Exam 1 - Urogenital Surgery (Sx) Flashcards
indications for castration
behavioral
abnormal testicle
cryptorchid
typical age of castration
6 mos - 2 yrs
testicle of young horse that is hard to find often sits where?
inguinal location
precautions to take when castrating
- correct horse
- both testes present
- overall health good
- season - NOT middle of summer (flies) or winter (cold)
general diff btwn open, closed and modified closed?
how you handle vaginal tunic
note: incision is same for all 3
describe open castration
- incision through vaginal tunic to expose testicle
- good visualization of cord and vessels
- entire tunic not removed but stays w skin and sub q tissues
- components of cord emasculated separately
describe closed castration
incision NOT through vaginal tunic
- tunic and components emasculated separately
- strip sub q tissues of the cord
modified closed castration:
testicle prolapsed thru small incision in vaginal tunic
increased removal of tunic - some of tunic is removed
can visualize some of the vessels
benefits of standing castration
no anesthetic risk, no recovery and waiting around
risks of standing castration
harder to isolate bleeders b/c cord will go back up and in so cannot find to stop bleeding if you need to
bad position if horse too short
harder to deal w complications
general protocol of standing castration:
sedate horses, block testes, inject into cord and allow 15 mins for block to take effect
clean area well
positives of recumbent castration
better exposure to allow for hemostasis and drainage
protocol (general) for recumbent castration:
- sedate and anesthetize horse
- dorsal recumbency or lateral w upper leg brought forward
- rough scrup
describe incision for castration
2 incisions - each 1 cm from and parallel to median raphe
how is hemostasis achieved?
emasculation - with emasculators - applied in “nut to nut” fashion
occasionally ligation
why is emasculation preferred over ligation?
emasculation is faster
and in old days, sutures had more reactions so avoided
why is “nut to nut” important?
to get proper emasculation
if not applied this way, you cut wrong side and get bleeding
how to apply emasculator
nut to nut and perpendicular to cord
do NOT stretch cord
wait about 2 mins
release slowly
what ligament is cut in open castration?
lig of tail of epididymis [what attaches tail of epididymis to tunic]
important peri operative care for castration?
tetanus prophylaxis
NSAID
animal confined first 24 hours then exercised after that
T/F: type of castration affects chance of intestines coming down?
F - the size of the inguinal ring does - not method of castration
most common castration complication?
edema
what causes edema post castration?
inadeqate exercise
premature closure of incisions / seroma formation
infection of sub q tissues
what days post castration is swelling/edema typical?
1 d and 3 d
when does swelling typically peak after castration ?
3-6 days post op
what is hydrocele?
closure of vaginal tunic before adequate drainage
cosmetic issue - looks like stallion
what is eventration?
serious complication of castration
escape of intestinal contents thru inguinal canal
how to repair eventration?
anesthetize horse, lavage and replace bowel
CLOSE superficial inguinal rin
what does incomplete castration lead to?
persistent stallion behavior - due to retained testicular tissue
may also be learned behavior
possible sources of hemorrhage after castration?
skin, subcutaneous, tunic
spermatic cord
T/F - clostridial infections common post castration
FALSE
T/F: if cryptorchid testicle, remove it second
false - remove retained testicle first
crypdorchid definition:
failure to descend into scrotum
location of abdominal testicle
testicle and epididymis in body cavity
partial abdominan crhptorchid?
incomplete
body of testicle in abdomen and tail of epididymis descended
inguinal cryptorchid
testicle in inguinal canal
ectopic cryptorchid
testicle in odd location, sub q or near scrotal region
what is the proper ligament?
attaches epididymis and testicle
may be long if testicle far into abdomen
what is lig of tail of epididymis
attaches tail of epididymis to tunic
may be long if testicle far from inguinal region
clin presentation of cryptorchid:
any age - often aggressive stallion like behavior
hard to train and work with animal
variable or unknown certain history of castration
hormonal assay options for cryptorchid dx?
testosterone - baseline will be higher in cryptorchid
hCG stimulation - testosterone should inc by 200%+ if retained testicle
anti mullerian hormone - present in cryptorchids [and stallions]
u/s to dx cryptorchidism?
may be helpful to ID location especially if inguinal
laparoscopy use in cryptorchidism?
visualize vaginal ring
determine location of testis
remove abdominal testicle
tx of cryptorchid?
sx removal [always undescended side first]
sx approaches that are recumbent for testicle removal?
inguinal
modified parainguinal
paramedian
sx approaches that can be standing flank or recumbent for testicle removal?
laparoscopic
flank
non invasive inguinal technique for removal of testicle?
abdominal cavity not entered
inguinal extension of gubernaculum identified and used to locate vaginal process blindly
vaginal process incised and epididymis used to exteriorize testicle
what structure was the gubernaculum supposed to become?
the lig of tail of epididymis
invasive inguinal technique to get retained testicle?
abdomen is entered w fingers or hand thru inguinal canal
search for epididymis or testicle
sx approach to modified parainguinal removal of testicle?
incision to side of inguinal canal - Cr to inguinal ring
aponeurosis of external abdominal oblique
advantages and disadvantages to laparoscopic removal of testicle?
small incisions
need experience and equipment
inguinal hernia etiology?
congenital (may spontaneously regress) - vaginal ring larger than normal
acquired - things that cause inc abdominal pressure
indirect hernia def?
hernia loc w/in vaginal tunic
direct hernia def?
hernia loc outside the vaginal tunic
inguinal hernia def?
intestines passing through body cavity via inguinal ring
indications for surgical repair of inguinal hernia?
non reducible
rupture into sub Q tissues
excessive edema, skin excoriation
owner preference
common presentation of acquired inguinal hernia?
scrotal swelling that presents as colic
indications for circumcision:
neoplasm
scarring
granulomas
sx technique for circumcision is called?
