Vaginal & uterine prolapse in cattle

VAGINAL AND UTERINE PROLAPSE IN CATTLE

1. VAGINAL AND UTERINE PROLAPSE
PENILE DEVIATION,
PHIMOSIS,
RENALFAILURE,
NEPHROPEXY,
TRANSPLANTATION AND ANASTOMOSIS
OF URETERS
ON
PRESENTATION
Dr. NAVEEN KUMAR VERMA
M-5724

2. oA prolapse literally means falling down or downward
displacement of a part from its normal anatomical
position
oTypes:
i.Vaginal prolapse
ii.Uterine prolapse
Prolapse

3. Vaginal prolapse
oBearing trouble,
oRed bag,
o‘Showing the rede’
o‘Throwing the rose’
o ‘Pushing out the button’

4. oTypically looks like a pink mass of tissue about size of
large grapefruit or volleyball.
oA part or whole of vaginal wall displaced in such a way
that its mucosa is visible at vulval lips.
o Frequency : Buffaloes (highest)
Cattle
Sheep

5. oAll over the world
oSeen in mature females in last trimester of
pregnancy
oYoung , non pregnant fatty heifers
oCommon in stabled than pastured animals
oMore common in pleuriparous animals
Occurrence:

6. oHereditary predisposition
o Increase in intra-abdominal pressure
o↑ size of pregnant uterus
oIntra abdominal fat
oRumen distention
oOld age
oEndocrine imbalance (estrogen)
oCystic ovarian degeneration
oFeeding of old mouldy corn & barley
oDeficiency of Ca & disturbed Ca :P ratio
oConstipation with difficult bowel movements
oUrinary infection, vaginal injuries
oDeposition of fat in perivaginal space
Etiology

7. oDepends on degree & duration of prolapse
oTenesmus : continuous or intermittent
oAttempts at frequent urination & defeacation
oAnorexia
oVarying degrees of prolapse according to
i.Size of prolapse
ii.Involvement of organs other than vagina
iii.Length of time for which prolapse has been present
Clinical signs

8. oClassification

•Simple : vaginal mucosa protrudes from vulva when cow
is recumbent but disappears when cow stands

•Moderate : protruding vaginal mucosa remains visible
even when cow stands; cervix not visible
•Severe : vagina protrudes & cervix is visible

9. oPart of vaginal wall at vulval lips in the form of a
large reddish swelling
oUterus & bladder not displaced
oSuperficial erythema & erosion of vaginal wall
oAppears pale pink, moist, smooth, glistening
oProlapse appear and disappear as animal lies down
and stands up respectively.
Simple prolapse:

10. oBladder or intestine become involved in prolapse & get
trapped in pelvis.
oVaginal prolapse is so great & vesico - genital pouch is
greatly increased in size allowing viscera to enter it.
oRubbing with tail, ground, feces, urine
↓
severe irritation
↓
more painful, expulsive efforts
Moderate prolapse

11. ↓
Increases both size of prolapse & involvement of other
organs
oListless and uneasy
oGrazes little
oSeparates herself from herd
oTrapping of intestine → signs of intestinal obstruction
develops → strangulation ensues.
oBladder within prolapsed vagina → occlusion of
urethra → becomes filled & enlarged → rupture.

12. oExposed vaginal mucosa becomes severely ulcerated
& dried
oBlood stasis, disturbance in venous return & edema
pale pink→ deep red → blue → black (severe case)
oPerforate with necrosis leading to peritonitis or to
rapidly fatal hemorrhage.

13. oThird and most severe stage
oUterus & cervix pushed so far caudally that cervix
appears at vulval lips
oBacterial liquefaction of cervical seal (If
pregnant)
oEstablishment of infection inside the uterus
oFetal death & abortion occur several days after
correction
oFetus invariably becomes emphysematous
Severe prolapse

14. oDepends on degree of prolapse & time of handling
case.
oPartial : good
oComplete & long time neglected cases : bad.
Prognosis

15. a. Reduction & Replacement
b. Retention
a. Replacement :
oFirst caudal epidural anesthesia
oThorough cleaning of prolapsed mass with cold
water/ N.S./ mild antiseptic solution like
acriflavine.
Treatment

17. oRaising prolapsed
mass to level of
labia thereby
reliving pressure
on urinary meatus
& immediate
evacuation of
bladder.

