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Our Unique Case of the Week! *WARNING: Graphic Pictures of an Actual Surgical Procedure*

This week we're highlighting a particularly unique case we had a few weeks ago, involving a two-year-old female Rottweiler.

Her primary medical problem was that she had a condition of recurring cystitis. Every 6-8 weeks, she would develop a bladder infection. Her infections began to occur around six months of age. Diagnostics were performed over an 18-month-period of time, including physical examinations, many urinalyses, several urine culture and sensitivities, complete blood counts, blood chemistries, as well as x-rays and ultrasounds of the bladder and the kidneys. No matter what treatments were used, the infections always cleared up then recurred in 6 to 8 weeks. During Dr. Carter's series of physical exams, he began to notice the progressive drooping of skin folds surrounding her vulva, the external parts of the female genital organs. Some call this condition a "hooded vagina." The correct term is hypoplastic vulva. This is a problem with the anatomic confirmation and structural formation of the skin tissues around the vulva.

Here's a picture of the patient's hypoplastic vulva, pre-surgery.

As she aged and her body grew, the skin folds progressively engulfed the vulva, or in laments terms, her "female parts." The excessive folds of skin trapped urine droplets. The persistent moisture and irritation from the urine caused what could commonly be called a "diaper rash." The accumulation of skin waxes, oils, and debris coupled with the absence of light and increased body temperature in the folds of skin made an ideal environment for bacteria to thrive and grow. As the skin folds increased in size, the vulva and surrounding skin became increasingly more inflamed. This inflammation caused itchiness and extreme discomfort for the patient. Because the area itched and was inflamed, the patient licked, scooted, and drug her rear-end across the floor. These behaviors created a vicious cycle of self-trauma. Added to this self-trauma was a localized physical trauma caused by the rubbing of the redundant skin folds during her daily activities of walking, running, and laying down. A persistent and recurring skinfold dermatitis, vaginitis, and lower urinary tract infection was the ultimate result.

A close-up picture of the patient's hypoplastic vulva.

Dr. Carter has found the hypoplastic vulva condition most commonly occurring in larger breeds of dogs, as well as in dogs that are obese. After many months of attempting medical management, he felt the ultimate cure for her hypoplastic vulva was to perform the surgical procedure called episioplasty or vulvoplasty. Dr. Carter sometimes jokingly calls this surgery a "face-lift for the female parts." An episioplasty is basically a surgical procedure where the folds of skin surrounding the vulva are removed.

The beginning of the episioplasty procedure, performed with our Accuvet CO2 Surgical Laser.

The initial incision with the surgical laser.

Dr. Carter has used his surgical laser for over 17 years. He considers it a superior tool compared to a traditional scalpel and scissors, especially for delicate procedures like this, because it cauterizes the nerve-endings and blood vessels. Since the nerve-endings are cauterized, there is much less postoperative pain. By cauterizing blood vessels, there is minimal bleeding. Minimal bleeding means there is minimal bruising, which greatly enhances postoperative pain management and healing. Safety of the procedure is also increased, since minimal bleeding means there is less likelihood of postoperative complications from blood clots.

One of the first folds to be excised.

Vulva after the removal of the excessive skin folds.

Vulva after stitches placed.

Dr. Carter implemented a seven day pre-operative care plan that consisted of the owner giving antibiotics, anti-inflammatory pain medication, and gently cleaning the area around the vulva using a soap-free antimicrobial shampoo. His postoperative care plan was for a period of 14 days, and involved the continued use of antibiotics and pain medicine. He also prescribed the use of an Elizabethan collar, the infamous "cone of shame," to prevent licking and further self-trauma. After 14 days of recovery and healing, the stitches were removed. Dr. Carter is happy to report that she has had no problems with skin infections, vaginitis, or bladder infections since her episioplasty procedure!

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