Chapter 60 - Testis surgical tx part II Flashcards
hat are some synonyms for castration
Orchidectomy, orchiectomy, emasculation, gelding, cutting.
What impact does castration have on the growth plates of bones in bulls?
Castration delays closure of the growth plates, allowing for greater height.
What must be inspected in young horses prior to castration?
The scrotum for inguinal herniation and the presence of both testes.
Which drug is commonly used for analgesia during the standing castration procedure?
Which drug is commonly used for analgesia during the standing castration procedure?
Which anesthetic agent is mentioned as producing rapid anesthesia characterized by muscular relaxation?
Thiobarbiturate along with Guaifenesin (5% to 10%) un combination
What combination can enhance the analgesic effects during recumbent castration?
Xylazine with ketamine.
What is one risk associated with the use of acepromazine in stallions?
It can occasionally result in priapism or penile paralysis.
What is the average age range for American Quarter Horse colts to reach puberty?
Between 55 and 101 weeks.
How much time of anesthesia provides ketamine?
10 to 15 minutes
Succinylcholine what is it?
muscle relaxant without analgesia inhumane use in castration
What are the 2 surgical approach for castration?
Scrotal approach
infuinal approach
Describe the scrotal incision performed GA
If difficult to feel the test (small in prepubescent stallion) the scrotum can be safely incised by pulling the scrotal raphe
make two parallel 8 to 10 cm incisions 2 cm distant from the raphe on either side while compressing the testes against the bottom of the scrotum
describe the incision for the inguinal approach
DR
superficial rigns are exposed through 8 to 15 cm skin incision over the superficial ring
What are the most common emasculators
Whites
Reimer
Serra
describe the Reimer
reimer crushes the cord and the blade perated by a spearate handle severs the cord distal to the crushed segment
Figure 60-12. Reimer (A) the Reimer emasculator severs the cord with a blade on a separate handle so that the cord is not accidentally cut before it is satisfactorily crushed.
Serra (B) emasculators.
Figure 60-13. The Sands emasculator is similar to the Reimer emasculator but has no cutting blade. The spermatic cord must be severed distal to the emasculator with a scissors or a scalpel blade.
Describe the Sands emasculator
The Sands emasculator is similar to the Reimer emasculator but has no cutting component and only crushes the cord (Figure 60-13). The cord must be severed distal to the crushed segment with scissors or a scalpel blade. More used in Europe
Figure 60-14. Serra emasculator. The grooves of the crushing blade are oriented vertically to prevent the blade from accidentally cutting the cord.
Figure 60-15. A Henderson equine castrating instrument. One handle of this instrument is attached to a variable-speed drill. The instrument is clamped across the spermatic cord and rotated slowly for about five turns before the speed of rotations is increased. The cord is rotated until it separates proximal to the instrument. The twisting of the cord seals the severed vessels.
Figure 60-15. A Henderson equine castrating instrument. One handle of this instrument is attached to a variable-speed drill. The instrument is clamped across the spermatic cord and rotated slowly for about five turns before the speed of rotations is increased. The cord is rotated until it separates proximal to the instrument. The twisting of the cord seals the severed vessels.
Describe the Henderson instrument and how it works
One handle of this pliers-like instrument is attached to a 12-W or greater variable-speed drill (slippage is likely to occur with a less powerful drill) with a 38-in or larger chuck. With one hand holding the testis, the instrument is clamped across the entire cord, just proximal to the testis. With slight tension on the drill and with the instrument held parallel to the cord, the testis is rotated slowly for about five turns. The speed of the rotations is gradually increased while keeping slight tension on the cord. After 20 to 25 rotations, the cord separates about 8 to 10 cm proximal to the instrument. The twisting of the cord effectively seals the severed vessels.
How many rotations should be performed with henderson before it separates?
20 to 25 rotations?
What are teh 3 surgical techniques?
Open
Closed
Half closed regardless if is standing or recumbent, inguinal or scrotal
what does the open and close refers to?
the terms open and closed should be used to describe whether the parietal tunic of each testis was removed and should not be used to describe whether the scrotal or inguinal wound was sutured.
describe open tx
With the open technique of castration, the parietal (or common vaginal) tunic is retained
describe closed tx
With the closed and the half-closed techniques, the portion of the parietal tunic that surrounds the testis and distal portion of the spermatic cord is removed
the scrotal skin incision is usually left open or closed?
open
describe all the strutures that are severed when the parietal tunic of the testis is incised during the open tx
The ligament of the tail of the epididymis (caudal ligament of the epididymis), which attaches the parietal tunic to the epididymis, is severed or bluntly transected.
