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Mucometra, cystic endometrial hyperplasia, and pyometra in the bitch: Advances in treatment and assessment of future reproductive success

Large Animal Clinical Sciences, Small Animal Reproduction Center, College of Veterinary Medicine, University of Florida, 2015 SW 16th Avenue, Gainesville, FL 32610-0136, USA.
Theriogenology (Impact Factor: 1.85). 09/2008; 70(3):364-74. DOI: 10.1016/j.theriogenology.2008.04.036
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ABSTRACT Pyometra is a common reproductive disorder which affects nearly one fourth of all female dogs before they reach 10 y of age. An association between pyometra and the most common uterine disease of the bitch, cystic endometrial hyperplasia, has been established, as the latter allows commensal bacteria originating from the vagina to proliferate in the uterus at the end of estrus. The progressive degenerative process in the development of cystic endometrial hyperplasia is usually proposed as the initiating lesion for pyometra in bitches; this is mediated by progesterone and potentially aggravated by estrogens. However, a separate process caused by local uterine irritation to trophoblastic reaction and bacterial proliferation has been recently proposed as an alternate mechanism leading to the development of pyometra. Pyometra is clinically distinct in pathogenesis, signs, treatment and prognosis from postpartum metritis or mucometra. Treatment of pyometra has historically involved ovariohysterectomy, however, during the last 10 y, numerous effective treatments have been proposed to treat both open and closed cervix pyometra with good success and future fertility. Among the treatments available, the use of repeated low doses of prostaglandins alone or in association with either dopamine agonists or progesterone-receptor antagonists has been demonstrated to be a viable alternative for valuable breeding dogs.

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    • "Pyometra is one of the most common diseases of the reproductive system in bitches, predominantly affecting older dogs in the metoestral phase of cycle [1]. Systemic inflammatory response syndrome, which often accompanies pyometra, is a response of the organism to secondary infection in the uterus caused by Escherichia coli [2] [3] [4] [5]. Prompt and appropriate diagnosis and treatment increase survival chances. "
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    ABSTRACT: Pyometra is one of the most common diseases of the reproductive system in bitches. The inflammatory processes occurring in the uterus result in changes in concentrations of numerous serum biomarkers, which are used for monitoring the postoperative period. The aim of the present report was to study the evolution of serum levels of insulin-like growth factor-1 (IGF-1) and C-reactive protein (CRP) in bitches suffered from pyometra and after ovariohysterectomy in comparison with the control group of healthy dogs submitted to the surgery. Our results indicate that the serum level of IGF-1 is decreased (101.6 ng/mL [73.8-177.8 ng/mL]), whereas CRP is increased (114.6 μg/mL [95.3-131.6 μg/mL]) during severe inflammation. When inflammation caused by pyometra and surgery is resolved, the level of IGF-1 is increased (186.0 ng/mL [94.6-344.3 ng/mL], P < 0.05) and CRP decreased (23.3 μg/mL [9.9-77.0 μg/mL], P < 0.01), suggesting that these markers could be useful for assessment of the postoperative period in bitches. Copyright © 2014 Elsevier Inc. All rights reserved.
    Theriogenology 12/2014; 83(4). DOI:10.1016/j.theriogenology.2014.09.024 · 1.85 Impact Factor
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    • "Pyometra is a severe disease of female dogs characterized by chronic uterine inflammation and bacterial colonization with consequent installation of a systemic inflammatory and septic syndrome (Smith 2008). The occurrence of this disease is most common in the first half of the dioestrus when there is a decrease in cellular immunity associated with an increase in serum concentration of progesterone in females (Sugiura et al. 2004; Tsumagari et al. 2005; Smith 2006). "
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    ABSTRACT: The occurrence of the pyometra is most common in the first half of the dioestrus when there is decreased cellular immunity associated with increased serum concentration of progesterone in females. The aim of this study was to determine the immunological profile of bitches with pyometra, studying serum levels of IL-2, IL-4, IL-10, IFN-γ, KC-like and TNF-α and comparing them with those of healthy bitches in anoestrus, dioestrus and pregnant. Forty females were divided into four experimental groups: group 1 (G1): with pyometra (n = 10); group 2 (G2): bitches in the second week of gestation (n = 10); group 3 (G3): in anoestrus (n = 10); and group 4 (G4): in dioestrus (n = 10). The serum levels for IL-2, KC-like, INF-γ and TNF-α were similar for all experimental groups. The values obtained for IL-10 were found increased (p < 0.001) in animals in dioestrus and pyometra compared with females in anoestrus and pregnant, and the levels of IL-4 observed were significantly greater (p < 0.001) in bitches with pyometra when compared with others. The cytokine profile in animals with pyometra is similar to bitches in dioestrus for IL-10 and had increase in IL-4 for bitches with pyometra, which represents an anti-inflammatory these cases. This suggests the presence of an immunosuppressive state in both cases, which may explain the propensity of bitches in dioestrus to be affected by pyometra and the severity of the disease on these animals.
    Reproduction in Domestic Animals 06/2014; 49(4). DOI:10.1111/rda.12360 · 1.18 Impact Factor
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    • "There is some controversy about the association between EH and pyometra in domestic dogs, the model available for understanding the condition in wild canids [De Bosschere et al., 2001]. The traditional dogma is that EH is a pre‐condition for pyometra [Verstegen et al., 2008], yet not all cases of EH proceed to pyometra and pyometra sometimes develops in the absence of EH. Particularly during the luteal phase of the reproductive cycle, when progesterone is elevated, a variety of physical, biological, and chemical substances have been shown to cause uterine endometrial irritation which can develop into pyometra in domestic dogs [De Bosschere et al., 2001]. "
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    ABSTRACT: The ability to safely and effectively manage reproduction is central to the success of AZA captive-breeding programs. Although the AZA Wildlife Contraception Center routinely monitors contraceptive safety, there have been no studies that compare the effects of contraceptive use to separation of males from females, the other option for preventing reproduction. We used retrospective medical records and pathology reports submitted by AZA and related facilities for the seven AZA-managed canid species to assess rates of uterine pathology relative to female reproductive life histories. Our results showed that the prevalence of both pyometra and endometrial hyperplasia (EH) was associated not only with treatment with the two most common contraceptives (Suprelorin® and MGA implants) but also with the number of years barren (i.e., not producing a litter and not contracepted). Rates of pyometra and EH were especially high in African painted dogs and red wolves, but lowest in swift and fennec foxes. The number of years producing a litter had a low association, suggesting it could be protective against uterine pathology. A more recently developed Suprelorin® protocol using Ovaban® to prevent the initial stimulation phase, followed by implant removal when reversal is desired, may be a safer contraceptive option. These results concerning the relationship between reproductive management and uterine health have important implications for AZA-managed programs, since the unsustainability of many captive populations may be due at least in part to infertility. Managing a female's reproductive lifespan to optimize or maintain fertility will require a reconsideration of how breeding recommendations are formulated. Zoo Biol. XX:XX-XX, 2013. (c) 2013 Wiley Periodicals Inc.
    Zoo Biology 02/2014; 33(1):8. DOI:10.1002/zoo.21069/pdf · 0.85 Impact Factor
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