Transcervical Endoscopic Catheterization Technique With Uterine Lavage to Improve Clinical Outcomes of Medically Managed Pyometra in the Bitch

Pyometra is a breed-related common cause of loss of fertility in the bitch. Many affected bitches become unable to reproduce, either because they are surgically managed by ovariohysterectomy or because of poor response to medical management. Treatment with antibiotics, prostaglandins, and medical supportive care can be augmented by transcervical endoscopic catheterization (TECT) and uterine lavage. The TECT procedure used concurrently with medical management has been hypothesized to lead to improved clinical outcomes leaving the bitch intact and able to be successfully bred again. The TECT and lavage was performed on five bitches with naturally occurring pyometra presented for medical management. Two were nulliparous, three were multiparous. Since treatment, three bitches have been bred, with two of the three conceiving and successfully carrying litters to term, resulting in live births. The remaining two have not yet been bred as there has not been sufficient time since the procedure for them to return to estrus. There are brief mentions of using TECT and lavage to improve non-surgical outcomes but the technique and outcomes had limited exposure in publications and application in practice. The TECT technique used will be described.
This technique was similar in equipment and procedures used to breed dogs by endoscopicguided transcervical insemination (TCI). However, the appearance of the vaginal vault was less crenated in bitches with pyometra during TECT than what is seen during estrus during TCI. Care was taken to avoid damage and perforation of the vagina, cervix, and uterus during the procedure as the tissues were thinner and more friable than during estrus. During the TECT, the bitches were awake and placed in standing position on an elevated table. Fluid was flushed in and out of the uterus via the cervix. The equipment used was either a ureteroscope or cystoscope with or without a TCI shunt system, using a 5 to 8 Fr catheter. The catheter was advanced through the endoscope and through the cervix. During the lavage, ultrasonography was useful to monitor flow of fluid in the uterus. Fluid with or without antibiotics was administered through the intrauterine catheter, to a volume of 100 to 1,000 mL, determined by the patient size and ultrasonic evaluation.