Hemi-uterus and post-spay season

Re: Hemi-uterus and post-spay season

toby travis — Fri, 06 Jan 2012 16:38:46 GMT

Nice work and photo!

Regarding the bitch - I went back in last month and found the other (right) ovary hiding away on its own, removing it with the help of an assistant and duodenal moanoevure. Still no sign of a right kidney whicih is obviously consisent with some of the dogs in the paper I quoted in an earlier post. Everyone happy!

Re: Hemi-uterus and post-spay season

Thomas Johnson — Fri, 06 Jan 2012 15:43:11 GMT

I started a flank spay on a 5 month old cat today, found and tied off the left ovary without any difficulty, followed the uterine horn down to the bifurcation to find that the right horn was missing, just ligament and blood vessel present. I removed the left ovary then changed to a midline approach to remove the uterus and right ovary.

Re: Hemi-uterus and post-spay season

sarah mason — Wed, 28 Dec 2011 22:51:45 GMT

once speyed a unihorn bitch for a rescue kennel,there was an obvious ovary but no horn

Re: Hemi-uterus and post-spay season

Simon Neuhoff — Fri, 16 Dec 2011 11:07:53 GMT

Agreed! Midline with intradermal vicryl best way forward.

Also being a Saffer I have done midline + nylon, flank with nylon, flank with intradermal catgut, flank with intradermal vicryl and midline with intradermals. In my opinion, and in my hands, this is far and away the best option.

Re: Hemi-uterus and post-spay season

Kate Richardson — Wed, 14 Dec 2011 12:51:34 GMT

[quote user="Richard Carter"]

[quote user="Kate Richardson"]A good reason to go midline in the first instance[/quote]

Actually South African trained and so used to always do midline but in UK find the cats find midline sutures much more interesting than flank and I hate buster collars esp on cats - yes I know I could do s/c but again have seen more complications with s/c than nylon removed after 10 days and as the statistics are 1/50000 according to above (ok was a study in dogs) should see out my career hopefully

[/quote]

I am surprised. We use intradermal vicryl and can't remember last time we had any complications or needed a buster collar. I've seen less post op 'self trauma' since doing midline compared to flank.

Re: Hemi-uterus and post-spay season

Richard Carter — Wed, 14 Dec 2011 09:00:16 GMT

[quote user="Kate Richardson"]A good reason to go midline in the first instance[/quote]

Re: Hemi-uterus and post-spay season

Kate Richardson — Tue, 13 Dec 2011 19:57:53 GMT

[quote user="Richard Carter"]Changed from flank to midline [/quote]

A good reason to go midline in the first instance

Re: Hemi-uterus and post-spay season

Richard Carter — Tue, 13 Dec 2011 16:49:55 GMT

Amazing within a week of this posting have now also had a 5 1/2 month DSH with definitely only one uterine horn and one kidney. Changed from flank to midline and followed the round/broad ligament to find the other ovary and apart from fairly strange blood supply - few too many blood vessels and the ovary very far anterior, all ok. Bit strange only one kidney - seems healthy otherwise. Lots of swearing from the vet though but now having been duly educated by vetsurgeon persisted...thanks!!

Re: Hemi-uterus and post-spay season

Julian Earl — Sat, 26 Nov 2011 10:20:29 GMT

Seen this twice in cats; one with half a right horn, and the other with no right horn at all. Fortunately was able to find the ovary in both cases.

Re: Hemi-uterus and post-spay season

mariette asselbergs — Fri, 25 Nov 2011 21:36:07 GMT

I had a case a bit similar once, no 2nd horn and did not find the 2nd ovary. When the dog got back in season I advised to treat her with delvosteron to prevent seasons, and she was maintained on this. Since there was no uterus, no risk of pyometra. Did well and saved both dog and owner another laparotomy with chance of not even finding anything.

Mariette

Re: Hemi-uterus and post-spay season

Richard Fox — Thu, 24 Nov 2011 07:52:16 GMT

No worries - yes hindsight is a wonderful thing! We pathologists relish in it ;) LOL

Thats a nice article - Good for the brain bank - thanks :) - Good luck in the hunt for red October :)

Re: Hemi-uterus and post-spay season

toby travis — Wed, 23 Nov 2011 23:40:41 GMT

Thanks very much for the responses. I think it's probably fair to say that I did have a good hunt round to find the 2nd ovary or 2nd kidney to lead me to the 2nd ovary but with no 2nd kidney present I had to decide on how urgent the situation was - interrupt the day by calling a colleague off consultations to assist or close up, and I decided on balance it probably wasn't urgent enough - hindsight is handy!

I had a quieter day today so was able to research things further (and post on here!)and I spoke to Dr Sue Long who taught me reproduction 10 years ago and she said that yes, the ovary, uterus and kidney all develop separately and the dog has Uterus Unicornis, something that she has seen in sheep, cattle and is reported in cats but she was not aware of it reported in bitches. In these other species two ovaries are present so yes, I need to get back in there.

Further googling led me to this abstract published 14 months ago http://avmajournals.avma.org/doi/abs/10.2460/javma.237.5.542 which is very interesting - in a study of 32260 bitch spays, 15 had uterine horn abnormalities - unicornuate uterus, hypoplasia or segmental agenesis, and the kidneys were evaluated in 12 of these dogs, of which 6 had ipsilateral renal agenesis. The figures for cats are 49 out of 53258 cat spays with renal agenesis in 10 out of 34 who had their kidneys evaluated. The abstract doesnt detail how many ovaries were present but says that in most animals with uterine abnormalities both ovaries were present.