18. oApplication of hygroscopic substances to reduce
size such as
Cold alum solutions
50% dextrose
Magnesium sulphate
Poppin spray (HERBAL)
oLubrication with non irritant liquid or jellies.
Glycerin (provides lubrication, reduces congestion
& edema by osmotic action)
Anesthetic jellies
oMass replaced back with fist or fingers held
together.
(Replaced organ requires to be straighten completely
as slightest invagination tends to immediate
recurrence)

19. Application of rope truss

21. Shoe lace suture
oPlaced using double
strand umbilical tape
o3 -4 eyelets made in
thick skin lateral to
labia through which
umbilical tape is
laced and labia
approximated

22. o Two mattress suture of
figure 8 and using piece of
gauze applied to vulval lips
using Gerlach needle,
leaving 1-2 cm apart from
rim of vulval lips.
Fixation of vulval lips

23. oFlessa sutures :
oCommonly used in field
conditions to retain
prolapsed organ.
oPossibility of vulval tears
if not placed sufficiently
deep/ when tenesmus is
present.

24. oEpidural anesthesia to prevent straining &
defecation
oSurgically scrubbing the vulval area
oFor chronic vaginal prolapse, removing narrow
strips of tissue (0.5-1.0cm) from dorsal two third
of mucocutaneous junction of labia.
oApposing wound edges with simple interrupted
sutures using nonabsorbable material
oRemoving sutures after 14 days.
Modified Caslick’s operation (vulvopexy)

26. oSterile elastic tape inserted subcutaneously, around
labia, orifice left open about 4 finger in width.
oDisadvantages :
oTape needs removal at parturition & since knot gets
buried under skin ventrally, professional help
required for the same.
oExtensive perivulvar edema
oModified Buhner method
oNot to bury knot by giving 2 separate incisions on
ventral aspect.
Buhner’s technique

29. oProvides secure external fixation
oWidely placed mattress sutures encircle rubber
tubing or latex linning or a piece of torn glove,
adequately padded inside, basically to prevent
pressure necrosis
Modified quill technique

30. Button technique
oHorizontal mattress sutures
placed through the holes in
the button on each side of
the lips of vulva

34. Permanent retention
oPreferred if cow is to be allowed subsequent
pregnancies
oBest performed in non pregnant state but may be
undertaken in late pregnancy

35. Sub mucosal resection
oDescribed by Farquarson (1949)
oApplicable to chronic cases with extensive necrosis
& swelling of vaginal mucosa
oAdministration of epidural anesthesia
oResection of damaged mucous membrane usually
over crescentic area
oCoaptation of incised edges
oTime consuming & accompanied with hemorrhage

36. Lateral wall fixation
oMinchev in Bulgaria
oObjective :
To anchor cranial vaginal wall of sacrosciatic
ligament by ligatures passing from vaginal lumen
through gluteal skin to outside on each side
oLigatures prevented from pulling through the tissues
by
1.Rolls of gauze impregnated with antiseptic
(Minchev)
2.Sterilized overcoat buttons (Hentschl)
3.Sterilized pads made up of industrial belting
(Norton)

37. oDisadvantages
1.Risk of damaging sciatic nerve
2.Not adequate to retain cranial portion of vagina
3.Cow may strain enough to pull sutures through
mucous membrane & cause peritonitis

38. Fixation of vaginal floor
oWinkler (1966): Anchoring vaginal floor to &
cervix to prepubic tendon with non absorbable
suture material
oAnchoring vaginal wall to ileo-psoas muscles on
the inner aspect of shaft of ileum with non
capillary, non absorbable suture material through
left flank laparotomy incision
oSuture placed in vaginal wall twice, once near the
cervix & once about 5-8 cm caudally so as to
produce tuck in wall

