Management and Treatment of Vaginal Prolapse
The management and treatment of vaginal prolapse include vulval tape retention suture, Bühner’s method, Caslick’s operation (vulvoplasty), Minchev’s technique, Winkler’s method, Farquharson’s method, and the Guard and Frank technique.
Method of treatment varies with:
- Species and breed of the animal
- Severity of the condition
- Stage of pregnancy
- Owner ability to care for and observe the animal until after parturition
Early prompt treatment often permits the use of simple conservative methods and remove the necessity of using more heroic techniques.
Operator should select the most conservative method possible under the circumstances and caution the owner that as pregnancy progresses other methods may need to be used to control the condition.
50-100 mg IM Progesterone injection daily or 500 mg once every 10 days, therapy should be discontinued before the completion of gestation period. Administer with a stiff dose of antibiotics (Amoxicillin), antihistamines for at least 3 to 6 days.
Important Points
Important points to keep in mind in vaginal prolapse case management:
- Shark liver oil with sulphanilamide paste may be applied intravaginally.
- Relieve the vulval tape retention suture at the time of parturition.
- Vulvar truss is also of practical value.
- Pessaries are popular in Europe but not in USA.
- Check the pulse and mucus membrane for evidence of internal haemorrhage.
- In mild cases the orientation of the animal may be changed by elevating the rear part by means of keeping the animal in an inclined position.
- Restrain the animal.
- Reduce the straining with caudal epidural anaesthesia.
- Removal of urine and empty the bladder.
- Removal of dung, dirt and dust; Clean the prolapsed mass with warm saline or mild, non irritant antiseptic solution.
- Reducing the edema using hypertonic solution.
- Reduce the bleeding and check the evidence of tears and if present it should be sutured.
- Raise the prolapsed mass upto the level of ischial arch or vulva to facilitate easy replacement.
- After reduction and proper replacement of the prolapsed mass, vulval tape retention suture should be applied to prevent recurrence.
Management and Treatment Methods of Vaginal Prolapse
The management and treatment methods for vaginal prolapse in animals include:
- Vulval Tape Retention Suture
- Bühner’s Method
- Caslick Operation (Vulvoplasty)
- Minchev’s Method
- Winkler’s Method
- Farquharson’s Method
- Guard and Frank Technique
- Hormone Therapy
1. Vulval Tape Retention Suture
- The sutures should be located at least 2-3 inches lateral to the vulvar lips in the hair line.
- This affords a much tougher and thicker skin for the suture, which does not tear out as readily nor cause as much irritation as one in the vulvar lips.
- It is desirable use a type of suture that can be untied or released.
2. Bühner’s Method
Buried or “hidden” purse string type suture, or Buhner’s method may be used in chronic post partum prolapse as well as prepartum prolapse Under epidural anaesthesia and with a near sterile procedure, two one-half inch incisions are made one to two inches above the upper commissure and below the lower commissure of the vulva.
With a long eye point needle similar to a seton needle, an 18 inch piece of one-eighth inch nylon cord or heavy vetafil is passed within the tissues from one incision to the other lateral to one vulvar lip.
Needle is withdrawn and reinserted in opposite direction lateral to opposite vulvar lip to the lower incision site and again withdrawn.
The purse string suture around the vulva is tightened sufficiently to allow 4 fingers in the vulva, and the knot is tied and buried beneath the skin of the upper incision by suturing the skin over the heavy purse string suture leaving it buried within the vulvar tissues until parturition, when it is removed.
- A– Insertion of perivaginal needle from the dorsal to ventral incision.
- B– Insertion of needle on the opposite side for completion of loop.
- C– Completed loop before tightening and tying.
3. Caslick Operation (Vulvoplasty)
- Treatment of chronic prolapse of the vagina 2 months or more before parturition or in post partum prolapse.
- Proved very valuable in controlling tenesmus associated with wind sucking and a highly inflamed vaginal and vulvar mm.
- Performed under epidural anaesthesia.
- Local infiltration of anaesthetic agents at vulval region.
- Removal of narrow strip of tissue from muco-cutaneous junction with scissors.
- Close the denuded area using continuous interlocking pattern by nylon sutures.
