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Old January 15th, 2010, 08:50 AM
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Episioplasty - canine

I've been prompted to enter an article about canine episioplasty, based on our experience with Jaida. There's not a ton of info available online, so I'll try to compile the most useful stuff here.

What is an episioplasty?

An episioplasty (also sometimes called a vulvoplasty) is a surgery that removes extraneous perivulvar skin. In English: extra skin growing around the vulva. If you would like to see an example of the surgery, there is a YouTube link available here. Warning: this video contains graphic, uncensored images of an actual surgery.

Where does the extra skin come from?

This problem of excess skin is especially common in obese dogs and those dogs born with prominent perivulvar skin folds that cover the vulva (also called recessed vulva, or vulvar hypoplasia). This means, in some cases (i.e., those involving obesity), the condition can be preventable. Weight management is also very important for the long-term management of the condition after the surgery; research indicates that post-surgical weight gain can lead to a recurrence of the condition.

Why would a vet recommend that a dog undergo an episioplasty?

Excess skin around the vulva traps urine, debris and bacteria. Common ailments of dogs that have these extra folds of skin include chronic urinary tract infection (UTI) and chronic perivulvar dermatitis (also called skin fold pyoderma, perivulvar pyoderma, mucocutaneous pyoderma of the vulva, perivulvar dermatitis, and intertriginous dermatitis), i.e., redness, itching, swelling of the skin around and on the vulva. Some dogs will worsen their condition through self-mutilation (chewing, etc. of the area). Vaginal tract infections and urinary incontience are also common.

These conditions are painful and can be costly for the owner. If other management methods (i.e. antibiotics, weight loss, topical creams, etc.) fail to improve the condition, the vet may recommend a surgery to remove the extra tissue.

What about cats or other animals?

Cats can get this condition as well, and can undergo a corrective episioplasty, but it doesn't seem to be as common. One article from the Journal of Small Animal Practice describes an episioplasty effectively treating perivulvar dermatitis in cat.

There are also several articles that describe the condition and surgery for mares (female horses). See here for an example.


What is the recovery like?


If your dog comes home the same day as the procedure, expect her to be a bit woozy/dopey from the anaesthetic. Anaesthetic can make dogs feel pretty weird for a day or two, so she may be whiny or clingy until it is flushed from her system.

You will see a horseshoe or crescent-shaped incision between your dog's vulva and anus (with the "ends" pointing down towards her feet). Our dog's incision is about 7" long with roughly 20 sutures. Some post-operative swelling for the first little while is normal.

She will very likely want to lick the surgical area, or even scoot her bum on the ground...both of which you must prevent in order to allow the incision to heal. The vet should give her an elizabethan colar (cone) to wear to prevent licking, and she may need to be crated and/or monitored closely to prevent scooting.

Your dog will go home with antibiotics to prevent infection, and pain medication. You may be asked to apply hot compresses to the area several times a day to help with pain and swelling. Your dog's activity level will be reduced for 10-14 days; your vet may recommend a different time frame. Sutures will have to be removed approximately two weeks after the surgery.

Expect your dog to be sore after the surgery. Medication should effectively manage the pain for the post part, but there will still be some discomfort; the mere presence of stitches can also be very agravating for some dogs. Some minor bleeding from the incision would be considered normal for the first few days.

Watch for unusual swelling, redness or discharge, as you would for any surgical incision.

You can read my own pets.ca thread on our experience with Jaida's episioplaty for a personal account of her experience and recovery.

I have also created a photobucket album of pictures taken during her recovery, plus one pre-operative picture. Warning: these are graphic photographs showing a recent post-operative surgical site.

What is the long-term prognosis after the surgery?

Research indicates that, barring weight gain after the surgery, the vast majority of dogs experience complete resolution of the UTIs or dermatitis after healing was complete. Post-surgical complications are extrememly rare. The surgery seems to be a very effective solution for the conditions listed above.

How much will this cost?

A fair question. I have been able to find no references to cost online, and of course the price will vary depending on your own dog's needs and your vet's pricing. Some things that could increase/lower the cost include: preanaesthetic blood work, medication, elizabethan colar (cone), IV fluids, extra surgical time/anaesthesia units, overnight hospitalization, etc. In our case, the surgery was roughly $550 CAN (I'm not sure of the exact cost because she had a lump removed as well, so I'm guestimating the amount of surgical time/anaesthetic that was used only for the episioplasty). We did not do any preanaesthetic blood work for this procedure (but have for others) and we did not need either a cone or one pain medication that was offered, since we have them both at home. I would say that $700-1000 would be a reasonable estimate for the procedure.

