Do we need to remove the whole uterus in bitch spays now?

RE: Do we need to remove the whole uterus in bitch spays now?

Sarah Keir — Tue, 28 Jan 2020 09:00:16 GMT

Ovariectomy is my standard now and I am extra cautious about using Incurin in any bitch. However, it is not standard in most places that I work and gives rise to concern so as a locum I tend to go with the standard for the practice as long as it is compromising by professional and ethical values.

Interesting that no-one can decide where the blood comes from in dioestrus.

RE: Do we need to remove the whole uterus in bitch spays now?

Anthony Todd — Mon, 27 Jan 2020 18:05:51 GMT

I would have been very happy if this thread had been the benchmark of the day...even around 50 years ago so that I and others, could have avoided the g-string tension on the ovarian ligament in our attempts to compete with the "2 stitch bitch-spay", the benchmark of the day, while ligating as far down the uterus as mechanically possible........

Very easy if you can move your incision over the ovaries and leave the uterus alone....

RE: Do we need to remove the whole uterus in bitch spays now?

Bob Russell — Fri, 24 Jan 2020 12:30:17 GMT

I have to say I am pretty relaxed about where I remove the uterus. Close to cervix generally.

What I am extremely picky with is making sure I can see a complete ovary on each side!

RE: Do we need to remove the whole uterus in bitch spays now?

Evelyn Barbour-Hill — Sat, 18 Jan 2020 19:30:29 GMT

[quote userid="9515" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/28794/do-we-need-to-remove-the-whole-uterus-in-bitch-spays-now/218857"] I thought it wouldn't have an uterus either as I do transfixing through the cervix and the blood comes from the vagina, but according to said specialist the blood comes from the uterus therefore the dog had some uterus left. Go figure![/quote]

Well, sorry, Herr Professor, but if what I remove includes the cervix (which was how I was taught and how I did it for many years (though I don't now)) then I have removed the whole uterus.

RE: Do we need to remove the whole uterus in bitch spays now?

Gillian Mostyn — Sat, 18 Jan 2020 18:48:12 GMT

A few years ago a practice local to me, with a very experienced vet, had a similar case. That vet was also sure they'd spayed it well, and it was AMH negative, so investigations stopped and eventually the bitch presented to me.

It had ovarian tissue. The tissue was very obvious at surgery, but maybe it was accessory tissue in the pedicle, or seeded during surgery, rather than inadequate excision during the spay?

I also don't see how you could get issues with incurin???

RE: Do we need to remove the whole uterus in bitch spays now?

Julie Turner — Sat, 18 Jan 2020 18:34:35 GMT

That’s really helpful to me Jill (and others) and I am going to find the courage to amend my surgical technique. Did you call your degree ancient??? I’m going to have to put an offended mark in the React box ha ha! I also noticed that Mr/Ms An On doesn’t have any qualifications ever....

RE: Do we need to remove the whole uterus in bitch spays now?

Dinu Catilina — Fri, 17 Jan 2020 14:56:17 GMT

Sarah, no progesterone in Incurin! But yes the blood does come from the uterus during oestrus, we see it nicely dripping through the cervix when we do TCIs.

RE: Do we need to remove the whole uterus in bitch spays now?

Sarah Keir — Fri, 17 Jan 2020 14:52:31 GMT

The dog was getting an external source of progesterone from the Incurin. It didn't have ovaries (it was also anti-mullarian hormone negative as well as I personally attest to both ovaries being removed). I thought it wouldn't have an uterus either as I do transfixing through the cervix and the blood comes from the vagina, but according to said specialist the blood comes from the uterus therefore the dog had some uterus left. Go figure!

RE: Do we need to remove the whole uterus in bitch spays now?

Evelyn Barbour-Hill — Fri, 17 Jan 2020 13:50:23 GMT

[quote userid="9515" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/28794/do-we-need-to-remove-the-whole-uterus-in-bitch-spays-now/218849"]

Lindsey Edwards said:
Bleeding does not come from uterus in any case? Is not diapedesis through vaginal wall,

That is what I thought but I contacted Garry England and was firmly corrected that in oestrus the bleeding is from the uterus and that even though my technique was to remove all the uterus there will be enough left to show enough blood.

