Female urogenital surgery

Urine pooling, perineal body transection and urethral extension

Mares (or cows) with poor conformation, particularly splanchnoptosis, can develop urine pooling due to a tilt in the vaginal vault

Vulvar tilt and evidence of urine pooling
view of urine inside the vagina (cervix at 12:00)

Urine is highly irritating and can create further vaginitis and/or enter the uterus. Urine in the uterus causes fibrosis and leads to infertility.

Treatment

Since vaginitis can lead to urine pooling, the first treatment is typically a Caslicks. This is a bad idea if the vulva is severely tilted and mostly above the  pelvic brim.

If problems persist, the perineal body can be transected (Pouret’s procedure), removing the traction from the viscera. This is a simple procedure performed with an epidural or line block. The tissue is transected until the vulva is again vertical. This is reflected internally as a flatter vaginal vault. While the article below describes closure, these usually do well when left to heal by second intention.

If perineal body transection is not sufficient, the urethra tunnel can be extended so that urine is released close to the vulvar lips, giving minimal opportunity to flow back toward the cervix. Both procedures can also be done at the same time.

Key Takeaways

To fix urine pooling:

  • Perform Caslicks if slope isn’t too severe
  • Perform perineal body transection if splanchnoptosis
  • Perform urethral extension if still not fixed

 

Resources

Perineal body transection video- youtube

License

Icon for the Creative Commons Attribution-NonCommercial 4.0 International License

Large Animal Surgery - Supplemental Notes by Erin Malone, DVM, PhD; Elaine Norton, DVM PhD; Erica Dobbs, DVM; and Ashley Ezzo, DVM is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.