Page 515 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

490 CHAPTER 2

VetBooks.ir spontaneously, resulting in resolution, or surgery Management
Many acute cases resolve spontaneously as the uterus
may be required.
Aetiology/pathophysiology involutes fully and the vagina resumes normal con-
formation. Sexual rest and improvement in the phys-
Age, weight loss, foaling/mating injuries, relaxation ical condition of the mare also help in some cases.
of the reproductive tract during oestrus, Caslick’s Caslick’s vulvoplasties that have been extended too
vulvoplasties that have been extended too far ven- far ventrally should be corrected to allow the nor-
trally below the level of the pelvic brim, or a large mal efflux of urine. Vaginitis/cervicitis/endometritis
pendulous multiparous uterus may result in changes should be treated appropriately with antibiotics and/
in conformation of the vulva/vagina/vestibule, which or flushing. Some cases of urovagina cause a prob-
result in urine pooling in the anterior vagina. Urine lem for fertility only while the cervix is open during
pooling may be a temporary state in the first post- oestrus and the urine refluxes into the uterus. These
partum oestrus while the uterus is still involuting. may be treated medically, with repeated manual
scooping out of urine from the vagina, lavaging of
Clinical presentation the uterus and use of intrauterine antibiotics while
The clinical signs are vulval discharge, failure to the mare is in oestrus and the cervix open.
conceive and an abnormal vulval conformation. In more severe, chronic cases a urethral extension
procedure, where a mucosal tube is created surgi-
Differential diagnosis cally from the urethral opening to direct urine cau-
Other causes of infertility/subfertility; bacterial endo- dally, may be required (Fig. 2.102).
metritis; bacterial vaginitis; CEM; pneumovagina. Perineal body transection (Pouret’s operation)
may help in mares with poor vulval conformation
Diagnosis (Fig. 2.103).
Urine/vaginitis is visible on vaginoscopy at oes-
trus. Urine pooling is evident on manual exami- Prognosis
nation. Ultrasonography may identify fluid in the The prognosis is good in young mares with the
uterus (urine or endometritis) and/or poor uterine temporary state and fair for older mares following
involution. surgery.

2.102 2.103
Fig. 2.102 Immediately
postoperative photograph of a
completed urethral extension
surgery with a bladder catheter
in place to divert urine away from
the surgery site. The vestibular
fold is cranial and dorsal. Note
how far caudally the catheter exits,
which is where the urine will exit.
(Photo courtesy Graham Munroe)

Fig. 2.103 This mare has just
had a Pouret operation carried
out. Note the way the dorsal
commissures of the vulval lips are
vertical and there is a shelf effect
above them before reaching the
anus.