[/quote]

Now I'm really confused.

If you have removed all the uterus, well, you have removed all the uterus.

RE: Do we need to remove the whole uterus in bitch spays now?

An On MRCVS — Fri, 17 Jan 2020 11:53:53 GMT

In regards to the op, leaving some or all the uterus doesn't matter, so long as you have removed all of the ovarian tissue.

RE: Do we need to remove the whole uterus in bitch spays now?

Sarah Keir — Fri, 17 Jan 2020 10:47:17 GMT

[quote userid="13683" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/28794/do-we-need-to-remove-the-whole-uterus-in-bitch-spays-now/218802"]Bleeding does not come from uterus in any case? Is not diapedesis through vaginal wall,[/quote]

RE: Do we need to remove the whole uterus in bitch spays now?

Dinu Catilina — Wed, 15 Jan 2020 10:50:23 GMT

At least to my knowledge is not the progesterone itself causing pyometra but rather the succession of high estrogen and high progesterone. Progesterone is actually a very common contaminant these days especially in USA where it can be used in animal feeds. I remember reading about water testing in USA and from 130 water sources tested 70 were contaminated with progesterone.

RE: Do we need to remove the whole uterus in bitch spays now?

Lindsey Edwards — Wed, 15 Jan 2020 00:05:17 GMT

Bleeding does not come from uterus in any case? Is not diapedesis through vaginal wall, which would never be removed regardless of spay technique. I would be concerned re exogenous progesterone and pyometra but do not see any clinical use for them in ovariectomised bitch (uterine remnants from incomplete ovh would also carry risk)

RE: Do we need to remove the whole uterus in bitch spays now?

Sarah Keir — Tue, 14 Jan 2020 13:32:51 GMT

[quote userid="9239" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/28794/do-we-need-to-remove-the-whole-uterus-in-bitch-spays-now/218785"]I thought incurin doesn't contain progestagens[/quote]

Sorry, pre-coffee brain - you are right.

RE: Do we need to remove the whole uterus in bitch spays now?

Lucy Fleming — Tue, 14 Jan 2020 11:54:24 GMT

[quote userid="8958" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/28794/do-we-need-to-remove-the-whole-uterus-in-bitch-spays-now/218786"]Are we not the only country in the world that routinely removes the uterus? Happy to be corrected[/quote]

I think full OVH pretty standard in US, Canada, Australia and NZ as well.

RE: Do we need to remove the whole uterus in bitch spays now?

Neil Wheadon — Tue, 14 Jan 2020 10:49:28 GMT

and the elephant in the room is 'how many bitches actually have all the uterus removed?' there will always be some remnant.

Are we not the only country in the world that routinely removes the uterus? Happy to be corrected

Neil

RE: Do we need to remove the whole uterus in bitch spays now?

Dinu Catilina — Tue, 14 Jan 2020 10:45:36 GMT

I thought incurin doesn't contain progestagens? And progestagens suppress rather than induce oestrus?

Oestriol can induce small vaginal bleeding from ovariohisterectomised bitches as well.

RE: Do we need to remove the whole uterus in bitch spays now?

Sarah Keir — Tue, 14 Jan 2020 09:37:58 GMT

[quote userid="9239" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/28794/do-we-need-to-remove-the-whole-uterus-in-bitch-spays-now/218772"]Why would it matter for Incurin users if the uterine horns are still present?[/quote]

Because in a small percentage (I think the SPC says up to 10% but from personal experience it is much lower than this), the progesterone in Incurin induces oestrus which includes bleeding from the uterus. I would say from experience that they don't technically need uterus, or certainly not a full one, for this to become apparent. I spayed the bitch over 5 years previously and I routinely do (actually did - I now do ovariectomies most of the time) transfixing ligatures through the cervix so I assume no uterus - however it started to show signs of oestrus and after frustrating search for oestrogen producing tumours, ovarian remnant etc, I remembered it was on Incurin!

RE: Do we need to remove the whole uterus in bitch spays now?