By transecting the fold of the mesorchium and mesofuniculum, the testis, epididymis, and distal portion of the spermatic cord are completely freed from the parietal tunic and removed using an emasculator.
describe the close technique
With the closed technique, the parietal tunic is not incised, so it is also removed along with the testis and a portion of the cord
describe half-closed technique
closed technique just described can be converted to a half-closed technique by making a 2- to 3-cm vertical incision through the exposed parietal tunic at the cranial end of the testis or the distal end of the spermatic cord. A thumb (the left thumb if the operator is right handed) is inserted through the incision into the vaginal cavity. The testis and a portion of the spermatic vasculature are prolapsed through the incision by applying downward traction on the tunic with the thumb while simultaneously using the fingers of the same hand to push the testis through the incision.The parietal tunic and cremaster muscle can be crushed and severed separately from the testicular vessels and the ductus deferens, if desired, by using the half-closed technique. In the end the parietal tunic is removed along with the testis and the distal portion of the spermatic cord
how much time should be the emasculator used?
2 to 3 minutes should be sufficient to achieve hemostasis
If you use a blade to severe the cord in case o using Sands emasculator how far and distal from the emasculator should be the transection performed?
2 to 3 cm distal
The closed and half-closed tx by removing the parietal tunic provide what advantage?
decrease the incidence of some postoperative complications, such as septic funiculitis and hydrocele
For Standardbreds that have risk of inguinal hernia what can you perform as tx to avoid?
closed tx with a ligature that is placed proximal to the site of transection
The closed and half-closed tx require more or less dissection?
require more dissection than does the open method of castration, and this may be a disadvantage when performing a standing castration on a fractious stallion.
which tx has higher rate of complications?
equids castrated using the half-closed technique had a significantly higher incidence of complications than did equids castrated using the open or closed techniques
what are the advantages of closing the wound?
decreases the likelihood of infection, and decreases edema, pain, and muscular stiffness
scrotal hematoma can be prevented how?
Ligating the cord proximal to the point of division with the emasculator ensures good hemostasis, and therefore should be considered an important part of the procedure.
what is the best methodology/type of suture to close a castration?
The cutaneous incision is best closed using a simple-continuous intradermal suture pattern with an absorbable USP size 2-0 monofilament suture
describe the technique per primam used in Europe
GA - DR - 5- to 7-cm cutaneous incision is created over the superficial inguinal ring, and the underlying fascia is incised, taking care to avoid lacerating large branches of the external pudendal blood vessels, and digitally enlarged to expose the parietal tunic over the testis. The parietal tunic is incised longitudinally for 5 cm in an area not covered by the cremaster muscle. The ligament of the tail of the epididymis is located with an index finger, and by applying traction on this structure, the testis is extracted from the vaginal cavity. The ligament of the tail of the epididymis, which attaches the testis to the parietal tunic, is transected. The mesorchium is bluntly separated from the epididymis, and the distal part of the mesofuniculum is bluntly separated from the parietal tunic. Bleeding vessels are cauterized to prevent hemorrhage into the vaginal cavity, and two heavy, absorbable, monofilament ligatures, one of which is transfixing, are applied 1 cm apart to the testicular vasculature and ductusdeferens, as far proximad as possible. The vasculature and ductus deferens are severed 2 cm distal to the distal ligature, and the stumps of the vasculature and ductus deferens are replaced into the vaginal cavity. The incision in the parietal tunic and that in the subcutaneous tissue are sutured separately with an absorbable USP size 2-0 monofilament suture using a simple-continuous pattern. The cutaneous incision is closed with the same suture using a simple-continuous intradermal suture pattern
what vessels should be avoided in the per primam castration?
large branches of the external pudendal blood vessels
what is the size of the cutaneous incision and what is the size of the parietal tunic incision in the per primam tx?
5 to 7 cm cutaneous incision
5 cm in the parietal tunic
the 2 heavy absorbable monofilament ligatures transficxing that are applied ___ cm apart to the testicular vasculature and ductus deferens are aksi severed __ cm distal to the distal ligature
the 2 heavy absorbable monofilament ligatures transficxing that are applied 1 cm apart to the testicular vasculature and ductus deferens are aksi severed 2 cm distal to the distal ligature
what is the complication rate of the per primam?
2.1%
In case of castration wound the horse should receive booster vaccination of tetanus toxoid if it had passed more than __ months after the last tetanus vaccination
In case of castration wound the horse should receive booster vaccination of tetanus toxoid if it had passed more than __ months after the last tetanus vaccination
A horse with 3 doses of tetanus vaccine has serum antibody titers for at least more than
3 years
The horse should be isolated from mares for at least __ days after castration.
The horse should be isolated from mares for at least 2 days after castration.
