REVIEW OF RESEARCH ARTICLES ABOUT THE PROS AND CONS
OF OE AND OHE PROCEDURES IN DOGS AND CATS
Prepared by T
J Dunn, DVM
WISCONSIN VETERINARY MEDICAL ASSOCIATION
(To quickly scan visually for primary information read the highlighted blue text.)
Definitions for this review:
OHE = Ovariohysterectomy: The patient’s ovaries and the uterus above the cervix is removed.
OE or OVE = Ovariectomy: The patient’s ovaries are removed and the uterus is left intact.
Appropriate patient for OE procedure: A patient that is healthy and has not had a litter, nor has a history of uterine pathology, nor displays any evidence of uterine pathology to the surgeon at the time of the spay surgery.
Best procedure: The one procedure of many that provides a solution for doing the surgery and that has the least potential to harm to the patient. (This definition is arrived at objectively. It is based upon knowledge of anatomy, physiology, aesthetology, and other scientific data.)
Most efficient: The procedure that takes the least time, effort, cost, and maintenance. (This definition is subjective in nature. The most efficient procedure is determined by considering the surgeon’s skill, staff’s skill and compatibility, pre and post op practice protocols, anesthetic selection and other individual habits and priorities.)
Goal: The goal of this review is to present just a few of the current references relating to the two commonly used methods of surgical sterilization… ovariohysterectomy and ovariectomy. The published literature will assist anyone wishing to understand, compare, and contrast the safety and efficiency of two different procedures when used on appropriate patients. Objective scientific data as well as subjective preferences of surgeons and staff should lead the inquiring mind to a conclusion regarding the best spay procedure to use on appropriate patients.
Apr 1, 2009
Many reasons exist for performing ovariectomies instead of ovariohysterectomies in healthy bitches. Compared with ovariectomy, ovariohysterectomy in dogs is technically more complicated and time-consuming and is likely associated with greater morbidity (larger incision, more intraoperative trauma, increased discomfort).1 No significant differences between the two procedures have been observed for the incidence of long-term urogenital problems, including endometritis, pyometra, and urinary incontinence.1 In addition, there is no benefit and, thus, no indication for removing the uterus during routine neutering in healthy bitches.1
TEXTBOOK OF VETERINARY INTERNAL MEDICINE
Sixth Edition Ettinger and Feldman; Vol. 2
Although OHE is the most common technique used for permanent female sterilization in the United States, it has been shown that the long term side effects associated with only performing ovariectomy are no different than when OHE is performed. The advantages of performing OE include shorter surgery time, a smaller incision, and less abdominal trauma. Perhaps North American veterinarians should contemplate the advantages of OE over OHE.
International Congress of the Italian Association of Companion Animal Veterinarians
May 30 – June 1 2008 Rimini, Italy
Ovariectomy versus ovariohysterectomy. Is the eternal argument ended?
Jolle Kirpensteijn DVM, PhD, Dipl ECVS, Utrecht, Olanda
Gonadectomy can be performed by
ovariectomy (OVE) or ovariohysterectomy (OVH), the latter
being the preferred approach in the USA. This preference is
most likely based on the presumption that future uterine
pathology is prevented by removing the uterus. In the
Netherlands and some other European countries, OVE is
routinely performed and has replaced OVH as the standard
approach for gonadectomy; the uterus is only removed when
uterine pathology is present
Endometritis and pyometra
Epidemiologic data for ~200,000 dogs covered by insurance
in Sweden revealed that ~ 1,800 non-spayed bitches
were treated for pyometra in 1996. The risk of an intact bitch
developing pyometra before 10 years of age was 23 - 24%.
Other studies, albeit on a smaller scale, had similar findings.