40. Care
o Balanced ration avoiding too much dry &
green fodder
oProper Ca, P supplementation
oAdministration of calcium borogluconate
every third day till animal is normal
oBed of animal s/not have slope & hind
quarters s/be elevated

41. Uterine prolapse
oFalling, sinking, sliding
of uterus from its normal
location in the body
oSeen immediately or
after some time of
calving

42. oCompared to vaginal prolapse, it is larger, longer
(usually hanging down to the hocks when standing)
more deep red in color 7 covered with caruncles
oFrequent sequel to protracted dystocia
oMost commonly observed in cows, buffaloes, ewes.
oPrognosis guarded to grave (no immediate veterinary
aid)

43. Etiology
oPredisposing factors
Lack of tonicity of uterine musculature
extensive manipulation to relieve dystocia →
secondary uterine inertia → uterine prolapse
oExciting factors
Expulsive efforts of dam / manipulative
interventions for removal of membranes
Presence of part of fetal membranes in genital
passage → strong tenesmus & prolapse

44. Clinical signs
oHypertrophied caruncles on exposed endometrial
surface
oDepending on duration of prolapse color change to
dark red with foci of necrotic tissue
oIf prolapse of intestine through rupture in uterine
wall → strangulation → shock
oAnorexia, pyrexia. Dyspnoea in latter stages
oIncontinence of urine
oRestlessness & tenesmus

45. Treatment
oReduction , replacement
oAmputation
oDecision depends upon following factors
•Placenta
•Trauma
•Gross hemorrhage

46. Reduction
oFirst caudal epidural anesthesia
oThorough cleaning of prolapsed mass with cold water/
N.S./ mild antiseptic solution like acriflavine
oEvacuation of urinary bladder if necessary by
catheterization

47. oSuturing uterine tear if any
oApplication of hygroscopic substances to reduce size
such as
Cold alum solutions
50% dextrose
Magnesium sulphate.
oLubrication with non irritant liquid or jellies.
Glycerin (provides lubrication, reduces congestion &
edema by osmotic action)
Anesthetic jellies

48. oAfter lubrication, replacing prolapsed uterus,
beginning from area nearest to vulva
oBetter to begin with ventral surface & alternate it
with dorsal surface
oAfter replacing major part, pushing ovarian pole
through cervix & uterus using closed fist in piston
fashion.
Replacement

49. oPushing several liters of warm water into uterus to
completely replace the ovarian pole, Then siphoning
out of water
oImmediate administration of 50 – 60 units of
oxytocin & IV calcium therapy (for resumption of
uterine tonicity & to fasten involution process to
prevent recurrence)
oRetention methods similar to that of vaginal prolapse

50. Amputation
oIndications
•Good removal of placenta not possible without
gross trauma & hemorrhage resulting
•Gross damage with continuous hemorrhage
•Permanent devitalisation of uterus
•Gross internal hemorrhage

51. oUrgency categories
•Almost elective: longstanding cases that show no
systemic effect or mild illness only
•Urgent: time to make considered decision, but
animal showing definite systemic effects
•Extremely urgent: usually ongoing gross
hemorrhage

52. oTechnique
oAdministration of epidural anesthesia
oThorough examination to exclude presence of
bowel or any other organ in prolapsed mass
( uterine wall is incised, visceral organ located &
replaced back)

53. Application of sutures
oPlacing of Series of heavy mattress sutures from
one side of prolapse to other, 4 cm anterior to point
of removal
oTying under tension
oRemoving the affected tissue
oApproximating raw edges with chromic catgut

54. Elastration technique
oCrude but practical method of correction under
range conditions
oApplication of elastic ligature/ heavy rubber
tubing about 4 -6 cm distal to cervix going round
uterus 3 – 4 times & tightened each time
oNo suturing
oProduces tissue strangulation & within few days
dropping of affected part