Ejaculates are highly unlikely to contain sufficient spermatozoa to cause pregnancy after __ days.
Ejaculates are highly unlikely to contain sufficient spermatozoa to cause pregnancy after 2 days.
The scrotal wound should be nearly healed by ___ weeks.
The scrotal wound should be nearly healed by 3 weeks.
In situ techniques of castration include
ligation and transection of the testicular artery and vein and ductus deferens within the abdomen (i.e., laparoscopic castration results in avascular necrosis of the testicular parenchyma with the testes in situ
describe in laparoscopic portals in situ tx
A laparoscopic portal is created just above the internal oblique abdominal muscle in the flank or at the 17th intercostal space using standard technique
The laparoscope is directed caudad to view the inguinal area. To perform in situ castration, a 10-mm-diameter instrument portal is created 8 to 10 cm cranioventral to the laparoscopic portal, and another is created 8 to 10 cm caudoventral to the laparoscopic portal.176 A third 5-mm-diameter instrument portal is created 8 to 10 cm caudodorsal to the laparoscopic portal.
How are the testicular vessels and ductus derens ligated in laparoscopic tx in situ
The testicular vessels and ductus deferens are identified in the mesorchium as they course toward the vaginal ring. A ligating loop is placed through the 5-mm instrument portal, and a right-angle dissecting forceps is inserted through the cranioventral portal and the ligating loop. The ductus deferens and testicular vessels are grasped with the forceps. Using a bipolar cautery forceps placed through the caudoventral instrument portal, the ductus deferens and testicular vessels are coagulated distal to the forceps. The cautery instrument is removed and replaced with a laparoscopic scissors, which are used to transect the ductus deferens and spermatic vessel immediately distad to the site of coagulation. The ligating loop is now slid over the right-angle forceps onto the coagulated stump of the ductus deferens and testicular vessels, tightened, and tied, and the ends of the ligature are cut. After releasing the forceps, the stump is inspected for hemorrhage
After in situ ligation the testes deprived of their blood supply when does the testosterone drop? when do the remants are no longer palpable per rectum?
7 days of the testicular vessels being ligated, the concentration of testosterone falls
by 5 months the remnants are no longer palpable
what can be the alternative blood supply of the testicles that were submited to laparoscopic castration?
cremasteric artery
external pudendal artery
Which in situ tx are described in donkeys?
incision-ligation technique
section-ligation technique
pinhole technique
describe in situ incision-ligation tx
a 5-cm-long, parallel incision is made through the skin over the spermatic cord, the spermatic cord is elevated through the incision, and the parietal tunic is incised. The vascular portion of the cord and ductus deferens are separated, each double clamped with hemostats, and each double ligated with absorbable suture. The parietal tunic and skin are sutured, leaving the testis in situ. The procedure is repeated on the contralateral spermatic cord.
describe section-ligation-release technique
The section-ligation-release technique is performed on both spermatic cords in a manner similar to that of the incision-ligation technique, but the vascular portion of the cord and the ductus deferens are each triple-clamped, triple-ligated, and divided between the middle and distal ligatures.
describe pinhole technique
Using the pinhole technique, the spermatic cord is retracted laterally using digital pressure. A suture needle threaded with two absorbable sutures is introduced medial to the spermatic cord through the caudal aspect of the scrotal skin, advanced cranially, and exited through the cranial aspect of the scrotal skin. The spermatic cord is repositioned and stabilized medially, and the needle is reintroduced through the same cranial cutaneous scrotal hole and advanced caudally, lateral to the spermatic cord, and exited through the caudal cutaneous hole. The suture encircling the spermatic cord is tightened to ligate the cord. The procedure is repeated on the contralateral spermatic cord.
the pinhole tx is used in calves but it is not advised in donkeys, why?
fails to result in complete necrosis of the testes of donkeys, and therefore should not be used to castrate donkeys or horses.
What is the purpose of vasectomy in a teaser stallion?
To prevent it from inseminating mares.
How can a stallion be vasectomized?
hrough an incision over each spermatic cord or a single incision over one testis.
What length is the cutaneous incision in a vasectomy?
2 cm.
describe the vasectomy surgery
GA - DR or LR - cutaneous incision is made on the medial aspect of one testis, and the incision is extended through the dartos and parietal tunic. The ductus deferens, which is identified as a white, 2- to 3-mm-diameter, cordlike structure, is exteriorized and separated for a length of several centimeters from its mesorchium, using a curved hemostatic forceps.
