Common uterine disorders in the bitch: challenges to diagnosis and treatment

Diagnostic tools for common uterine disorders like cystic endometrial hyperplasia (CEH), mucometra, hydrometra or pyometra as well as effective treatments are discussed. Cystic Endometrial Hyperplasia (CEH), a chronical degenerative disease of the endometrium, coincedes with delayed uterine clearance of fluids after mating and reduced uterine contractions and perfusion. Since in bitches with CEH, adherence, colonization and growth of bacteria is facilitated, the disease can be complicated by inflammation and infection, which can be diagnosed by uterine swabs or biopsy from the cranial uterine body after transcervical catheterization during oestrus. The diagnosis can furthermore be made by clinical examination, abdominal sonography and a blood picture (total white blood cell count, band neutrophils, percentage of band neutrophils, segmented neutrophils, monocytes and lymphocytes, cholesterol, albumin). Measurement of C reactive protein and prostaglandin(PG)M can help to diagnose beginning sepsis and systemic inflammatory response syndrome (SIRS). Conservative treatment should be restricted to breeding bitches with mild, beginning CEH and regular cycles; furthermore when operation is not possible. The treatment of choice is the repeated administration of the antiprogesterone aglepristone combined with broad spectrum antibiotics. Pyometra is caused by bacteria that belong to the physiological vaginal flora, Escherichia coli is mostly involved. Clinical symptoms will be very variable; diagnosis aims to quickly differentiate between beginning CEH/pyometra and advanced pyometra complicated by SIRS and sepsis. The usual diagnostic possibilities like vaginoscopy, cytology, sonographical examination and x-ray can be supplemented by measurement of C reactive protein and PGM, combined with assessment of the percentage of band neutrophils. Only bitches with mild pyometra and no signs of intoxication or SIRS should be conservatively treated. Best results were obtained with the anti-progestin aglepristone, combined with broad spectrum antibiotics and eventually with natural or synthetic prostaglandins (PGF2α). Resolution of the uterus was achieved in most bitches within 4 weeks. Intravaginal or peroral application of PGE1 is under investigation.