Sarah Keir — Tue, 14 Jan 2020 09:23:28 GMT

[quote userid="12930" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/28794/do-we-need-to-remove-the-whole-uterus-in-bitch-spays-now/218771"]laparoscopic procedures, I'm not convinced I see a benefit?[/quote]

The recoveries - seeing is believing. Really, you have so see it to see what a difference it makes for the majority.

RE: Do we need to remove the whole uterus in bitch spays now?

Dinu Catilina — Mon, 13 Jan 2020 21:57:49 GMT

There is no need to remove the uterus. There was a study out there CT scanning uteruses to monitor their involution post ovariectomy.

I currently do 80% of our spays laparoscopically. 2 ports technique so two small incisions. The most cranial incision can be made slightly larger for bitches with a fat ovary but overall it is still small. I think very few people will ligate but rather use bipolar or a vessel sealer. For any clients requiring classic spay I do open ovariectomy. I tend to control haemorrhage with bipolar forceps and don't ligate the ovarian pedicle or the uterine horn.

Why would it matter for Incurin users if the uterine horns are still present?

RE: Do we need to remove the whole uterus in bitch spays now?

Beats — Mon, 13 Jan 2020 21:28:28 GMT

My rule, if I'm leaving significant part of uterine horns behind, then I don't break down the broad ligament so I don't have 2 x large floating wormy things with catgut on the end that might conspire to strangle a piece of intestine with adhesions.

You can remove any amount of uterine horn you wish along with the ovaries - maybe go 1cm approx from the ovary on to each horn for your first one to get the feel of doing something different!

Top tip is to force yourself to concentrate and think when doing anything different in a surgery where you are normally working on auto-pilot.

I've never seen a laparoscopic bitch spay, but other than practising use of laparoscopic equipment routinely so confident in less-seldom performed laparoscopic procedures, I'm not convinced I see a benefit? Perhaps seeing is believing. How many holes does one make when doing a laparoscopic bitch spay? Is it still just one hole? How big are the holes? Presumably you still need to get the ovary out the hole? Is it done with ligatures still or just burning off the ovary with cautery? I saw one study suggesting bitches were more comfortable in recovery, but they didn't use any local in the control group in the ovarian stumps prior to tugging them out to ligate, so I'm not sure the comparison told me very much really on the benefits of laparoscopy in terms of patient comfort.

RE: Do we need to remove the whole uterus in bitch spays now?

janine redman — Mon, 13 Jan 2020 18:32:20 GMT

It is a question I am considering as I am looking to neuter my own 9year old bitch soon and wondered if she would be a good patient to start with . Any practical tips anyone ? Do I just leave the horns dangling from the broad ligaments ?

RE: Do we need to remove the whole uterus in bitch spays now?

jane alexander — Mon, 13 Jan 2020 12:33:27 GMT

Most important is to record if the uterus is still present, in case Incurin is used in the bitch's future.

RE: Do we need to remove the whole uterus in bitch spays now?

Neil Wheadon — Mon, 13 Jan 2020 11:44:20 GMT

My take these days is simple

If people are paying hundreds of pounds more for a laparoscopic spay where only the ovaries are removed, then why are the rest of us removing the uterus?

Neil

RE: Do we need to remove the whole uterus in bitch spays now?

Jill Butterworth — Mon, 13 Jan 2020 10:49:04 GMT

You are right, there's no reason to remove a healthy uterus at ovariectomy, as it will atrophy without hormonal stimulation from the ovaries, it's just never universally caught on, I think due to the theoretical but erroneous worry that a pyo could still occur. I have a friend who routinely performs laparoscopic ovariectomies and had a mildly swollen uterus in a bitch recently, and he simply took the ovaries out, confident that the uterus would settle down, which it did. The old school surgeon in me would have had to whip that out! You are also correct that statistically most of the dangerous surgical complications arise from the cervial end of the business, despite the feeling that the removal of the ovaries seems more technical challenging. Accidentally leaving a small piece of ovary behind would potentialy cause future problems. Informed consent of the pros and cons with clients is the way forward.

Just wondering if the new system will pick up my ancient degree and decide my opinion is invalid