Two ligatures of USP size 2-0 absorbable or nonabsorbable suture are placed around the most proximal aspect of the exposed portion of the ductus deferens, and a third ligature is placed around the most distal aspect of the exposed portion of the ductus deferens. The segment of ductus deferens between the two proximal ligatures and the distal ligature is removed. The incision in the parietal tunic is sutured with an absorbable USP size 2-0 suture using a simple-continuous pattern. The ductus deferens on the medial aspect of the other testis is subsequently palpated through the cutaneous incision and exposed by incising the scrotal septum and overlying parietal tunic.
Why are two ligatures placed on the proximal end of the ductus deferens?
To minimize the likelihood of reanastomosis and sperm granuloma formation.
What is removed during the vasectomy procedure?
The segment of ductus deferens between the proximal and distal ligatures.
What does immunologic castration target?
Gonadotropin-releasing hormone (GnRH).
What effect does immunization against GnRH have on testosterone?
It decreases serum testosterone concentrations.
What effect does GnRH immunization have on testicular size?
It decreases testicular size.
What is the goal of immunologic castration in stallions?
To suppress testicular function and sexual behavior.
Does immunization against GnRH completely suppress libido in all stallions?
No, libido is not totally suppressed in all cases.
What adverse effects may arise from using an anti-GnRH vaccine like Improvac in stallions?
Pyrexia and apathy.
Mention the surgical tx for removal of retained testis
- Flank
- Inguinal
- Parainguinal
- Suprapubic paramedian
which 2 tx allow a non invasive removal of the testis
termed noninvasive if the testis can be removed by introducing only one or two fingers into abdominal cavity
describe inguinal approach
GA - DR - superficial inguinal ring exposed with eliptical insicion 8-12 cm, scrotal incison or 8-15 cm incision directly over the sup ring
in the inguinal approach what is the advantage of doing the scrotal incision instead of superficial inguinal ring?
A cryptorchid testis and the contralateral scrotal testis (or two cryptorchid testes) can be removed from one incision if the incision is created over the scrotum, rather than over the superficial inguinal ring.
Which ligament can help you exteriorize the tesitcle from the abdomen through the vaginal ring?
proper ligament - The body of the epididymis can be exposed through a small incision in the vaginal process and traced to the tail of the epididymis, which is connected to the testis by the proper ligament of the testis. By placing traction on this ligament, the abdominal testis can usually be exteriorized through the vaginal ring
what is the scrotal ligament? how is it known?
the scrotal ligament, also known as the inguinal extension of the gubernaculum testis (IEGT) can be making traction on this one the inverted vaginal process can be everted into the inguinal canal
Figure 60-16. An inverted vaginal process can be everted into the inguinal canal by exerting traction on the inguinal extension of the gubernaculum testis. This ligament is a remnant of the gubernaculum and attaches the vaginal process to the scrotum.
Figure 60-17. (A) The everted vaginal process is stripped of inguinal fascia and longitudinally incised. (B) The epididymis contained within is grasped with a hemostat and exteriorized.
Figure 60-18. Cryptorchid testis. b, Body of epididymis; cle, caudal ligament of the epididymis; ct, cryptorchid testis; d, ductus deferens; h, head of epididymis; plt, proper ligament of the testis; pt, parietal tunic; t, tail of epididymis; tv, testicular vessels.
Figure 60-19. With traction on the proper ligament of the testis, the testis is pulled through the vaginal ring.
Figure 60-20. Parainguinal approach to cryptorchidectomy. A 4-cm incision is made in the aponeurosis of the external abdominal oblique muscle 1 to 2 cm medial and parallel to the superficial inguinal ring. The incision is centered over the cranial aspect of the ring.
Figure 60-21. Parainguinal approach to cryptorchidectomy. The vaginal ring is palpated caudolateral to the point of entry into the abdomen. Either the epididymis, gubernaculum, or ductus deferens is located at the vaginal ring and exteriorized.
Figure 60-23. Escape of small intestine through the vaginal ring and scrotal incision after castration.
Figure 60-25. The exteriorized portion of the spermatic cord is thickened and hardened from infection. The demarcation between normal and abnormal portions of the cord is obvious. A thick, hard, infected cord after castration is commonly referred to as a scirrhous cord.
Figure 60-24. Protrusion of greater omentum through the scrotal incision after castration.
Figure 60-26. Stump of penis emerging from a scrotal incision. Much of the shaft of the penis was inadvertently removed during a standing castration.
Figure 60-27. The arrow points to the epididymis of a partial abdominal cryptorchid. A portion of the epididymis lies within the inguinal canal, enclosed within the vaginal process. This portion of the epididymis could be mistaken for an inguinal testis by an inexperienced surgeon and amputated
Figure 60-28. Extraction of a right testis of a partial abdominal cryptorchid stallion through a parainguinal approach. Note that the epididymis is not present. The horse had previously undergone incomplete cryptorchid castration.