Fukuda reported a 15.2% chance for the development of
pyometra in 15.2% chance female dogs > 4 years old (n =
165) and Von Berky reported a 14.9% chance for uterine disease
Thus, it is important to determine if the uterus in ovariectomized
dogs is predisposed to develop endometritis and
pyometra. Pyometra has been defined as a hormonally mediated
diestral disorder resulting from bacterial interaction
with an abnormal uterine endometrial that has undergone
pathologic changes assumed to be caused by an exaggerated
response to progesterone stimulation. Recently, the concept
of considering cystic endometrial hyperplasia (CEH)-
pyometra as a complex has been questioned. It has been suggested
that 2 different disorders; one where CEH-endometritis
appears to have a strong hormonal component and
pyometra might be more influenced by the bacterial component.
Nevertheless, both conditions are exclusively encountered
in the luteal phase of the oestrus cycle. Experimentally
CEH or CEH-endometritis can be induced by administration
of progesterone, even in ovariectomized bitches. Withdrawal
of progesterone treatment causes regression of the
naturally occurring disease. Thus exposure to progestagen
appears to be necessary for the development of CEH-endometritis.
A study by Okkens et al comparing the long-term effects
of OVE versus OVH was conducted at the University of
Utrecht in 1997. Questionnaires were sent to 264 owners of
bitches that had either OVE (n = 126) or OVH (n = 138) performed
for routine neutering 8-11 years earlier. Complete
data were obtained for 69 OVE bitches and 66 OVH bitches.
None of the OVE bitches had signs consistent with having
had endometritis. With the exception of urinary incontinence,
no other problems related to surgical neutering were
identified. These findings agree with those of Janssens who
performed ovariectomy on 72 bitches and after a 6 - 10 year
follow-up, no pyometra was detected. When OVE is correctly
performed (all ovarian tissue removed) and in the absence
of supplementation of exogenous progestagens, endometritis
(CEH or pyometra) cannot occur.
These studies strongly suggest that progesterone is an essential factor in the occurrence of CEH-endometritis-pyometra and that correctly performed, OVH or OVE will prevent development CEH-pyometra in later life. OVE will not increase the chance for development of CEH-pyometra compared with OVH.
Since 1981, after introduction of OVE as the standard
technique for canine neutering at Utrecht University, no
increase in short-term complications has been observed.
With respect to long-term urogenital problems, including
endometritis/pyometra and urinary incontinence, it has been
clearly established that they do not any occur more frequently
with either technique.
The overall chance for development
of uterine tumours is very low (0.003%), and, in our
opinion, does not warrant performing a potentially more
traumatizing surgical procedure, OVH, that might be associated
with more postoperative complications.
Without benefit of more prospective studies comparing
surgical complications between OVE and OVH, most evidence
extracted from the literature leads us to the conclusion
that there is no benefit and thus no indication for removing
the uterus during routine neutering in healthy bitches. Thus
we believe that OVE should be the procedure of choice for
Reprinted in IVIS with the permission of Close window to return to IVIS www.ivis.org
Proceedings of the International SCIVAC Congress 2008
From VETERINARY SURGERY Volume 35, Issue 2
Making a Rational Choice Between Ovariectomy and Ovariohysterectomy in the Dog: A Discussion of the Benefits of Either Technique
BART VAN GOETHEM, DVM 1 , AUKE SCHAEFERS-OKKENS, DVM, PhD, Diplomate ECAR 1 , and JOLLE KIRPENSTEIJN, DVM, PhD, Diplomate ACVS & ECVS 1
1 From the Department of Clinical Sciences of
Correspondence to Address reprint requests to Bart Van Goethem, DVM, Spoorweglaan 38A, 9140 Temse, Belgium. Copyright © Copyright 2006 by The American College of Veterinary Surgeons
Objective—To determine if ovariectomy (OE or OVE) is a safe alternative to ovariohysterectomy (OVH) for canine gonadectomy.
Study Design—Literature review over a 35 year period.
Methods—An on-line bibliographic search in MEDLINE and PubMed was performed in December 2004, covering the period 1969–2004. Relevant studies were compared and evaluated with regard to study design, surgical technique, and both short-term and long-term follow-up.
