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The incidence of uterine pathology in ovariectomised bitches
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PICO question
What is the incidence of postoperative uterine pathology in ovariectomised bitches compared to ovariohysterectomised bitches?
Clinical bottom line
Category of research question
Incidence
The number and type of study designs reviewed
Three retrospective case series
Strength of evidence
Weak
Outcomes reported
None of the reviewed case series found any uterine pathology for ovariectomised bitches in the long-term follow-up of several years, although none of the studies performed a proper gynaecological examination to confirm a lack of pathology
Conclusion
With the limited evidence available, it appears that leaving the uterus when gonadectomising bitches does not seem to have a high risk for developing pathology as long as the ovaries are completely removed.
How to apply this evidence in practice
The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
Knowledge Summaries are a resource to help reinforce or inform decision-making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care
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Appraisal, application and reflection
Only three studies were identified that addressed the PICO question and these studies were retrospective case series. Thus, the evidence base for answering the question is limited, but at least all three of the studies did not report a case where uterine pathology developed in an ovariectomised bitch.
Van Goethem et al. (2006) reviewed the outcome for ovariectomy and ovariohysterectomy, and they found that there was no difference in outcome when they analysed the present literature comparing the two methods. Ovariectomy did not lead to any pathologic changes in the remaining uterus. Bitches undergoing ovariectomy did not show symptoms of pyometra or endometritis years after the surgery.
In 1958, Dow reported the ability to experimentally induce cystic endometrial hyperplasia (CEH) or CEH-endometritis by administration of progesterone, even in ovariectomised bitches. Withdrawal of the progesterone treatment causes regression of the experimentally produced disease. Similarly, ovariectomy leads to regression of the natural disease (Dow, 1958), thus exposure to progestogen appears to be necessary for the development of CEH-endometritis and that is the main proposed answer to why the uterus seems to remain healthy after ovariectomy (Okkens et al. 1997).
Stump pyometra have been reported in bitches that have had an improperly performed ovariohysterectomy in association with ovarian remnant syndrome, breaks in aseptic technique, or exogenous progesterone administration (De Tora & McCarthy, 2011; Van Goethem et al., 2006; Janssens & Janssens, 1991; and Okkens et al., 1997).
Uterine neoplasia can develop after ovariectomy; however, uterine tumors are reportedly rare (0.03%) and are benign in 85% to 90% of the cases (Brodey, 1967). Therefore, the overall risk has to be balanced against the disadvantages of ovariohysterectomy compared with ovariectomy in terms of surgical time, additional trauma, and potential complications.
It is important to note that none of the articles reviewed performed any diagnostic tests as part of the follow-up, and all three articles relied solely on owner responses to the questionnaires for data on uterine pathology or ovarian remnants. Also, in the study by Corriveau et al. (2017) 15% of the patients in the group that underwent ovariectomy were lost to follow-up and in the study by Okkens et al. (1997) 45% of the ovariectomised patients were lost to follow-up and the status of the remaining uterus in those patients is unknown.
To bring more evidence to properly answer the PICO question, a randomised multi-centre prospective study should be done with active follow-up including diagnostic workup (ultrasound, vaginal cytology, luteinizing hormone (LH) test, anti-muellerian-hormone tests etc.) to confirm the lack of uterine pathology or ovarian remnant occurring for a period of at least 5 to 10 years after the surgery.
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