Exam 2: Lecture 8/9 - Methods of Surgical Sterilization Spay-Neuter Flashcards
Define Ovariohysterectomy (OHE)
surgical removal of the ovaries and uterus
Define Ovariectomy (OVE)
surgical removal of the ovaries
Define Orchiectomy
Surgical removal of the testicles
Define casteration
Surgical removal of either the male or female sex organs (most commonly used interchangeably with orchiectomy)
Define Hysterotomy
surgical incision into the uterus
Define Gonadectomy
excision of ovary or testis
Reproductive surgery encompasses a variety of techniques designed to?
- alter the animal ability to reproduce
- Aid In parturtition
- Treat or prevent disease of the reproductive organs
What is the primary goals of reproductive and genital surgeries
Primarily to limit reproduction
What are indications done for reproductive and genital surgery
- Relieve dystocia
- Prevent or treat tumors influnced by reproductive hormones (mammary tumors, testicular tumors, and perianal ademonas)
- Control certain diseases of the reproductive tract (pyometra, metritis, prostatitis, and prostatic absecssation)
- Help stabilize system diseases (diabetes and epilepsy)
Neutring is performed in some animals to _____ or _____ behavioral abnormalities and to reconstruct traumatized, diseased or malformed tissue
prevent or alter
The following are surgical producedures of the which tract?
- OHE
- casteration
- C-section
- mastectomy
- scrotal ablation
- prostatectomy
- penile amputation
reproductive tract
Clinical signs of genital and reproductive tract conditions include?
- high variable and dependent upon the disease or condition affecting your patient
- Clinically normal to sepsis, and anything in between
On the female pt. inspection and palpation of which organs are done during a PE
abdomen
vulva
mammary glands
When should a vaginal exam be done on a PE for females
when discharge or enlargement present
during a PE if the pt is too small for vaginal exam you can perform one ______. Normally you want to vizualize and digitally palpate vestible and vagina
rectal
During a PE you want to inspect mammary glands for?
symmetry
texture
size
mobility
discharge
presence of masses
What other assessement can be done as indicated from the PE
clinical pathology
hormone levels
diagnostic imaging
cystometrogram
urethral pressure profiles
histology
Preoperative management is _______ dependent
condition
T/F: Antibiotic consideration is normally necessary for routine OHE/casteration
FALSE!! they are not necessary
When should abx be used on C&S
Pyometra - Abx efficacious against E. coli until C&S
- Avoid aminoglycosides in pyometra
When messing with the prostate, consider the need for what time of barrier penetration
blood-prostate barrier penetration
Why should be consider blood-prostate barrier penetration?
lipid soluble
nonprotein bound
high pKa
Surgical neutering has numerous techniques for dats and cats, however the goals are the same, which is to?
remove the ovaries, with or without the uterine horns and body, or testes with secure ligature placed
What is the traditional method of surgical sterilization of female dogs in the US?
OHE
What is the traditional method of surgical sterilization of female dogs in European countires?
OVE
Is there a significant difference in OHE and OVE?
- no difference in post-op complications
- No difference in
total surgical time
pain scores
wound scores
OHE or OVE?
- Technically more complicated
- more time consuming
OHE
OHE or OVE?
- quicker
- smaller incision
- less traction on genital tract
OVE
T/F: BOTH OHE and OVE are considered appropriate for neutering healthy female dogs?
true
Which approach, equiptment and knots should be used doing OHE?
- midline approach
- flank approach
- Laparoscopic approach
- staping equiptment
- ultrasound scaples
- vessel sealing devices
- transfixing ligatures
- millers knots
Early gonadoectomy is safe in dogs and cats over _____ weeks of age?
7 weeks of age
What is the most common reason early age/prepubertal gonadoectomy is done in shelter animals?
reduce the liklihood of reproduction in animals adopted from the shelter
Other benefits aside from reducing the likihood of early age gonadoectomy include?
- decreased anesthetic and material requirements
- simplicity or procedure
- rapid recovery
- reduced complication rate
Early age gondaoectomy expectations are NOT associated with?
- increased obesity
- ** amount of daily food consumption**
- activity level
- lower urinary tract disease
- long bone fractures
- arthritis
- immune suppression
- small urethra
same affect as neutering after puberty
Ealry age / prepubertal gonadoectomy in cats compared with cats done at the traditional time, there is no effect on?