55. Aftercare
oAntibiotic cover
oAppropriate fluid therapy/ animal s/have plenty of
opportunity to drink, especially during 1
st
24 hrs
oAfter sloughing → gentle, clean vaginal examination
→ removing any remaining foreign body (rubber cord,
suture)

56. Penile deviations
►Spiral or corkscrew
►Ventral or rainbow
►S-shaped
►Lateral

57. Spiral or corkscrew deviation
►Most common
►Occur between 2.5-5
years of age
►Dorsal apical ligament
slips off to left hand
side during peak
erection
►Causes counter-
clockwise spiral

58. ►Normal in 50% of bulls during copulation
►Occurs in normal bulls during masturbation, after
intromission, and with the use of an electroejaculator
►Considered abnormal if it occurs repeatedly during
normal breeding attempts before intromission

59. Ventral or rainbow deviation
►Prevents intromission
►Can be diagnosed by
electroejaculator.
►Dorsal apical ligament
is thin, stretched,
incapable of supporting
distal penis.

60. S-shaped deviation
►Rare
►Older bulls with
excessively long penis
►Dorsal apical ligament
sufficient in strength,
insufficient in length
►No surgical treatment
described

61. Surgical correction of spiral or ventral
deviations
►Fascia lata implant
►Synthetic mesh implant
►Suturing of dorsal apical ligament of penis to tunica albuginia
Objective: To form a firm union between the dorsal apical ligament
& the tunica albuginea

62. Suturing technique
►General anesthesia indicated
►Exteriorize penis & held out by towel clip.
►Prepare surgically.
►20cm long incision is given on dorsal surface of
penis starting about 2cm from tip.
►Incision is extended through fascia & elastic tissue
down to apical ligament.

63. ►Ligament is incised along the length of previous incision
to expose tunica albuginia.
►Suturing is done with alternate catgut & stainless steel
suture material to provoke reaction & for strength resp.
►If implant is used it’s sutured to both tunic & ligament
after placing in between.

64. Phimosis
►PHIMOSIS is inability to protrude the penis beyond the
preputial orifice.
►Acquired due to lacerations.
►congenital
►Sequel to chronic preputial prolapse
►Surgical Treatment
 A triangular incision is made over the preputial
orifice,usually on the dorsal surface of prepuce.

65. •Removal of wedge of prepucial lining , sheath skin and
intervening fascia, mucosa on the ventral aspect.
•As much tissue as possible is removed ensuring that penis
remain covered with prepuce.
• Afterthat Lining and skin are then sutured together.

66. Renal failure

67. Nephropexy
Indication:- Nephroptosis(floating or hypermotile kidney).
This procedure is used to affix the kidney to the retroperitoneal tissue
via open or laproscopic surgery.
Based on the principle that ptotic kidney must be irreversibly fixed
into normal position by securing the kidney or perinephritic
tissue(renal capsule,perirenal fat) to the body wall high in the
retroperitoneum via either suture or subsequent adhesion formation.

68. Transplantation and Anastomosis of Ureters
Ureteral anastomosis is technically difficult in small patients (i.e.,
small dogs and cats) bcoz of high rate of postoperative obstruction.
If the ureter is transected or damaged near the bladder,
ureteroneocystostomy may be performed
During ureteral anastomosis, minimal dissection should be done
around the ureter to prevent compromising its blood supply.
 Stay sutures should be placed for manipulation, and traumatic
forceps should be avoided to prevent damaging the ureter.

69. Various synthetic materials have been used to replace the ureter,
but most are unacceptable because they promote fibrosis, formation
of calculus, and/or infection.
For ureteral trauma near the bladder Bladder-flap ureteroplasty is
performed.
Bladder-flap ureteroplasty : A flap is elevated from the ventral surface
of the bladder, and the ureter is reimplanted into the flap and the
flap is then closed as a tube.
As with ureterotomy, stenting catheters should be used with caution
because they may promote stricture formation.

73. THANKS!!!