This may seem like a lot of money, but if you consider that treating a single UTI can cost several hundred dollars (examination fee, urine collection, urine analysis, urine culture&sensitivity, antibiotics, and recheck exam), this procedure is likely less expensive for the owner in the long run, and means fewer bouts of illness for your pup as well...it's a win-win.

References:

American College of Veterinary Surgeons page on Vulvar Fold Dermatitis Warning: post-operative pictures on the page

University of Guelph web page on Reproductive Pathology

Episioplasty for the treatment of perivulvar dermatitis or recurrent urinary tract infections in dogs with excessive perivulvar skin folds: 31 cases from the Journal of the American Veterinary Medical Association

Results of Vulvoplasty for Treatment of Recessed Vulva in Dogs , from the Journal of the American Association of Animal Hospitals
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Gracie - Mutterooski X - scary smart (9)
Jaida - GSD - tripod trainwreck and gentle soul (4)
Heidi - mugsly Boston Terrier X - she is in BIG trouble!!! (3)
Audrey - torbie - sweet as pie (11 months)
Patrick - blue - a little turd (but we like him anyways) (6 months)
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Last edited by bendyfoot; January 19th, 2010 at 05:50 PM. Reason: added photobucket album link, other edits
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Old January 15th, 2010, 09:22 AM
BenMax BenMax is offline
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Very informative Bendyfoot.

How about adding the approximate cost of this surgery? Or do you think that would deter people from going forward with it?

Well written Bendyfoot - but then again I would never expect less from the bug lady DR. goru.
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Old January 15th, 2010, 09:39 AM
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Very good info! Thanks!
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Old January 15th, 2010, 09:40 AM
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No, I'll include it. Of course it will vary for each clinic, but if you've already put your dog through 3 or 4 urinalyses and rounds of antibiotics, it will pay for itself in short order.
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Solomon - black DSH - king of kitchen raids (11)
Gracie - Mutterooski X - scary smart (9)
Jaida - GSD - tripod trainwreck and gentle soul (4)
Heidi - mugsly Boston Terrier X - she is in BIG trouble!!! (3)
Audrey - torbie - sweet as pie (11 months)
Patrick - blue - a little turd (but we like him anyways) (6 months)
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Riley and Molly
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Old January 15th, 2010, 01:06 PM
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Bendy, I am so glad you you started a thread on this subject and what an excellent job you did .......it is very well written.
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Old September 15th, 2010, 11:08 AM
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Quick update:

I just uploaded an 8-month post-op photo on the photobucket page...wow, what a difference! I'd do this again in a heartbeat now that we know what the outcome would be.
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Owned by:
Solomon - black DSH - king of kitchen raids (11)
Gracie - Mutterooski X - scary smart (9)
Jaida - GSD - tripod trainwreck and gentle soul (4)
Heidi - mugsly Boston Terrier X - she is in BIG trouble!!! (3)
Audrey - torbie - sweet as pie (11 months)
Patrick - blue - a little turd (but we like him anyways) (6 months)
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Riley and Molly
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Old September 15th, 2010, 11:15 AM
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I just saw this thread ! Good job Bendy !
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Old September 15th, 2010, 11:40 AM
BenMax BenMax is offline
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Quote:
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I just saw this thread ! Good job Bendy !
You just saw this now Frenchy??? Whose house have you been sleeping at?
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Old September 15th, 2010, 11:46 AM
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Quote:
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You just saw this now Frenchy??? Whose house have you been sleeping at?
LOL, be nice, now, BM!
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Owned by:
Solomon - black DSH - king of kitchen raids (11)
Gracie - Mutterooski X - scary smart (9)
Jaida - GSD - tripod trainwreck and gentle soul (4)
Heidi - mugsly Boston Terrier X - she is in BIG trouble!!! (3)
Audrey - torbie - sweet as pie (11 months)
Patrick - blue - a little turd (but we like him anyways) (6 months)
__________
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Riley and Molly
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Old September 15th, 2010, 01:13 PM
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Quote:
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You just saw this now Frenchy??? Whose house have you been sleeping at?