- immune function
- bone density
- Prevalence of obesity
- Prevalence of diabetes mellitus
T/F: Male cats do not have decreased urethral diameter or increase the incidence of lower urinary tract disease and obstruction when neutered early
true
What are the benefits of early age / prepubertal gonadoectomy in male cats done before 5.5 months old?
- Decreases aggression
- Decrease sexual bahvior
- Decrease urinary spraying
- Bite would Abscesses from fighting
T/F: reduced incidence of astham, gingivitis and hyperactivty are all results from early age / prepubertal gonadoectomy in cats?
true
Potential side effects of early age / prepubertal gonadoectomy in cats include?
- increased shyness
- increased immaturity of external genitalia
- less than 7 weeks of age (persistent balanoprepucial fold): Does not affect urination and may make urethral catherization more difficult
- Physeal closure may be delayed if casterated before 7 months of age but may not increase the risk of physeal fracture development
early age / prepuberal gonadoectomy in female dogs reduced incidence of mammary neoplasia by if done before the 1st heat?
95% if before the 1st heat
Early age / prepubertal gonadoectomy in female dogs reduced incidence of mammary neoplasia by how much if done after the 3rd heat?
25% after the 3rd heat
What breed of dogs may have increased risk of other cancers. _______ gonadectomized at less than 1 yr old are 2-4 times more likely to develop OSA than intact ______
Rottweilers
______ abnromalities - penis, prepuce and vulva may appear smaller and infantile if surgery done at 6-8 weeks (early age / prepubertal Gonadoectomy done)
urogenital
Are male or female dogs at a greater risk for urinary incontinence when surgery is performed before 3 months of age
female dogs
Delayed physeal closure by _____ weeks resulting in increased bone length of early age / prepubertal Gonadoectomy done
8 to 9 weeks
What joint incongruity can be potential side effects of early age / prepubertal Gonadoectomy done
- increased risk for excessive tibial plateau angle in large breed dogs
- If gonadoectomy before 5.5 months of age, compared with dogs gonadectomized at a later age, there is an increased risk of mild hip dysplasia
T/F: Early gonadoectomy expectations are associated with higher morbidity and qicker anesthestic recovery
FALSE!!
lower morbidity and quick anesthetic recovery
When is too late to casterate a tom cat?
three days after he is dead and buried!
For a feline casteration, how should the patient be preped?
- position in dorsal or lateral recumbency
- pelvic limbs pulled cranially
- pluck hair from the scrotum
- aseptic prep of scrotum
- drape?
How should you pluck hair from the feline scrotum and when may it be difficult?
- from distal to proximal is easier
- may be difficult in kittens (16-20 wks)
- can use clippers for gentral scrotal hair removal
Feline casteration techniques include?
- feline square knot technique
- overhand hemostat technique
- ** ligature : Encirculing or trans fixation**
- stainless steel clips
- Multifunctional tissue sealing system
What type of technique is described as?
Feline Square knot Technique
What technique is described as?
Figure of Eight hemostate technique
What type of technique is shown in this image?
Overhand hemostat technique
What technique is described in this image?
overhand hemostat technique
What technique is described as?
Overhand hemostat technique
Canine casteration reduces overopulation by inhibiting?
- male fertility and decreases male aggression
- roaming
- undesirable urination behavior
Canine casteration helps prevent androgen-related disease such as?
- prostatic disease
- perianal adenomas
- perineal hernias
Indications for canine casterations include?
- congenital abnormalities
- testicular or epididymal abnormalities
- scrotal neoplasia
- trauma or abscesses
- inguinal-scrotal heriorrhaphy
- scrotal urethrostomy
- epilepsy control
- control of endocrine abnormalities
- testicular infection
- testicular torsion
- testicular trauma
- perianal adenomas
- prostatic cysts
- prostatitis
- benign prostatic hyperplasia
- prostatic abscesses
- sex-hormone associated alpoecia
Testicular tumors occur in ____% of intact males
29%
In dogs with uncomplicated BPH, prostate size decreases by _____% in 3 weeks and clinical signs resolve in 2-3 months
50%
Resolution of perianal adenomas are _____%
95%
K-9’s may have higher risk for which disease if they are not casterated
- prostatic carcinoma
- hemangiosarcoma
- Osteosarcoma
- transitional cell carcinoma
What is the most common and easiest approach for canine casteration?
