Page 227 - Manual of Equine Field Surgery

Urethral Extension (Urethroplasty) 223

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A

B

Figure 41-2 A, The right side of the transverse ure-

thral fold and corresponding ventrolateral vaginal wall

are split horizontally i11 an interrupted manner. Arrows

indicate the direction of tissue mobilization. The left

Figure 41-1 The transverse urethral fold is caudally side of the transverse urethral fold has been sutured to

retracted. On the right side, an incision has been made the corresponding ventrolateral vaginal wall. B, Close-

through the transverse urethral fold and corresponding t1p view of a two-layer closure. The ventral layer is

ventrolateral vaginal wall. On the left side, a dotted line apposed using a ConneU pattern, and the dorsal layer is

indicates the proposed incision line. apposed using a continuous horizontal mattress

pattern.

position with No. 2-0 absorbable suture using a

two-layer pattern. The ventral layer is apposed right vaginal walls to a point approximately 3 cm

using a Connell pattern, and the dorsal layer is cranial to the vulvar labiae (Figure 41-3). Under-

apposed using a horizontal mattress pattern mining of the ventral and dorsal mucosal layers is

(Figure 41-2). A simple interrupted suture should performed to decrease tension. The ventral mu-

be placed at the caudalmost aspect of the two cosal layer is closed with No. 2-0 absorbable su-

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111ClSIOnS. ture using a Connell pattern, everting the tissue

ventrally (Figure 41-4). Submucosal tissue is

closed with No. 2-0 absorbable suture using a
Brown Technique
simple continuous pattern (Figure 41-5). Finally,

This is the most common urethral extension tech- the dorsal mucosal layer is everted dorsally with

3
nique used. Correction of urovagina in mares No. 2-0 absorbable suture using a continuous

caused by severe perinea! conformation abnor- horizontal mattress pattern (Figure 41-6).

malities can be achieved with this technique by

extending the urethral opening far caudally. Shires Technique

However, rnares with vaginal scars or vaginal

mucosa atrophy are not good candidates for this Although simple and efficient, this technique" is

technique because of increased tissue tension.3 limited in that it may be used only in mares that

A 30- Fr Foley catheter is placed in the urinary have redundant vestibular folds that may be

bladder and the cuff is inflated. The transverse pulled together to form a tunnel without the need

urethral fold is split horizontally, and the mucosal for dissecting and undermining tissue flaps to

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incision is extended caudally along the left and form a shelf.