical Correction of Abnormalities of the Female Reproductive Organs




SURGICAL CORRECTIONS FOR ABNORMAL PERINEAL CONFORMATION





Surgical Procedures



Episioplasty (Caslick’s Surgery)


Episioplasty2 is the surgical procedure used to reduce the length of the vulvar opening. Following is a summary of the steps involved:











SURGICAL CORRECTION OF URINE POOLING IN THE MARE


Urine pooling (vesicovaginal reflux) is a well-known cause of infertility. It is commonly encountered in multiparous mares because of relaxation of the ovarian and uterine ligaments. Other predisposing factors for urine pooling are weight loss, abnormal perineal conformation (recessed anus), and the combination of edema and relaxation of the reproductive tract that occurs during estrus or the early postpartum period. Mares that experience urine pooling due to poor perineal conformation should have Caslick’s surgery. Mares may pool urine only during estrus and suspect mares should be examined during standing heat. Several techniques have been described for surgical correction of the condition. The goal is to extend the existing urethra caudally. Three surgical approaches are described here; however, surgical corrections often fail postoperatively and must be repeated.




Surgical Procedures



Posterior Fixation of Transverse Fold


This technique is among the first described to extend the urethra.4 The urethral fold is pulled caudally, and its edges trimmed and sutured to incisions in the vaginal wall with No. 0 absorbable material. In most cases, caudal traction on the fold creates excessive tension and results in failure of the suture line. Additionally, it is difficult to achieve good apposition between the edges of freshened urethral fold and the vaginal wall (Fig. 28-4).




Urethral Extension (Shires Technique)5


After placement of a 30 French Foley catheter in the urethra (Fig. 28-5, A), interrupted horizontal mattress sutures (No. 0 synthetic absorbable material) are placed in the vaginal mucosa, sparing the catheter. As the sutures are tightened, folds of mucosa close over the catheter. Adequate mucosa must be present on the formed crest to allow mucosal tissue to be trimmed. Following excision, a simple continuous suture pattern is used to appose the cut edges. After completion of the procedure, the catheter is removed (Fig. 28-5, B to F).




Sep 3, 2016 | Posted by in SUGERY, ORTHOPEDICS & ANESTHESIA | Comments Off on Surgical Correction of Abnormalities of the Female Reproductive Organs

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