Recurrent Complete Vaginal Prolapse with Rectal and Urethral Prolapse in a Bitch Treated by Hysteropexy and Colopexy
Department of Clinical Studies, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, Greece.
A 4-year old, nutritionally deficient, Greek Hound bitch, weighing 18 kgs, was presented at the end of "heat" with intermittent stranguria, partial anorexia and mild depression, bearing a 15 day-complete vaginal prolapse that was focally necrotic. The prolapse was routinely amputated (circular part of 5-7 cm) and the sutured vagina was allowed to retract. Although the animal seemed to have recovered uneventfully, a month later it was readmitted presenting a 3 day-complete prolapse of the remaining vaginal wall, a 6 cm- rectal and a 3 cm- urethral prolapse, being caused by a 20 day-intense straining. Faecal examination revealed plenty roundworm eggs. A celiac caudal midline surgical approach was preferred. Urinary bladder was found mainly behind and partly inside the pelvic canal, intensely dilated and compressing all intra-pelvic structures. Caudal uterus had also been pulled inside and behind the pelvic canal by the prolapse. To restore the prolapsed viscera, bladder evacuation was necessary (feasible only by cystocentesis). Bilateral ovariectomy was performed; ovaries presenting mature corpora lutea. One uterine horn (sutured through the anti-mesometrial fold) and the descending colon were fixated on the abdominal wall. Abdomen was routinely closed. Anti-helminthic treatment was applied for the first 3 days postoperatively. During those days the bitch was presenting intense straining, severe perineal pain and stranguria. Urine elimination was found completely arrested during the first postoperative day and was facilitated by urethral catheterization under epidural anaesthesia. The bitch had fully recovered by the 6th day postoperatively without prolapse recurrence ever since (3 years).
Amputation is the treatment of choice in cases of complete vaginal prolapse and as a rule, no relapse occurs, at least before next proestrus. In this animal, relapse occurred soon after amputation and exceptionally during dioestrus, when spontaneous regression of vaginal oedema should have been awaited. The increased abdominal pressure, caused by intense straining, contributed to this multi-prolapse. Straining could be attributed to the intestinal parasitism, the post-surgical vaginal irritation and finally the recurrent vaginal prolapse. Bladder evacuation had to be assisted pre- and postoperatively. Hysteropexy, colopexy and preventive ovariectomy seems to be effective in cases of simultaneous occurrence of vaginal, rectal and urethral prolapse.