Quote:
Originally Posted by bendyfoot View Post
LOL, be nice, now, BM!
thank you Bendy !

note to self : put BM on the "not friend anymore" and move Bendy up the friends list.

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Old September 15th, 2010, 05:11 PM
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Originally Posted by Frenchy View Post
thank you Bendy !

note to self : put BM on the "not friend anymore" and move Bendy up the friends list.





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Owned by:
Solomon - black DSH - king of kitchen raids (11)
Gracie - Mutterooski X - scary smart (9)
Jaida - GSD - tripod trainwreck and gentle soul (4)
Heidi - mugsly Boston Terrier X - she is in BIG trouble!!! (3)
Audrey - torbie - sweet as pie (11 months)
Patrick - blue - a little turd (but we like him anyways) (6 months)
__________
Boo, our Matriarch (August 1 1992 - March 29 2011)
Riley and Molly
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Old September 15th, 2010, 09:31 PM
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Wow! What a difference, Bendy!!! Yay, Jaida!!
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Old September 16th, 2010, 01:56 PM
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Quote:
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I just saw this thread ! Good job Bendy !
Quote:
Originally Posted by BenMax View Post
You just saw this now Frenchy??? Whose house have you been sleeping at?

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Old September 16th, 2010, 01:57 PM
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That is an amazing difference and glad to hear that it was so successful.

OUCH on the 24 hr pic though.
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Old September 23rd, 2010, 12:53 AM
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Is breeding possible after episioplasty?

Well...just as the title says...we have a very nice AKC black lab puppy who was born with this condition. We really wanted to have her bred when she is old enough. She has had two cases of vaginitis and appears to be getting a third one. The vet immediately suggested we have her spayed. When we questioned them, they said this would probably resolve the vaginitis issue....the told us that her vulva was too low and it would be next to impossible to have her bred. On our next visit I questioned them further to find out if there was a medical name for this condition. The only thing I could find about it on the internet was Inverted Vulva. She told me it was similar but she actually had Redundant Vulvar Folds and then explained what an epsioplasty was. She said this could easily be done at the same time as a spay. We got this puppy from a friend who breeds labs, and she asked another breeder friend if she had any experience with this problem. She pretty much blew us off and said that the dog hasn't even sexually matured and she will probably grow out of it. (No mention of having any experience with this condition or even knowing what it is). So we are just searching for anyone who has had experience with this and trying to find out if we are SOL or if there is a possibility of breeding her. it's a little disconcerting that this seems to be a learning process for my vet as well. Thank you for posting about your experience. If you have any suggestions about where we might turn for more information on this I would welcome them.

Quote:
Originally Posted by bendyfoot View Post
Quick update:

I just uploaded an 8-month post-op photo on the photobucket page...wow, what a difference! I'd do this again in a heartbeat now that we know what the outcome would be.
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Old September 24th, 2010, 06:45 AM
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How old is your puppy? I have read that sometimes these folds can resolve themselves if the dog is allowed to reach sexual maturity. Our Jaida also had recurrent vaginitis. I've often wished we allowed her to at least have one heat before spaying (we couldn't have known about the skin fold issue, but it is better for large breeds anyways).

That said, I think it's unethical to breed any dog that posesses a physical flaw like this one. Your friend who breeds should have told you that breeding should be done only for the betterment of the breed (i.e., to produce as-close-to-ideal individuals as possible...so dogs who are bred should have been evaluated and deemed superior specimens by professionals in a show ring), and breeding a dog with an obvious physical flaw like this one will do nothing to further this aim. It would be unfair to any offspring if they inherited this condition. If you've seen the post-op pictures from Jaida, I think you'll agree that it would be unfair to breed your pup knowing that her babies could be subjected to a similar fate.

I see two options for you here: 1. wait until she is 12-18 months before spaying her. The vulvar folds may correct themselves as she matures (just make sure you have lots of doggie diapers on hand...a female in heat is a messy, messy business). If they don't, then I would have the episioplasty performed at the same time as her spay. 2. Have her spayed when she's 6 months and have the episioplasty performed at the same time...you may spare her future episodes of vaginitis...I know Jaida's last bout was very scary and hard on her...she was basically oozing blood...not nice.

