Surgery for Ruby?

Question:
 Hi all. I know I haven't been around much lately (I'd hurt my back quite badly and a couple of other things have been going on) but I'd really like some advice from anyone here experienced in such things.
Some of you may remember that Ruby gets very bad urinary tract infections and was recently diagnosed with bacterial cystitis (after a cystocentesis and bladder x-ray turned up crystals in her urine).
Anyway, after a couple of months on antibiotics, vitamin C powder in her food, and other stuff, she's been much better and hadn't had an infection for a few months.
The other day she started getting despondent again, was a little incontinent, so before she could start her 50-squats-no-pee routine we got a sample and took her to the vet.
It wasn't our regular vet, as they are closed on a Sunday, but a new vet down at our local clinic, where Ruby has been before. He examined her vulva, and said that it seemed to be abnormally formed - recessed and with a thick ridge/fold of skin growing up over it, which doesn't obstruct her urine but does stop her from being able to clean the area, and traps bacteria inside her vagina.
The vet said she may need corrective surgery, and I wondered if anyone here has had the same or similar surgery on one of their dogs? It wasn't called an episiotomy but started with `episi' - I've googled but I can't find it. We would not hesitate to have it done if she needed it, but I'd just like to talk to some people who may have gone through this with their baby.
Thanks :)

Answer:
I haven't went through this, but I just wanted to say that I will be thinking about you and Ruby and hoping the best no matter what you decide to do :)

Answer:
Is Ruby spayed?
The majority of inverted vulvas or juvenile vulvas will correct themselves after the first heat...when the vulva area swells it will usually pop out and not receed again.
I think I asked you before if Ruby had this....but could have been someone else. ?
Whatever Vet spayed her (if she is) should have recognized this and NOT done the spay until after she had her first heat.
But anyway, with some preventative measures at home could prevent the infections... Simply use baby wipes to clean the vulva after she pees, or a couple times a day. Just pull the tip of the vulva or the hair on the tip of the vulva until all the skin is exposed and clean with a baby wipe and make sure it is dry before letting it go. If she still keeps getting infections after you start keeping her clean, then I would consider the surgery, although I have never experienced the surgery.
Oh yea, I have also heard you can put a little bag balm in the fold of the skin...but I am not sure if this would help or hamper....so if you decide to try that, do a little more research about it.
Do a search for inverted vulva.....tons of things come up. :)
Also Ruby's breeder should have had a clue about this too... It is not uncommon in female labs. And I think it can be hereditary.
Good Luck,
Julie.

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Also I know it is important to never withhold water from Ruby... that will concentrate the urine and make things worse...
So if you ever crate her find a way to always provide her with water access.
:)

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Thanks so much for your advice. She is spayed, and initially it was thought that her problems were due to post-spay incontinence, but as infection always preceded or accompanied incontinence, we knew it wasn't from that.
I don't know that Ruby ever has had a proper examination of her vulva before. The vet who saw her today was quite young, and I think pretty new, and therefore very thorough. I'm not saying our regular vet isn't - he has just done more lab work (pardon the pun), but only had a quick look at her anatomically. He felt it was important to determine whether or not the infections were systemic.
But we'll see how she goes, Max gave her a good clean tonight, and hopefully once things are less sore and swollen down there, it may not look as bad. She tends to respond well to antibiotics, and she'll be on them for a month or so, with regular urinalyses. If she's resistant or things aren't clearing up quickly enough, we will look into the surgery and its risks and complications. Hopefully the benefits would outweigh any risks, though.
Will keep you posted. :)

Answer:
Sometimes it comes to surgery to fix stubborn problems. Too many anti-biotics for too long can result in resistant strains and it can become a real problem later. I think rinsing (flooding) the area with just warm water is a good idea in the meantime. You could use a large sized syringe and gently rinse it off a few times a day. (well, ask your vet) I wouldn't put anything greasy on the skin because that can really attract and hold in the bacteria. If she had crystals, that can irritate the urethra so that it burns when she goes so she stops midstream. When the bladder is not emptied, the urine gets stagnent and the ph changes which also attracts bacteria. It sounds like you've done everything and that surgery will be the best thing. Good luck and keep us posted. You're a good Mommy to take such good care of Ruby.