Conclusions—OVH is technically more complicated, time consuming, and is probably associated with greater morbidity (larger incision, more intraoperative trauma, increased discomfort) compared with OVE. No significant differences between techniques were observed for incidence of long-term urogenital problems, including endometritis/pyometra and urinary incontinence, making OVE the preferred method of gonadectomy in the healthy bitch.
Clinical Relevance—Canine OVE can replace OVH as the procedure of choice for routine neutering of healthy female dogs.
Submitted April 2005; Accepted June 2005
Source: Okkens, AC, Kooistra, HS, Nickel, RF
(2003): Comparison of long-term effects of ovariectomy versus
ovariohysterectomy in bitches
Neutering of bitches is a routine surgery in small animal practice. If ovariectomy or ovariohysterectomy is performed, is a common point of discussion. In this study, 135 dog owners answered questionnaires concerning their bitches neutered years ago with either ovariectomy or ovariohysterectomy.
The present study compares long-term effects of ovariectomy
versus ovariohysterectomy in the
bitch. Questionnaires were sent to 264 owners of bitches, in which
ovariectomy or ovariohysterctomy had been performed as a routine
neutering procedure 8-11 years earlier. Complete data were available
for 69 bitches of the ovariectomy group and for 66 bitches from the
ovariohysterectomy group. There were no indications that endometritis
had developed in bitches of the ovariectomy group. None of the bitches
was sexually attractive to male dogs after neutering. The occurrence of
a clear to white vaginal discharge was reported in two bitches of each
group, but none of these four bitches appeared to be ill during the
period when the discharge was present. Furthermore, with the exception
of urinary incontinence, no problems were reported that could be
related to the surgical neutering. Six of the ovariecto- mixed bitches
and nine of the ovariohysterctomized bitches eventually developed
urinary incontinence. Of these 15 bitches (11 %), 12 weighed more than
20 kg. Bouvier des Flandres bitches were at a higher risk of developing
urinary incontinence than were those of the other breeds. The
possibility that the urinary incontinence was due at least in part to
other conditions must be considered, since eight of the bitches were 9
years or older before urinary incontinence occurred and seven of the
incontinent bitches also had polyuria or polydipsia. There were no significant
differences in the incidence of urogential problems listed above
between the bitches of the ovariectomy and ovariohysterectomy group. It is hypothetized that a uterine disease
such as CEH-endometritis cannot develop after complete ovariectomy,
unless progestagens are administered. The results of this study
indicate that ovariectomy does not increase the risk of
CEH-endometritis or other complications in comparison with
CANINE AND FELINE THERIOGENOLOGY is the only comprehensive, up-to-date textbook on small animal reproduction available. Veterinary management of normal reproduction and reproductive disorders in the male and female dog and cat are covered in detail, including such topics as sexual differentiation and normal anatomy, breeding management, use of chilled and frozen semen, pregnancy and parturition, neonatal care, clinical approach to infertility, and diseases of each of the reproductive organs. Some chapters address the pet overpopulation problem in the United States and approaches to population control in these species. This book is an invaluable resource to veterinarians, veterinary students, and others interested in companion animal reproduction. See page 172 regarding OE vs OHE topics.
Should You OE or Should You OHE?
From Veterinary Practice News
By Phil Zeltzman, DVM, Dipl. ACVS
1. E. Arnold Stone, Textbook of Small Animal Surgery. Saunders, 2003, p. 1495.
2. B. van Goethem, et al, “Making a rational choice between ovariectomy and ovariohysterectomy in the dog: A discussion of the benefits of either technique.” Veterinary Surgery. 2006, Vol. 35, No. 2, pgs. 136-143.
3. L.A.A. Janssens, “Bilateral flank ovariectomy in the dog-surgical technique and sequelae in 72 animals.” Journal of Small Animal Practice, 1991, Vol. 32, No. 5, pgs. 249-252.
4. L.M. Howe, “Surgical methods of contraception and sterilization.” Theriogenology, 2006, Vol. 66, No. 3, pgs. 500-509.
T J Dunn, DVM