“reefing”
post circumcision care:
NSAIDs and mild to moderate activity
before circumcising the penis, do this:
biopsy lesion
indications for penis amputation
extensive lesions
post penis amputation care?
rest
abx
NSAIDs
complications of penile amputations?
bleeding
dehiscence
urethral stricture
what is welliam’s approach to penis amputation?
ventral approach
spatulate urethra - open it and close mucosa in a wider triangle fashion
what is vulvoplasty and why is it done?
vulvar seal made with sutures - done to decrease pneumo vagina and ascending bacT infections
to the level of what anatomical marker is vulvoplasty done?
ischial arch
suture pattern used for vulvoplaslty?
interrupted pattern to learn then more advanced - continuous pattern
what does a 2nd degree perineal laceration include?
the perineal body
what does a 3rd degree perineal laceraiton entail?
surgically repair necessary
minimal tissue on tissue shelves
evert mucosal layers to rectum and vagina
immediate care for perineal lacerations?
anti inflammatory
abx
debridement (light)
mineral oil to soften stool
what is the Aanes method to perineal repair?
to repair 3rd degree perineal lacerations
2 stage
what is the goetz methon (vaughin) method of surgical repair?
one stage repair of 3rd degree perineal lacerations
how to repair rectovaginal fistula?
create septum by creating 2 shelves of tissue
ways to repair rectovestibular fistula?
through rectum
through transected perineal body
through vestibule
converted into 3rd degree perineal laceration
what is perineoplasty?
to correct poor perineal conformation that Caslicks/vulvoplasty cannot do alone
repair tear of perineal body - reconstruction or transection
what is the perineal body?
fibromuscular septum btwn the anus and vulva
rectal tear MC cause?
iatrogenic
clin signs of rectal tear?
straining, colic, endotoxemia, peritonitis
dx of rectal tear?
blood on sleeve after palpation
grade 1 rectal tear?
Tx?
through mucosa
soften manure, no palpation for 30 days, nsaids, abx, monitor
grade 2 rectal tear?
tx?
mucosa intact but muscular layer under is torn
-almost theoretical - rare
dietary mgmt
grade 3 rectal tear?
Tx?
more typical tear - through mucosa and muscularis
repeated small volumes of manual evacuation
primary repair often NOT possible
laparotomy approaches
rectal liner-laparotomy
grade 4 rectal tear?
Tx?
through serosa and into peritoneal cavity
endotoxemia - shock Tx abx, nsaids abdominal lavage euthanasia often :( very guarded/poor prognosis
Sx: suture laparotomy, rectal liner laparotomy, diverting colostomy, abdominal lavage
initial mgmt of rectal tear?
inform owner determine extent of tear broad spec abx reduce straining - epidural, nsaids, sedation, lidocaine enema evacuate tear refer!
indications for ovariectomy?
sterilize
adjust behavior
pathology - tumor
ovariectomy approach?
standing and general anesthesia
laparoscopic (method of choice, typically)
flank
colpotomy
when to use ventral approach for ovariectomy?
large tumor
ventral approaches for ovariectomy are?
midline
ventral paramedian
diagonal paramedian
ovariectomy pedicle ligation techniques?
ligature ligasure stapling instruments ecrasuer emasculator cautery
how does an ecraseur work?
remove ovary blindly
vasculature is crushed
post ovariectomy repair?
analgesics
abx
rest
complications to ovariectomy?
hemorrhage abdominal pain adhesions peritonitis herniation, evisceration death
what is urovagina?
urine pooling b/c urethral orifice is pulled cranially to allow some urine to fall cranial toward vagina and cervic
result: vaginitis, cervicitis, endometritis
clin signs of urovagina:
dec conception
apparent incontinence
predisposing factors (poor condition and multiparous)
uro vagina Dx:
clin signs, vaginal exam, vaginal floor tilts Cr and ventral
urine on Cr vaginal floor
uro vagina Tx:
urethroplasty - create tunnel so urine exits Cd to brim of pelvis
urethroplasty Monin’s Sx technique:
relocation of transverse fold
mild cases
urethroplasty Browns Sx technique
commonly used
3 layer closed
Caesarean section indications:
dystocia
uterine torsion
elective [rare]
approaches to C-section:
ventral midline
ventral paramedian
flank (vertical/modified low)
recumbent
prognosis for mare and foal if C-section performed during dystocia?
mare - good
foal - poor
MC type of cystic / urethrarl calculi?
type 1
speculated - cause irritation to bladder and cystitis
composition of cystic calculi?
calcium carbonate salts
cystic calculi MC in M or FM?
why?
MC in M b/c FM have wider urethra for stones to pass better
clin signs of cystic/urethral calculi?
hematuria, dysuria
urine scalding, colic
dx cystic calculi?
clin signs, rectal exam, catheterize, cystoscopy, U/a
endoscopy to confirm
dx cystic calculi with high carbonate?
NO b/c many horses have high carbonate normally
Tx or cystic / urethral calculi?
celiotomy and cystotomy
parainguinal or caudal ventral midline incision for better bladder access b/c hard to exteriorize bladder
standing procedure to remove cystic / urethral calculi?
FM - direct access through urethra
M - subischial urethrotomy approach to bladder
if gelding, can palpate rectally and find bladder, find stone in bladder and break stone into smaller pieces
radial shock waves to treat cystic / urethral calculi: through what procedure?
subischial urethrotomy
post op care for cystic / urethral calculi?
Tx cystitis
inc salt intake to inc water intake
pararectal approach to cystic / urethral calculi used?
for M
retroperitoneal approach to bladder
economical, standing procedure but inc complication rate