Good luck with your pup
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Owned by:
Solomon - black DSH - king of kitchen raids (11)
Gracie - Mutterooski X - scary smart (9)
Jaida - GSD - tripod trainwreck and gentle soul (4)
Heidi - mugsly Boston Terrier X - she is in BIG trouble!!! (3)
Audrey - torbie - sweet as pie (11 months)
Patrick - blue - a little turd (but we like him anyways) (6 months)
__________
Boo, our Matriarch (August 1 1992 - March 29 2011)
Riley and Molly
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Old September 27th, 2010, 11:17 AM
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She is a little over 4 months old. Initially the vet said this was genetic, then changed their tune and said that most likely it was not genetic and had more to do with her development in the womb. And no...I definitely would not want to breed her if there is a chance it can be passed on to the puppies. Either way, my husband has finally come around and realizes breeding her will not be a simple thing and we should just go ahead and have her spayed. Now we are having the argument as to whether we should also have the surgery done at that point since the vet initially told us that spaying would most likely resolve the vaginitis issue. The episioplasty is a much bigger expense and he now feels they are just out to make as much money as they can on this. I feel they are being as honest as they can be with something they have little experience dealing with. The fact that they have little experience does bother me...but I'm not sure I'd find any local vet who had any more experience dealing with this issue. If we spay her first then end up doing the episioplasty later...it will cost a lot more than just doing both at the same time. Anyhow, I very much appreciate your advice and will consider our options carefully before making a decision. Thank you so much for your reply.

Carol

Quote:
Originally Posted by bendyfoot View Post
How old is your puppy? I have read that sometimes these folds can resolve themselves if the dog is allowed to reach sexual maturity. Our Jaida also had recurrent vaginitis. I've often wished we allowed her to at least have one heat before spaying (we couldn't have known about the skin fold issue, but it is better for large breeds anyways).

That said, I think it's unethical to breed any dog that posesses a physical flaw like this one. Your friend who breeds should have told you that breeding should be done only for the betterment of the breed (i.e., to produce as-close-to-ideal individuals as possible...so dogs who are bred should have been evaluated and deemed superior specimens by professionals in a show ring), and breeding a dog with an obvious physical flaw like this one will do nothing to further this aim. It would be unfair to any offspring if they inherited this condition. If you've seen the post-op pictures from Jaida, I think you'll agree that it would be unfair to breed your pup knowing that her babies could be subjected to a similar fate.

I see two options for you here: 1. wait until she is 12-18 months before spaying her. The vulvar folds may correct themselves as she matures (just make sure you have lots of doggie diapers on hand...a female in heat is a messy, messy business). If they don't, then I would have the episioplasty performed at the same time as her spay. 2. Have her spayed when she's 6 months and have the episioplasty performed at the same time...you may spare her future episodes of vaginitis...I know Jaida's last bout was very scary and hard on her...she was basically oozing blood...not nice.

Good luck with your pup
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Old September 27th, 2010, 02:17 PM
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It's a tough decision, I understand. We hemmed and hawed about it for months before finally deciding to take the plunge, and I can only say I wish we'd done it sooner to spare Jaida the discomfort we made her endure.

I really don't know what I would do in your shoes. If you're going to do a spay early (at 6 months) I think I might do the episioplasty then. It would mean only one surgery, one round of anaesthetic, one recovery period and it would be a little easier on your pocketbook. If you're going to delay her spay until she's mature (keep her under lock and key when she's in heat, male dogs will break down walls to get to a female in heat!!!) then you could just wait and see how she does. If it starts to really get out of hand with the vaginitis, or she also develops dermatitis, you might decide to get both surgeries done sooner. It really is a tough call. Maybe talk over the timing options with the vet a little more, or get a second opinion on how best to proceed.

Good luck with the little one!
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Owned by:
Solomon - black DSH - king of kitchen raids (11)
Gracie - Mutterooski X - scary smart (9)
Jaida - GSD - tripod trainwreck and gentle soul (4)
Heidi - mugsly Boston Terrier X - she is in BIG trouble!!! (3)
Audrey - torbie - sweet as pie (11 months)
Patrick - blue - a little turd (but we like him anyways) (6 months)
__________
Boo, our Matriarch (August 1 1992 - March 29 2011)
Riley and Molly
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