Impact of histeroscopy in the mare in daily practice

Most reproductive abnormalities in mares can be detected using common procedures such as palpation, vaginoscopy and ultrasonography and are sometimes supplemented by microbiological culture, cytology and biopsy. However, sometimes it is necessary to apply more sensitive procedures to achieve a definitive diagnosis and/or to objectively classify the severity of a problem when interpreted with ultrasonography. One of these techniques is endoscopy, which provides a real-time visualization of the inside of the uterus without the need for interpretation1,2,3. Endoscopy is commonly used in equine medicine for observation of the upper respiratory system and the first portion of the digestive system such as oral cavity, esophagus and stomach. In the mare an endoscope can be used to detect intrauterine abnormalities that most of the time are not observable by ultrasound such as adhesions, endometrial cysts, foreign bodies, volume increases, hemorrhages, biofilms, mucus, retention of endometrial cups, etc. Also an endoscope achieves images with more detail of problems at the vaginal level such as vaginal varicose veins, lacerations and accumulation of urine in the vaginal fundus as well as a more accurate evaluation of cervical integrity. In addition, an endoscope can be used to perform deep artificial insemination with low doses of semen on the utero-tubal papilla1,2. It is an uncommon procedure and therefore not routine in the daily practice of the reproductive clinic in mare. Since the necessary endoscopy or video-endoscopy equipment demands a high investment, often difficult to transport to the field and need adequate facilities for a good examination and proceed1 . In 2017 in Bioteq®, we acquired a video-endoscope and in these 6 years we have performed a total of 147 hysteroscopies in mares of different breeds and ages. 130 of them (89%) were performed for a diagnostic purpose in mares with a history of subfertility or infertility and 17 of them (11%) for a therapeutic purpose in mares with an undergoing problem and already diagnose. Of the 130 diagnostic hysteroscopies, 82 of them did not have a previous ultrasound finding, so 56% of the cases had a finding only with endoscopy. Of the 44% (65 endoscopies) who had a previous ultrasound finding, in 37% (24 cases) their previous ultrasound finding was of lower clinical magnitude in its interpretation than the observed reality and in 63% of cases (41 cases) endoscopy revealed and confirmed something very similar to what was observed by ultrasound. This denotes and confirms the importance that this real-time image generator tool can have and the potential it offers to make correct therapeutic decisions and therefore better prognoses. 

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