Management of Vaginal Hyperplasia in Bitches by Bühner Suture

Abstract

Vaginal hyperplasia in bitch is an exaggerated response of the vaginal mucosa to estrogens during the proestral-estral phase of the cycle that can protrude through the vulvar lips. The present study refers to the management of vaginal hyperplasia in bitches by Bühner vulvar suture. Fourteen private-owners animals were refereed for spontaneous vaginal hyperplasia and complete protrusion of the mucosa, without ischemic or necrotic areas, which occurred during the proestral-estral phase. Under general anesthesia, prolapsed mass was cleaned with 50% glucose solution to reduce oedema and gently repositioned; the Bühner suture was applied using a Gerlach needle and a sterile vaginal suture tape, maintaining a minimal opening to allow urination in order to avoid possible recurrence in the same estrus. None of the bitches showed recurrence during the current cycle, proving the effectiveness of the Bühner suture. To prevent the possible recurrence of vaginal hyperplasia at the subsequent estrus, all the bitches underwent an ovariectomy 2 months later, when the Bühner suture was removed. In conclusion, the Bühner suture proved to be useful for the conservative treatment of vaginal hyperplasia in medium- or large-sized bitches. However, this approach should be considered only for cases in which the prolapsed mass does not show trauma, ulceration, ischemic or necrotic areas.

Keywords: canine reproduction; estrogens; proestral–estral disease; vulvar suture.

Figure 1

Degrees of vaginal hyperplasia [4]: (a) Type I, vaginal hyperplasia is indicated by an arrow; (b) Type II; (c) Type III.

Figure 2

Patients are positioned in sternal recumbency, with the hindlimbs off the table and a soft thickness below the pelvis. The tail is wrapped and hairs are clipped from the tail to the limbs.

Figure 3

(a) Gerlach needle; (b) sterile vaginal tape.

Figure 4

Bühner technique: (a) place the Gerlach needle into the ventral incision (black arrow) and push it through the subcutaneous tissue, laterally to the vulva, exiting at the dorsal incision (white arrow); (b) thread one end of the tape into the eyelet of the needle and pull it back, through the subcutaneous tissue (red arrow).

Figure 5

Bühner technique: (a) place the Gerlach needle into the ventral incision (black arrow) and push it through the subcutaneous tissue, laterally to the vulva, exiting at the dorsal incision (white arrow); thread the dorsal free end of the tape into the eyelet of the needle and pull it back, through the subcutaneous tissue so that the tape loops surrounding vulvar labia; (b) tie a knot with the vaginal tape exiting the ventral incision (red arrow); reduce the vulvar opening up to allowing proper urination.

Figure 6

Type III vaginal hyperplasia, with urethral involvement (*) in the prolapsed mass. Urethral catheterization was performed prior to prolapse reduction and vulvar suturing.

Figure 7

Recrudescence of vaginal hyperplasia. Bühner suture proved to be useful for the prevention of a new prolapse through the vulvar lips.