Prescrotal
which approach for canine casteration is used to avoid repositioning when patient already in perineral position and testicles are more difficult to exteriorize
Perineal
Which approach for canine casteration is sometimes used if the patient is prepubertal
scrotal
what approach for canine casteration is used when the animal has a retained testicle
abdominal
For a right-handed surgeon, casteration of an adult is easier when performed from a dogs ____ side
- left hand pushes testicle fowards
- right hand makes the incision
dogs left side
Open or closed cateration can be used in any size dog as long as the spermatic cord (stretched + stripped) less than 1 cm diameter
closed
Spermatic cords may be clamped, but large cords are easier to _____ if they are not clamped
transfixed
Scrotal ablation is performed concurrently in dogs with?
- scrotal dermitis
- neoplasia
- dogs with thin, pendulous scrotal sacs
- dogs that live in kennels (on the floor)
- the scrotum will regress sufficiently in most dogs
Define an open canine casteration technique
spermatic cord (stretched + stripped) greater than 1 cm
Define closed canine casteration technique
can be used in an size dog as long as the spermatic cord (stretched + stripped) less than 1 cm diameter
Define modified open canine casteration technique
combination technique where the parietal vaginal tunic is opened, the structures are externalized, ligated and placed back inside the tunic, which is then closed
What type of casteration is shown?
closed prescrotal canine casteration
What type of casteration is shown?
Closed prescrotal canine casteration
What type of casteration is shown?
Closed prescrotal canine casteration
The scrotal ligament is formed by the remnant of which embryonic structure? It was once referred to as the ligament of the epididymis
gubernaculum
Using the closed prescrotal canine casteration what type of ligature may be placed proximal to the transfixing ligature for added security
circumferential (encircling)
What type of casteration is shown?
Prescrotal canine casteration
What type of casteration is shown?
Three-clamp technique
What happes at number 1 during the three-clamp technique
encirculing ligature in the crush of clamp 1
What happes at number 2 during the three-clamp technique
transfixation ligature proximal to clamp 2 (flash)
Which number is used as a “flash”
2
What happes at number 2/3 during the three-clamp technique
cut between clamps 2 and 3
Which clamps do you cut between?
2 and 3
During a closed prescrotal canine casteration always inspect the ____ for hemorrhage before replacing the cords in the patient
sprematic cord
Closing the prescrotal canine casteration _____ the incised dense fascia on either side of the penis with interrupted or continious sutures
appose
When closing the prescrotal canine casteration avoid closing which organ structure
avoid the urethra when closing!!!!!!!!!!
When closing the prescrotal canine casteration close the subcutaneous tissue with a ____ pattern. then appose the skin with what type of suture pattern?
- Subcutaneous tissue with a continuous pattern
- Appose skin with an intradermal, subcuticular, or simple interrupted suture pattern
What type of canine casteration is shown?
open prescrotal canine casteration
What type of canine casteration is shown?
open prescrotal canine casteration
During the open prescrotal canine casteration, inspect the _____ for hemorrhage and replace the word within the tunic
spermatic cord
During the Open prescrotal canine casteration encircle the ____ muscle and ____ with a ligature
cremater muscle
tunic
During the open prescrotal canine casteration advance the second testicle into the incision, incise the fascial covering and remove the _______ as described
testicle
What type of canine casteration is shown?
Modified open prescrotal casteration
What type of canine casteration is shown?
Modified open prescrotal casteration
What type of canine casteration is shown?
Modified open prescrotal casteration
During the Modified Open prescrotal casteration what structure do you ligate (2 of them) and then encircle both with a proximal circumferential ligature. Apply carmalt forceps distal to the ligatures and transcet between the clamp and ligatures
Ductus deferens and vascular cord
What type of forceps do you use with a modified open prescrotal casteration. You apply these distal to the ligatures and transcet between the clamp and ligatures
Carmalt forceps
What type of canine casteration is shown?
