Changes

==Introduction==

==Introduction==

Vaginal hyperplasia describes the '''exaggerated response to oestrogens''' by the vaginal and vestibular mucosa resulting in '''excessive mucosal folding''' of the vaginal floor cranial to the external urethral orifice. Redundant tissue '''protrudes through the vulva''' as a mass.

Vaginal hyperplasia describes the '''exaggerated response to oestrogens''' by the vaginal and vestibular mucosa resulting in '''excessive mucosal folding''' of the vaginal floor cranial to the external urethral orifice. Redundant tissue '''protrudes through the vulva''' as a mass.

It usually occurs during '''prooestrus and oestrus''' and regresses spontaneously during the luteal phase.

It usually occurs during '''proestrus and oestrus''' and regresses spontaneously during the luteal phase.

Several grades of hyperplasia have been describes:

Several grades of hyperplasia have been described:

 

:'''Type I''': slight eversion of the vaginal floor but no protrusion through the vulva

'''Type I''': slight eversion of the vaginal floor but no protrusion through the vulva

:'''Type II''': vaginal tissue prolapses through the vaginal opening: tongue-shaped

 

:'''Type III''': donut-shaped eversion of the entire vaginal wall, including the urethral orifice which can usually be seen ventrally.

'''Type II''': vaginal tissue prolapses through the vaginal opening: tongue-shaped

 

'''Type III''': donut-shaped eversion of the entire vaginal wall, including the urethral orifice which can usually be seen ventrally.

Severe hyperplasia can lead to '''urethral obstruction''' and prevent urination.

Severe hyperplasia can lead to '''urethral obstruction''' and prevent urination.

The pathophysiology of the condition is an exaggerated response of the vaginal lining to oestrogens normally present during prooestrus and oestrus. Some bitches also have '''follicular cysts'''.  

The pathophysiology of the condition is an exaggerated response of the vaginal lining to oestrogens normally present during proestrus and oestrus. Some bitches also have '''follicular cysts'''.  

The condition is usually seen in '''younger bitches, typically during their first oestrous period'''.  

The condition is usually seen in '''younger bitches, typically during their first oestrous period'''.  

==Clinical Signs==

==Clinical Signs==

The bitch will have a history of being in prooestrus or oestrus.

The bitch will have a history of being in proestrus or oestrus. There may be '''excessive licking of the vulva''', or straining to urinate. A '''mass''' will usually be visible protruding from the vulva.

 

There may be '''excessive licking of the vulva''', or straining to urinate.

 

A '''mass''' will usually be visible protruding from the vulva.

'''Vaginal examination''' will help determine the extend of the hyperplasia and prolapse, as well as the position of the urethral orifice.

'''Vaginal examination''' will help determine the extend of the hyperplasia and prolapse, as well as the position of the urethral orifice.

If the mass has become traumatised or necrotic, it will need to be resected via an '''episiotomy'''.

If the mass has become traumatised or necrotic, it will need to be resected via an '''episiotomy'''.

#Bitch in sternal recumbency, perineum prepped and purse-string suture around the anus

#Bitch is positioned in sternal recumbency, perineum prepped and purse-string suture placed around the anus.

#Episiotomy performed: incising skin dorsally from the commissure of the vulva midline and deepening through subcutaneous tissues to the vestibule.

#Episiotomy is performed by incising skin dorsally from the commissure of the vulva midline and deepening through subcutaneous tissues to the vestibule.

#Mass lifted from the vaginal flood and the redundant vaginal tissue is '''amputated''' by making a transvers elliptical incision around the base

#The mass is lifted from the vaginal floor and the redundant vaginal tissue is '''amputated''' by making a transverse elliptical incision around the base.

#The vaginal defect is closed with simple iterrupted absorbable sutures marking sure the external urethral orifice isn't involved.

#The vaginal defect is closed with [[Suture Patterns|simple interrupted]] [[Suture Materials|absorbable sutures]] marking sure the external urethral orifice isn't involved.

#The episiotomy is close in 2-3 layers, involving the vestibular mucose, the subcutaneous tissues and the skin.

#The episiotomy is closed in 2-3 layers, involving the vestibular mucosa, the subcutaneous tissues and the skin.

Post-operatively, the bitch should be '''confined to a clean area''' to prevent contamination, and may benefit from the placement of a buster collar.

Post-operatively, the bitch should be '''confined to a clean area''' to prevent contamination, and may benefit from the placement of a buster collar.

Mazzaferro, E. (2011) '''Blackwell's Five-Minute Veterinary Consult Clinical Companion: Small Animal ECC''' ''Wiley-Blackwell''

Mazzaferro, E. (2011) '''Blackwell's Five-Minute Veterinary Consult Clinical Companion: Small Animal ECC''' ''Wiley-Blackwell''

[[Category:To Do - Helen]]

 

[[Category:To Do - Review]]

 

 

[[Category:Reproductive Diseases - Dog]]

[[Category:Female Reproductive System - Pathology]]

[[Category:Expert Review - Small Animal]]