- One or two deep horizontal mattress vulvar sutures of umbilical tape are placed thorugh the skin 2-3 inches lateral to vulva to protect lip from tearing during straining.
- After 10 days all sutures should be removed.
4. Minchev’s Method
Minchev’s method is indicated in recurrent prolapse of dorsal or dorso-lateral walls of vagina.
Restraint
- Low caudal epidural anesthesia
Instruments
- Gerlach’s perivaginal needle
- Non-absorbable, monofilament, heavy gauge suture– 1 metre
- Small gauge plugs (5 cm long x 2 cm diameter)– 4 Nos
Procedure
- Clip and surgically prepare on one or both sides, a 10 cm square area of skin, 11 cm lateral and anterior to the base of the tail.
- Along the course of anchor suture, infiltrate local anesthetic (2% Lignocaine; 20 ml) of all layers of pelvic and vaginal wall.
- Form a loop with the suture material doubled and threaded through the eye of the gerlach’s needle.
- With one hand, push the needle and loop threaded through the anesthetized path of the skin, muscles, and sacrosciatic ligament in to the vaginal cavity, with the other hand guide the needle from the vagina.
- When the needle eye and loop enter the vagina, insert a gauze plug into the loop to anchor the loop while the needle is withdrawn.
- Tie the suture outside over another gauze with enough tension to hold both the plugs in position.
- Too tight sutures may lead to inflammatory swelling.
- Sutures are left in situ for at least 14 days to allow adhesion formation between the vagina and pelvic wall.
- Remove sutures later.
5. Winkler’s Method
Winkler’s method is indicated in recurrent vaginal prolapse of ventral vaginal wall or cervix.
Restraint
- Epidural Inj. 2% Lignocaine HCl sufficient enough to cause analgesia of perineal skin ~3 cm below the dorsal commissure.
Instruments
- Suture needle (size 1), half circle, cutting edge bent to a U shape
- Non-absorbable, monofilament, extra heavy suture material– 100 cm
- Metal urinary catheter
Procedure
- Clean and reduce the prolapse
- Per vaginally locate the attachment of the pre pubic tendon to the anterior border of the pubis.
- Insert a metal urinary catheter in to the urethra and push away from the operation site.
- Pass the needle with suture material through the ventral vaginal wall immediately posterior to the cervix and through the triangular space formed by the main tendon and accessory band.
- Now pass the needle medially and dorsally through the prepubic tendon and back through the ventral vaginal wall about 5 cm from the original point of insertion.
- Direct the needle through the ventral wall of the posterior cervix without entering the lumen.
- Tie the ends of the suture such that a loop is formed, short enough to prevent recurrence.
6. Farquharson’s Method
Farquharson’s method indicated in recurrent vaginal prolapse unresponsive to other methods. It can be used in conjunction with Buhner’s method.
Instruments Required
- Scalpel
- Straight scissors
- Minimum 6 hemostats
- Large Vulsellum- Albrecht or Glock’s forceps
- Needle driver
- Chromic catgut– Size 2
- Curved, round bodied suture needles– Size 10
Restraint
- Epidural Inj. 2 % Lignocaine HCl sufficient enough to cause analgesia of perineal skin ~3 cm below the dorsal commissure.
Procedure
- After correction of prolapse, exteriorize the devitalized portion.
- At the widest portion of devitalized vagina wall, make a transverse, crescent shaped incision on the mucosa.
- Excise the mucosa using a scissors.
- Easily accomplished, if mucosa is edematous and some separation from underlying structures.
- Perform stripping of mucosa in small section.
- Appose the edges of each section by simple, interrupted catgut sutures.
- Tie sutures with great tension than normal, to prevent suture tension slackening following decrease in size.
- Subsequent fertility and parturition unaffected.
7. Guard and Frank Technique
Guard and Frank technique is used in removal of large amounts of perivaginal fat by incising the dorsal wall of the vagina.
8. Hormone Therapy
In cows suffering with chronic postpartum prolapse, treatment with a gonadotropic hormone rich in the luteinizing factor is indicated, if cystic ovaries are present.
50-100 mg IM Progesterone injection daily or 500 mg once every 10 days, therapy should be discontinued before the completion of gestation period. Administer with a stiff dose of antibiotics (Amoxicillin), antihistamines for at least 3 to 6 days.
