EPISIOPLASTY FOR A COMPLETE RESOLUTION OF A RECURRENT URINARY TRACT

INFECTION IN A DOG
1 1 1
Xavier Escoda Llorens , Laura Fresno Bermejo , Maria Montserrat Rivera Del Alamo , Marta
Planellas Bachs1
1) Hospital Clnic Veterinari Universitat Autnoma de Barcelona (UAB)

INTRODUCCIN Y CASO CLNICO / INTRODUCTION AND CASE REPORT

Most canine urinary tract infections (UTI) occur as single episode although persistent and recurrent UTIs
are commonly diagnosed in small animal practice.1,2,3,4,5
Host factors seem to be important in preventing UTIs. Several local and systemic components of the host
immune system protect against infections such as normal micturition, mucosal defense barriers,
1,3,6,7
antimicrobial properties of urine, specific anatomic structures and systemic immunity. Any alterations
of these immune defenses can lead to development of UTI.
Persistent or relapsing UTI take place when the original infection is not fully resolved after withdrawal of
the therapy. This condition can be seen in dogs with predisposing factors such as endocrine diseases
(e.g., hyperadrenocorticism, diabetes mellitus), mechanical or neurological impairment to normal
micturition, abnormal uroepithelial surface, immunosuppressive therapy (e,g., chemotherapy, prolonged
corticoid treatments), anatomical anomalies (e.g., ureteral ectopia, juvenile vulva, excessive perivulvar
skin folds) and when there is a focus of infection within de urinary tract (e.g,. neoplasia, calculi,
pyelonephritis).1,3,6,8 Reinfections tend to be with different species or strain bacteria after a period or urine
sterility, which is documented by a negative culture.1,3,9
Some cases of persistent UTI can be especially challenging and underlying diseases and predisposing
conditions should be addressed before starting multiple antimicrobial treatments in order to avoid the
appearance of new multi-drug resistant uropathogens.

DESCRIPCIN / DESCRIPTION
A two-year-old, neutered female Golden Retriever was presented to our facilities for history of recurrent
UTI. The dog was neutered before the first heat (at 7 months of age). During the last year, the bitch had
several episodes of UTI. Clinical signs comprised increasing micturition frequency, dysuria, haematuria,
and perivulvar dermatitis. Periodic systemic antibiotics treatments (amoxicillin/clavulanic acid) of less than
2-week duration achieved only temporary improvement. Clinical signs reappeared in less than one month
after antibiotic therapy.
The dog was healthy with a body condition score of 6/9. Physical examination revealed a juvenile vulva
with redundant skin folds arising dorsally and from both sides of the vulva, which prevented the normal
voiding of urine.

Results of complete blood count and routine biochemistry were unremarkable. Abdominal radiographs
were within the normal limits and abdominal ultrasonography showed signs suggestive of chronic cystitis
and a mild bilateral pyelectasis. The urinalysis proved a moderate pyuria and bacteriuria. Urine (collected
by cystocentesis) and vaginal culture and sensitivity tests were performed. Proteus mirabilis (>100.000
colony-forming units (CFU)/mL) and Pseudomonas spp. (vaginal abnormal microbiota) were isolated in
urine and vagina, respectively.
A vaginoscopy and a reconstructive surgical procedure of the vulvar area were recommended.
Cephalexin at 20mg/kg TID was prescribed for 6 weeks, and after ten days, all clinical signs disappeared.
Four weeks after the initiation of the antibiotic treatment, an episioplasty or vulvoplasty was performed. All
the excessive skin folds over the vulva were excised including all the excessive subcutaneous fat.
Vaginoscopy revealed a mild vaginal stricture. Postoperative treatment consisted on cephalexin for 2
weeks more, oral prednisone 1 mg/kg SID during 4 days, oral tramadol 2mg/kg TID, and an Elizabethan
collar.
Fifteen days after surgery the perivulvar area looked normal. The skin sutures were removed and all the
treatments were discontinued. One month after the surgical procedure, urine and vaginal samples were
collected for culture. The urine culture was negative meanwhile normal microbiota was isolated in the
vaginal culture (Escherichia coli, Staphylococcus pseudointermedius and Streptococcus spp.). Follow-up
was conducted by telephone 90 days postoperatively and revealed no recurrence of clinical signs.

DISCUSIN Y CONCLUSIONES / DISCUSSION AND CONCLUSION

Pollakiuria, dysuria, stranguria and inappropriate urination are common signs in patients with lower UTI,
although some individuals may be asymptomatic.1,3,10 The main cause of lower UTI in dogs is ascending
bacterial colonization from distal sites such as proximal urethra or epithelial surfaces peripheral to the
external urethral orifice.8
It is estimated that up to 14% of dogs will develop a bacterial UTI during their lifetime; being female dogs
more commonly affected than males.1,3,6,10 Incidence of fungal UTI seems to be uncommon in dogs and
10
the occurrence of viral UTI is unknown. Escherichia coli is the most common uropathogen in both
simple and complicated UTIs in humans, dogs and cats. Other common isolated bacterial species from
urine samples in dogs include Staphylococcus spp., Streptococcus spp., Proteus spp., Klebsiella spp.,
1,2,3,8,10
and Enterobacter spp.
Anatomical abnormalities may predispose to UTIs. Vulvar hypoplasia is defined as a small or infantile
vulva, which is commonly recessed by the perineal skin folds. Especially in obese patients, these
redundant skin folds predispose to both urine and vaginal secretions retention. Dampness, darkness,
body heat and accumulation of skin debris create a perfect environment for bacteria proliferation. 8,6,7 This
anatomic configuration leads to skin fold dermatitis and pyoderma. Chronic vestibulitis, vaginitis,
ascending UTIs and urinary incontinence have been reported to develop secondary to pervivulvar
dermatitis.7,8,11
Episioplasty appears to offer prompt relief of perivulvar dermatitis and chronic or recurrent UTI in bitches
with redundant skin folds.7,8 The pathogenesis of these disorders is complex and while episioplasty alone
may not completely solve the clinical signs, it normally improves the outcome of the treatment.
The fact that there was no postoperative recurrence of the clinical signs in absence of further medical
treatment suggested that the anatomical conformation of the vulvar area could be the most probably
cause of the lower UTI in this patient. This case report increases the awareness of predisposing factors of
UTIs in dogs, especially in females, where juvenile vulva should be included in the differential diagnosis.

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