So, I'll be going back in soon and I've made sure I have scheduled time for a colleague to assist me! Pricing wise, I've suggested to the owner that I charge them for the extra time spent on the surgery above what would be spent on spaying a normal bitch and they seem pretty happy with that gesture. From being quite down about it, I'm now quite excited!

Richard, thanks for the photos.

Re: Hemi-uterus and post-spay season

toby travis — Wed, 23 Nov 2011 23:40:40 GMT

Richard, thanks for the photos.

Re: Hemi-uterus and post-spay season

Richard Fox — Wed, 23 Nov 2011 16:46:12 GMT

Basically this sounds like aplasia of the uterine horn and kidney - this can also be segmental in the uterus and also no involve the ovary. Although if the kidney is not present it would be likely that the ovary also, but best not to assume.

This is bilateral segmental aplasia:

This is unilateral - as you can see the ovary is still present:

Basically you can get combinations of anything above so it still would be possible that an ovarian remnant or even extra-ovarian tissue is present? With the described conformation I would not be surprised in malformation of ovarian tissue (maybe any where in the abdomen and maybe quite small? - looking for a needle in a haystack?) Was the remaining kidney relatively large?

Re: Hemi-uterus and post-spay season

Mark Holmes — Wed, 23 Nov 2011 16:05:59 GMT

[quote user="Hannah Wynne Richards"]

Toby

Firstly A human consultant surgeon has no excuse for being unable to afford proper investigation and referral

Secondly If this is the standard he considers acceptable, I would definitely refer my children elsewhere !!!!!!!!!!!!!!

Bloody doctors

Wynne

[/quote]

Eh? What needs investigating, she will come into season from time to time, she is not suffering, she will not get pregnant. So what? I could afford it, I could do it my self but probably wouldn't bother.

That said I would have had a good exlap at the time of the surgery if I had been doing it, although realistically I probably wouldn't have spayed her either if she'd been mine.

Re: Hemi-uterus and post-spay season

Mark Rowland — Wed, 23 Nov 2011 15:55:39 GMT

Could be a job for the deslorelin implants as another option Goodluck

Re: Hemi-uterus and post-spay season

Bob Russell — Wed, 23 Nov 2011 15:30:47 GMT

[quote user="Gerry Henry"]

At the risk of being the only dissenting voice ... if you only find one ovary then my advice would be to unzip it and have a good look; scrubbed assistant, lap towel, viscera to one side and really eyeball the area round the caudal pole of the kidney on the side where the missing ovary should be; nine times out of ten you'll find something to remove, careful its not the ureter!

[/quote]

Not dissenting. it is what I would do nowadays.

Re: Hemi-uterus and post-spay season

Gerry Henry — Wed, 23 Nov 2011 15:23:38 GMT

Re: Hemi-uterus and post-spay season

Bob Russell — Wed, 23 Nov 2011 14:53:48 GMT

Had a similar case in a cat many years ago. I could not find a second horn or ovary. A colleague looked as well and found nothing either! This cat came into season after but as far as it was owned by a breeder they did nothing more about it!

Clearly the ovary/ovarian tissue was present but I could not find it nor could a much more experienced surgeon!

Re: Hemi-uterus and post-spay season

james herriot lied — Wed, 23 Nov 2011 13:51:12 GMT

From quite a way back, I have some (!) recollection that the ovaries and the uterus develop from separate structures - is it the Mullerian duct that forms the uterus and fallopian tubes, but the ovaries come from an influx of some kind of stem cells? (with apologies to the various hard working embryology lecturers whose efforts I callously disregarded)

So, the absence of a horn on one side wouldn't necessarily mean absence of ovary? Although I have enough trouble finding the things when they're attached to a horn, never mind when tucked away in the fat behind a kidney. Happy hunting!

On the subject of human medics, I had one guy, a consultant anaesthetist, whose puppy had a persistent aortic murmur beyond the first six months. We quoted him £130 for an ultrasound with a visiting specialist, to which he utterly flipped his lid and denounced as an astronomical and criminal sum. (The previous week, we'd had a nuchal crest scan done for our second pregnancy. Ten minutes, cost £165.) We never saw the bloke again, but neither did we ever receive a request for a history. He just let it all go.

Re: Hemi-uterus and post-spay season

Hannah Wynne Richards — Wed, 23 Nov 2011 13:38:27 GMT

Toby

Firstly A human consultant surgeon has no excuse for being unable to afford proper investigation and referral

Secondly If this is the standard he considers acceptable, I would definitely refer my children elsewhere !!!!!!!!!!!!!!

Bloody doctors

Wynne

Re: Hemi-uterus and post-spay season

Kate Richardson — Wed, 23 Nov 2011 13:25:31 GMT

Not seen this before, but sounds as though you have acted appropriately and advised correctly all the way and your plan is a good one. Makes me laugh though how owners don't want any work up or costs but are prepared to go to surgery; I assume you will be charging your normal fees for this?

I would ask your lab regarding hCG doses, I am sure they will be able to advise- there are doses for use in cats, so there must be dose for small dogs, and a lot of stimulating hormones tend to be 1-2 sizes fits all.

And not negligent at all in my opinion.