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Thursday, July 10, 2014

Puppy's Receeded Vulva

Debby sends this to me....

I have spent hours scouring the Internet for information about chronic eColi bladder infections in young dogs.
My Havanese Gracie has had them since 8 weeks of age. I take her to my trusted vet immediately when she shows symptoms and she has been on numerous rounds of antibiotics. She has a "tucked" vulva and may need surgery to correct. Very disappointing since I went to a reputable breeder with champion dogs who has been breeding for over 13 years.

Now my dear friend Kimberly has a 10 week old yellow lab with an inverted or tucked vulva. Her vet said he has never seen such a severe case.

1) is this a defect that our breeders should have disclosed?

2) Does surgery always correct chronic UTIs?

We want to find a veterinary surgeon with expertise in this condition. Can you tell us where to go? Is UGA the best option? I have searched the web for "canine vulvoplasty specialist in GA" and all I find are owner blog posts.

Any help you can give us will be greatly appreciated.

An inverted vulva is an uncommon problem and can happen in any dog.  For those who are not aware of this condition, the outer vulvar lips become depressed within a fold of the skin in the genital area.  This is a problem that can be genetic with an abnormal development of the tissues, but it can also be secondary to obesity or inflamed skin.    Obviously in a case like this it is likely genetic.  And it can predispose a dog for both urinary tract infections and localized skin infections as superficial bacteria are more likely to ascend into the vagina and bladder, and urine can pool in the folds causing irritation.

Debby, first I want to say that this doesn't mean that the breeder did something wrong or was careless.  Breeding good quality is all about genetics, and there is no way to 100% control those factors.  A great breeder can choose dogs carefully and thus improve the odds of high quality puppies, but nobody can completely control how the genes will combine and how those genes are expressed in an individual.  Due to the nature of gene replication and combination there is always a chance that two champion dogs with no defects of their own can produce a puppy with some problems.  Picking a great breeder only lessens your odds of a puppy with abnormalities; it doesn't eliminate them.  Genetics is a bit of a crap shoot and while you can changes the odds a bit you can't fix them to always be in your favor.

Should your breeder have disclosed this?  Honestly, they may not have noticed it.  This is an uncommon problem and not something for which we routinely check unless it's glaringly obvious or there seems to be a health concern.  Most breeders and owners don't routinely make a careful exam of their dogs' genitalia.  And since it's uncommon they may not have seen it before or been aware of it as a legitimate concern.  So this is a quesition for them.

The way to fix the problem is with a vulvoplasty, as you mentioned.  Essentially this surgery results in removing the deep fold by removing the skin in that area, then suturing the outside of the vulva to the skin.  If done properly you end up with a normal looking genital area and no increased risks of urinary problems.  Since there is a genetic component to this problem I would also strongly recommend spaying her if you weren't already planning to.  If the chronic infections were due to the receeded vulva then surgery should correct that tendency.  However, there is a small chance that it won't and in this case there may be other issues that need to be addressed.  Since you now exactly what the bacteria is I assume that your vet has performed a urine culture and sensitivity.  If not, then this should be an immediate step in order to rule out resistance to common antibiotics.

There is no such things as a "vulvoplasty specialist".  In veterinary medicine we simply don't see enough of a certain case to become specialized in one single form of surgery.  A very skilled general practitioner can do this surgery.  I've done this before and truthfully it's not a complicated procedure.  I wouldn't want a new graduate to do it without supervision, but a specialist is not required.  Your vet may not feel comfortable with it and may recommend a specialist, which is perfectly normal.  There are plenty of surgeries that I won't do but other vets will (such as cruciate repair).

If you really do want to go to a specialist you would need to look for a board-certified veterinary surgeon.  I actually practice in northern Georgia, so I'm familiar with the ones in this area.  If you're close to Athens then the University of Georgia veterinary school is your best option.  If you're closer to Atlanta I would recommend either Georgia Veterinary Specialists or Veterinary Referral Surgical Practice. South of Atlanta I'm not familiar with who might be an option.  But really you should ask your own vet who they recommend and with whom they typically work.

With a good surgeon there should be no reason why this puppy couldn't go on to lead a normal life.