Dr. Claude Ragle, the senior equine surgeon at Washington State University's veterinary teaching hospital who is working on Brynn's case, called me this evening with a report on the diagnostic procedures they performed today.
After making a small incision in Brynn's flank this morning, they inserted a laparoscope -- a lighted scope that allows doctors to see inside the abdomen -- to get a clear view of the exterior of her bladder and the ectopic ureters. The results confirmed what they suspected from the last round of endoscopy a few days ago, which was that her ureters were not laying across the outside of the bladder wall and thus were not connected to the bladder wall tissue. If that had been the case, they could have punched small holes from inside the bladder wall and up into the ureters, allowing them to drain into the bladder.
This photo is one the hospital staff took last week during Brynn's endoscopy. That's Dr. Kristin Gablehouse on the left and Dr. Ragle on the right.
So Dr. Ragle said there's only one thing left to do: a urethral extension. The surgical team will basically create -- using Brynn's own body tissue -- a tube that will extend her urethra all the way to the very edge of her vulva, to what Dr. Ragle called the 'vulvar lips.' Because Brynn's ureters -- the tubes that normally carry urine from the kidneys to the bladder -- are emptying into her vagina, the goal of the urethral extension will be to re-direct the urine back down and into her bladder. Right now the urine just dribbles out of her vagina, causing the urine scalds all over her thighs and legs.
Dr. Ragle thinks that the urethral extension will essentially change the internal "lay of the land" in her vagina and cause the urine to either do something unnatural -- flow uphill at a dribble, through the urethral extension -- or take the easy way and flow downhill and into the bladder. He said it's all fluid dynamics, so in theory the urine will take the path of least resistance and flow back down and into the bladder. When it's full, she should have the urge to pee and expel the urine normally through the full length of her extended urethra using the mare's "abdominal thrust," with her back legs spread apart and the urine shooting out well past her backside and legs.
Because this little blind girl has now had three rounds of procedures, Dr. Ragle is going to give her some "time off" this week and let her just hang out for a while. He expects to do the urethral extension surgery next week.
(Spellchecker weirdness: The blog spellchecker helpfully suggested 'periscope' instead of 'laparoscope.' Well, kind of the same idea, I guess!)