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An interesting post !! I'll be interested in the follow ups ! Hugs for Ruby !

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Sometimes it comes to surgery to fix stubborn problems. Too many anti-biotics for too long can result in resistant strains and it can become a real problem later. I think rinsing (flooding) the area with just warm water is a good idea in the meantime. You could use a large sized syringe and gently rinse it off a few times a day. (well, ask your vet) I wouldn't put anything greasy on the skin because that can really attract and hold in the bacteria. If she had crystals, that can irritate the urethra so that it burns when she goes so she stops midstream. When the bladder is not emptied, the urine gets stagnent and the ph changes which also attracts bacteria. It sounds like you've done everything and that surgery will be the best thing. Good luck and keep us posted. You're a good Mommy to take such good care of Ruby.
Thanks so much Carrie, we do feel like we're getting to the point where we've done everything, and that this is probably the best option - but it's the first time we've heard of this as an option, so I rang our regular vet today and brought them up to speed, and said that I would pass on the results of the tests when they came back. Although the vet I went to on Sunday was very good, thorough and professional, Ruby doesn't know him, and he's not our Dr Drew, and whilst I'm a bit miffed that Drew didn't do that examination in the first place, he has been very attentive to Ruby and she loves him.
I am also going to ring my sister-in-law and have a good chat to her about it, because she is very knowledgeable about gynaecological surgery in dogs to begin with, and has performed many tricky operations on her patients. I trust her judgement.
Ruby has already become resistant to Rilexine, the most commonly prescribed antibiotic for this, so she's on sulphur drugs now for ten days and then further treatment will be pending the results of her urinalysis.
She's such a good girl though - despite her pain and discomfort, she's such a trooper. Her `boyfriend' came over last night (Max's best friend) who lets her get away with all the things she's not allowed to do (i.e. paws-on-shoulders `Ruby hugs' and licking and general getting in your face) and she virtually jumped through hoops when he arrived. Nothing keeps our girl down for long!

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Hugs for Ruby that she gets better soon.

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Well, I just rang the vet and found out some of Ruby's urinalysis results.
She does have struvite crystals again and an alkaline pH in her urine. But this time the protein result was lower, the pH was lower, there was NO blood, no ketones, no glucose and no bilirubin.
So, as soon as the bacteria results are back he'll know exactly which antibiotics to use.
I'm pleased that things are not as bad this time (and she's certainly back to her old cheeky self - she deposited every sock and pair of stockings I own on the pillow next to me last night because I went to bed too early for her liking!!) but I feel that they're only better results because we got to things earlier (as we know all the less obvious signs now) and not because the underlying problem has been solved.
I am taking the results and Ruby to our regular vet on the weekend, and he will examine her again and we'll talk about the surgery. It all depends on the bacteria analysis - if it's systemic, surgery won't help. If it's coming from an external cause, we should be able to eliminate that cause (and I think it's the water at the river beach we take her to).
If it turns out that her vulva is too recessed and eliminating the cause will only help a bit, then we'll get her the surgery.
Silly baby. I am very relieved that she's feeling better, though, and the tests weren't too bad.

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Sound like you're on top of it !! It's getting to being black or white now instead a grey !!!! I hate not knowing !!

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A-h-h....she has protein in her urine too? Aa-r-r-g-g. Well, it sounds like she's in good hands and that's cool that your sister is a vet. That ought to really make you feel more confident. Sounds like Ruby is a super good sport and that she has good vets taking care of her. I'm glad it's not too bad this time. Let us know how everything goes. Give her an extra cookie for me. And a hug.