Abstract
Simple SummaryPyometra is an infectious uterine disorder marked by important clinical alterations and uterine contamination and blood flow changes in bitches. Although uterine removal is the most common mode of treatment, conservative therapy is an alternative. However, the success of medical treatment in restoring both clinical and uterine alterations has not yet been attested. Thus, we aimed to analyze the effects of both aglepristone alone or in combination with prostaglandin (associative) on clinical, laboratory and uterine hemodynamic features. Bitches were clinically and ultrasonographically (uterine blood flow) evaluated and medically followed-up throughout treatment (8 days) and castrated for local uterine analysis after 9 days of therapy onset. Associative therapy led to altered respiratory rate and decreased body temperature. Both treatments resolved bitches’ clinical condition and laboratory changes, and reduced uterine size. However, associative protocol was more effective in decreasing uterine vascularization and modulating uterine blood flow. Nevertheless, uterus remained microscopically altered soon after both therapy ending, thus not fully restoring local uterine changes in a short-term evaluation.Cystic endometrial hyperplasia–pyometra complex is a canine endometrial disorder, considered the most common and important among uterine diseases. The treatment of choice is ovariohysterectomy, but medical treatments have become an alternative. However, no studies have been performed in order to evaluate uterine hemodynamic changes during medical treatment for pyometra bitches. Therefore, the aim of this study was to compare the effectiveness of two medical protocols by means of clinical (heart rate, respiratory rate and body temperature), medullar response (complete blood count (CBC)) and uterine hemodynamic evaluation in pyometra bitches. For such purpose, 10 bitches with pyometra were assigned to two groups: Aglepristone Group (n = 5) and Associative Group (aglepristone + prostaglandin; n = 5). The Associative Group had altered respiratory rate and decreased body temperature. The Aglepristone Group had decreased plasma protein, however, leukocyte count reduced over time for both therapeutic protocols. Uterine area and vascularization score decreased throughout treatment. There was a significant reduction in uterine perimeter, area and vascularization score. The Associative Group had lower final diastolic velocity and higher systole:diastole ratio (S/D), pulsatility index (PI) and resistance index (RI). In conclusion, both medical treatments are effective in reversing clinical and CBC changes of pyometra, especially aglepristone, however they cannot fully restore local uterine changes in a short-term evaluation. Conversely, associative therapy was more effective in decreasing uterine vascularization and modulating uterine blood flow.
Highlights
Genitourinary disorders account for approximately 16–18% of all surgical pathologies in small animal veterinary hospitals and can be considered the second most frequent surgical cases [1].Among the uterine disorders, the complex Cystic Endometrial Hyperplasia–Pyometra (CEH–Pyometra) is the most frequent and important endometrial disorder in non-castrated bitches [2]
Based on such novel uterine hemodynamic data, Doppler ultrasonography can be used as a diagnostic tool for pyometra in bitches
No triple interactions were observed in this experiment
Summary
The complex Cystic Endometrial Hyperplasia–Pyometra (CEH–Pyometra) is the most frequent and important endometrial disorder in non-castrated bitches [2]. CEH–Pyometra is defined as an uterine inflammatory disorder in which thickening of the endometrial wall (CEH) coupled with bacterial infection lead to purulent content within the uterine lumen during or soon after the period of high blood progesterone concentration [4]. Pyometra has been related to increased uterine blood flow and decreased vascular resistance, along with inflammatory, cell proliferation and local angiogenesis [7,8]. Based on such novel uterine hemodynamic data, Doppler ultrasonography can be used as a diagnostic tool for pyometra in bitches. As a non-invasive test, it provides important information on blood flow through the uterine artery, as well as tissue perfusion, blood vessel architecture and hemodynamic features [9]
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