Buhner Vulvar Suture in Type III Vaginal Hyperplasia: A Conservative Surgical Approach

Type III vaginal hyperplasia represents the most severe manifestation of this condition, characterized by complete circumferential prolapse of the vaginal mucosa. While surgical intervention is often required, conservative techniques aimed at preserving tissue integrity and preventing recurrence are increasingly preferred. Among these, the Bühner vulvar suture has emerged as an effective and practical solution. 

Clinical Rationale for Conservative Surgery 

In cases where the prolapsed tissue remains viable and free from necrosis or ulceration, conservative surgical management offers significant advantages. The primary objective is to restore the anatomical position of the vaginal mucosa while minimizing surgical trauma. This approach is supported by the natural course of the estrous cycle, during which decreasing estrogen levels and rising progesterone promote spontaneous resolution of hyperplasia¹. 

In the cases examined, all patients were in good general condition, and the prolapsed tissues showed no signs of ischemia or necrosis. This clinical scenario justified the choice of repositioning combined with vulvar suturing rather than immediate tissue amputation. 

Preoperative Preparation and Edema Reduction 

Effective preparation is critical to facilitate repositioning. The application of a 50% glucose solution to the prolapsed tissue was used to reduce edema and improve tissue handling. Similar osmotic methods, including the use of dextran or potassium permanganate, have been reported in the literature^1,2. 

This technique, derived from large animal practice, allows for partial dehydration of the edematous tissue, making manual reduction easier and less traumatic. 

Manual Repositioning Technique 

The repositioning procedure involves careful cleaning of the prolapsed mucosa followed by gentle manual reduction. The clinician must ensure that the tissue is returned to its physiological position without causing additional trauma. Particular attention is required to avoid damage to the urethral meatus during manipulation. 

Although specific repositioning methods are not extensively detailed in the literature, the principle remains consistent: restoration of normal anatomy while preserving tissue viability¹. 

Application of the Bühner Suture¹ 

The Bühner vulvar suture, originally developed for ruminants, has been adapted for use in canine patients. In this technique, a circumferential suture is placed around the vulva to reduce the opening sufficiently to prevent recurrence of prolapse. 

In the described cases, the classical method was used due to the suitability of patient size and available instruments. Modified techniques have also been reported, involving simpler suturing methods around the vulva. Regardless of the technique, it is essential to maintain a balance between preventing prolapse and allowing normal urination. 

Anesthetic Considerations and Pain Management 

While earlier reports suggested that mild sedation may be sufficient, more recent practices favor the use of general anesthesia to ensure adequate pain control and adherence to animal welfare standards¹. In the cases discussed, intraoperative pain was managed systemically, allowing adjustment based on the patient’s clinical response. 

Postoperative Outcomes and Monitoring 

Following surgery, the animals were monitored for recurrence and progression of the estrous cycle. In some cases, mild Type I hyperplasia persisted temporarily due to prolonged estrogen exposure; however, the vulvar suture effectively prevented further prolapse. 

The resolution of the condition corresponded with the onset of diestrus, reinforcing the importance of hormonal influences in disease progression. 

Prevention of Recurrence and Role of Sterilization¹ 

Given the high likelihood of recurrence, particularly in predisposed animals, long-term management must be considered. Ovariectomy is recommended for animals not intended for breeding, as it eliminates the hormonal stimulus responsible for hyperplasia. 

In the discussed cases, sterilization was performed two months later, at the end of diestrus, to reduce the risk of pseudopregnancy. The vulvar suture was removed at the same time to minimize additional anesthetic procedures. 

Conclusion 

The Bühner vulvar suture provides an effective and minimally invasive approach for managing Type III vaginal hyperplasia in dogs. By combining careful repositioning with strategic suturing, clinicians can achieve successful outcomes while preserving tissue integrity. When integrated with appropriate follow-up and long-term planning, this technique represents a valuable tool in the management of reproductive emergencies. 

References: 

1. Bucci R, Fusi J, Robbe D, Veronesi MC, Carluccio A. Management of vaginal hyperplasia in bitches by Bühner suture. Animals. 2022 Dec 12;12(24):3505. https://doi.org/10.3390/ani12243505 
2. Ahuja AK, Shivkumar S, Singh AK, Dhindsa SS. Management of true vaginal prolapse in bitch. International Journal of Environment, Agriculture and Biotechnology. 2017;2(4):238837. https://www.academia.edu/download/53952885/25_Management_of_True_Vaginal_Prolapse.pdf