Various anatomical abnormalities can cause a female dog to suffer from chronic urinary tract infections (UTI). Either folds of skin over the vaginal opening that are too long, or a vulva that is too small, can trap bacteria near the urethra. This can also manifest in overweight dogs. The area remains moist, which allows the bacteria to swim up the urinary tract. 

Dogs who suffer from urinary tract infections may show obvious vaginal irritation and excessively lick the area or rub their back ends on the floor. The skin around the vulva can also become inflamed and or infected. If oral or topical antibiotics do not get rid of the infection, surgery may be the next option. The skin folds that are causing the issue can be removed to prevent recurrence of the condition. This procedure should be performed by an ACVS board-certified veterinary surgeon.

A large vaginal hood or a recessed vulva can be confirmed by a visual examination by a veterinarian. Urinalysis may be run to determine what kind of bacteria is present in the urinary tract. Full blood work will also be needed, including a complete blood count and a biochemical profile to reveal how extensive the infection is. This can also help the veterinarian decide if the dog is healthy enough to undergo general anesthesia or not. An endoscopy may be used to get a visual of any abnormalities inside the vagina. Ultrasounds, x-rays or sometimes CT scans may be used to help plan the surgical procedure.

The dog will be required to fast for several hours before the operation takes place. An IV and an epidural catheter will be placed in the dog. The genital area will be shaved and cleaned. The area to be removed will be marked prior to any incisions being made. A shallow incision will be made all around the skin folds, making a crescent or horseshoe shape. The fat underneath the skin will also be removed. The remaining skin will be sutured together to complete the procedure.

This treatment is not often used to treat chronic infections of the urinary tract, however it carries very high success rates. If done correctly, an episioplasty, or vulvoplasty as it is sometimes called, is a simple and long-term solution for dogs suffering from complications related to large skin folds. The vast majority of dogs that undergo this surgery are cured completely from chronic UTIs and dermatitis. In those who are not cured, improvement is still noted. In cases where infections and incontinence remain, often other issues exist such as a shortened urethra or ectopic ureters. 

The dog should be closely watch as the anesthesia wears off. This is to make sure that heart rate, breathing and normal body functions resume properly. A cold compress will be applied to the surgical site for the first two days after the procedure has been done. Pain medication can be administered as soon as the dog regains consciousness. Bowel movements may be delayed for several days post-surgery. The dog may need to be coaxed to eat during this time. 

Extra care will be needed to keep the surgical area clean throughout the healing process. The incision will need to be regularly checked for signs of infection such as redness or swelling. An Elizabethan collar will likely be needed to keep the dog from lick or biting at its surgical wound. All activity should be kept to a minimum for two weeks after the operation. Non-steroidal anti-inflammatory drugs and antibiotics will be prescribed for a period of time as the dog heals. A follow-up appointment will be needed 10 to 14 days after the procedure to remove all sutures. 

As the procedure is simple, the cost of an episioplasty is lower than many other surgeries. It can range from $600 up to $1,500. The type of diagnostic imaging that is used will greatly affect the overall price of the treatment. Prescriptions given upon discharge will also contribute to the total cost. The only other treatment for this issue is a lengthened course of strong antibiotics, which often does not permanently fix the cause of the infection.

As with all surgical procedures, the use of general anesthesia brings with it possible health risks to the dog. Some dogs experience adverse reactions when put under anesthesia. Complications with the actual surgery are rare, but tend to involve having either too much or too little skin removed. If too much skin has been excised, the surgical wound may pull apart. If not enough skin has been taken, the chronic infections may not be eliminated. It may be beneficial to delay this surgery until the dog is sexually mature, as some dogs grow out of this problem. Overall, this procedure carries a good prognosis and a low morbidity rate.

Recessed vulvas have been directly linked with dogs who receive a spay surgery early in life. Waiting until the dog is at least 2 years of age may be advantageous, especially in large and giant breeds. Some dogs have vaginal abnormalities due to hereditary problems. Always inquire about your dog's family health history when obtaining the animal. 

Dogs who are overweight can develop enlarged vaginal skin folds. Keeping your dog at an appropriate weight can help prevent the need for an episioplasty. This can be accomplished by feeding your dog a high quality and healthy diet. Regular exercise through daily walks can also contribute to weight loss. Walking daily is also beneficial to the owner, and can be an excellent way to bond with your pet.