Episioplasty in Cats

Episioplasty (also known as vulvoplasty) is a surgical procedure to remove excess folds of skin which form a curtain around or over the vulva. These folds trap bacteria around the vulva and the warm moist environment provides the ideal breeding ground for infection. The latter may be skinfold infections or recurrent urinary tract infections.

The need for episioplasty in the cat is rare, especially in lean cats. Those most likely to need this procedure are overweight or obese cats who have extra folds of skin secondary to weight gain. 

Episioplasty can be undertaken in first opinion practice. 

The patient is carefully screened to rule out other causes of recurrent UTIs, such as bladder stones or urinary calculi. The cat is then given a general anesthetic and supported on their belly with the hind quarters elevated. The fur around the vulva is clipped and the skin aseptically prepared for surgery. 

The surgeon assesses the amount of tissue to be removed by gently pinching the folds of skin around to see how much to remove in order to 'air' the vulva. Typically, two crescent shaped incisions are made either side of the vulva, to encompass the redundant fold. The spare skin is undermined and removed, and the deficit repaired using fine suture material. The sutures stay in place for 10 to 14 days. The cat must wear a cone until healing is complete.

The 'nip and tuck' of episioplasty is an effective way to remodel the peri-vulvar area. Success largely depends on good surgical judgement of how much tissue it is necessary to remove. Too much and the skin wound is under tension and may then break down. Too little, and the procedure may need to be repeated. 

Most cats are fully recovered after two weeks. 

In the immediate perioperative period, the cat should be given painkillers so as to reduce the inevitable discomfort. Typically non-steroidal anti-inflammatories with the addition of opioids are sufficient to control the pain and allow comfortable urination. 

In cooperative patients, cold compresses held against the vulva can reduce postoperative swelling and increase comfort. 

It is vital the cat does not lick the op site, and so a cone must be worn until healing is complete. Rest is also advisable, as activity will exacerbate swelling. 

Surgery can be undertaken in first opinion practice and costs around $500 to $700.

Episioplasty can improve the quality of life of cats suffering recurrent UTIs because of an inverted vulva. However, cat anatomy means vulval folds are much less likely to form than in the dog. Those cats that do require surgery are usually overweight, therefore weight reduction is advisable prior to surgery. Not only could weight loss alleviate the need for an operation, but if it's still necessary to proceed, then anesthetic safety is improved. 

Keeping the cat at a healthy weight is vital to general health. This can be a challenge for indoor cats that aren't particularly active. However, strategies such as weighing out the daily food allowance, plus using puzzle feeders, are great ways to encourage net calorie loss. Also, providing an enriched environment with high perches, regular play, and interaction with the owner helps to decrease the boredom that can lead to comfort eating.