Modified open prescrotal casteration
What are the indications for casteration with scrotal ablation
- Older dogs - pednulous scrotum
- enlarged testicle
- Scrotal hematoma
- Severe scrotal dermatitis
- Dogs that live in kennels
- Neoplasia
Casteration with scrotal ablation requires which two techniques
electrocautery
vessel ligation
What are the complications associated with casteration with scrotal ablation
- excessive tension at suture site
- would disruption and self mutilation
- infection
Which type of surgery uses the following techniques
- Broad clip
- plan incision to leave ample skin
- penis/urethra deep to excision
- 3 layer closure
- Release leg ties if tension seems excessive
Scrotal ablation
What prevention techniques can be used for scrotal ablations?
- E-collar
- Bite-not-collar
- Bucket
What type of canine casteration is shown?
Scrotal ablation
Define ovariohysterectomy
surgical removal of the ovaries and uterus
What is the traditional method of surgical sterilization of female dogs in the United States
Ovariohysterectomy
What are the indications for Ovariohysterectomy?
- prevent estrus and unwated offspring
- Prevention of mammary tumors or congenital anomalies
- Prevention and treatment of pyometria, metritis, neoplasia (orvarian, uterine, or vaginal) cysts
- Uterine trauma/uterine torsion/uterine prolapse
- Subinvolution of placental sites
- vaginal prolapse
- vaginal hyperplasia
what are two endocrine abnormalities that an OHE can help control
- diabetes
- epilepsy
Which dermatoses can OHE help control?
generalized demodex
Many technical variations of ____ have been described, including flank and laparoscopic approaches and the use of stapling equipment, ultrasonic scalpel, vessel sealing devices, transfixing ligatures, or millers knots
Ovariohysterectomy
During an OHE draw an imaginary line from what two points?
from the umbilicus to the pubis
Using the imaginary line from the umbilicus to the pubis, where do you divide the line into thirds for the dog?
Cranial 1/3
Using the imaginary line from the umbilicus to the pubis, where do you divide the line into thirds for the puppies?
Middle 1/3
Using the imaginary line from the umbilicus to the pubis, where do you divide the line into thirds for the cats?
Middle 1/3
Where should you draw the incision line for an OHE
From the umbilicus to the pubis
Using which instrument can you gently grasps the abominal wall on the side that you are attempting to retrieve the ovary
brown-adson forceps
Using your ______, sweep the spleen or other organs cranially and laterally, out of the surgical field if necessary during and OHE
finger
Using which instrument against the body wall, insert this instument and advance it cranially to caudal at the approximately a ____ degree angle, toward the inguinal canal on the side you are retrieving, until it stops. Rotate the handle of the spay hook 180 degrees. Sweep the hook across the ______ body wall to the midline. Gently life the spay hook straight up, paying close attention to the amount of tension you can feel the tissue
spay hook
45 degree angle
dorsal
“Goldie locks theory” of spay hooks. Does the following indicate if too tight or too loose?
- Hook feels snagged deep against the dorsal body wall and does not want to pull up
too tight
“Goldie locks theory” of spay hooks. Does the following indicate if too tight or too loose?
- Hook comes up out of incision often with omentum or a loop of small intestines
too loose
How can I tell using the “Goldie Locks Theory” that the spay hook feels just right
if it feels right, its in there! peel through tissue in the hook and find it
Is the right or left ovary tighter
the right ovary is tighter
What type of technique is shown here?
Left: Modified 3 clamp technique
Right: 3 clamp technique
NOTE **If the uterine body is friable and appers unhealthy (EX: postpartum), the use of clamps may have the same effect as scissors. What can this cause on the uterus?
severing
- it is even possible that the suture could slice through the tissue if overtightened
As for a celiotomy, how can you close the incision?
- 3 layered closure
- monofilament absorbable suture
- +/- skin sutures
T/F: Some blood will normally pool on top of the intestines or in the paraspinal regions because of subcutaneous bleeding
true
Some blood is normal on top of the intestines or the paraspinal regions due to subcutaneous bleeding. This is especially true is which cases?
- the dog is in heat
- lactating
- pregnant
T/F: Clots are usually an indication that there is a problem
true
What is ovarian remnant syndrome disorder characterized by?
clinical signs related to functional residual ovarian tissue after an OHE
How can you diagnose Ovarian Remnant syndrome in dogs?
baseline progesterone concentration
How can you diagnose Ovarian Remnant syndrome in cats?
progesterone concentration measured 7 days after administration of HCG
Affected animals with Ovarian Remnant Syndrome should be surgically explored while the animal is in what stage of reproduction?
estrus
