Genital organ surgery Flashcards
Indications for castratio, orchidectomia. (4)
Castration is probably one of the oldest surgical techniques in the world.
Sexual urge suppression (all species)
Prevention of escape/running away from home (cats and dogs)
Therapeutic purposes (inflammations or neoplasia of testes, scrotum, spermatic cord, and prepuce, prostatic hypertrophy)
Prevention of passing on congenital diseases (most commonly in pets)
The scrotum has two integuments:
The skin of the scrotum (cutis scroti) is a relatively thin layer that may be pigmented.
The dartos tunic (tunica dartos) – consists of omnidirectional smooth muscle cells that extend into the skin, elastic and collagen fibers, which wrinkle the skin of the scrotum in case of thermal and mechanical irritation.
(NB not all animals have scrotums such as elephants, birds, reptiles etc.)
Integuments of the testis and spermatic cord: (3+2)
External spermatic fascia (fascia spermatica externa)
Cremaster muscle (musculus cremaster) starts at iliac fascia and adheres to vaginal tunic of the testis.
Vaginal tunic (tunica vaginalis)
- parietal laminae (lamina parietalis) located externally
- visceral laminae (lamina visceralis) covering spermatic cord, testis and epididymis
(cavum vaginale between the laminae and around the speramtic cord this is termed canalis vaginalis)
Name the layers of the scrotum-testicles in order from outside in. (7)
- cutis scroti (skin of scrotum)
- tunica dartos (muscle tunic of scrotum)
- fascia spermatica externa (external spermatic fascia)
(musculus cremaster) - fascia spermatica interna
- tunica vaginalis with,
(6.) - lamina parietalis
(cavum vaginale)
(7.) - lamina visceralis
The area between visceral and parietal laminae at the spermatic cord level is termed
canalis vaginalis (canalis vaginalis);
and the one at the level of the testis – cavum vaginale (cavum vaginale).
Blood supply of the Testis:
testicular artery and vein (a. et v. testicularis)
(come from the aorta so if you can’t locate a cryptorchid testis, you could follow the artery from the aorta to find it)
Blood supply of the Scrotum:
external pubic and cremasteric artery (a. cremasterica).
Venous blood flows along the veins bearing the same names.
Innervation of the Testis:
sympathetic fibers of caudal mesenteric plexus (plexus mesentericus caudalis)
Innervation of the Scrotum: (3)
iliohypogastric nerve (n. iliohypogastricus),
ilioinguinal nerve (n. ilioinguinalis),
genitofemoral nerve (n. geniofemoralis)
layers of the abdominal wall from outside in (7)
skin
subcutis (scarpa’s fascia)
external oblique muscle
internal oblique muscle
transverse abdominal muscle
transverse fascia
parietal peritoneum
ligament to pull testes into scrotum
gubernaculum
what structures run within the spermatic cord? (7)
ductus deferens (vas deferens),
the testicular artery,
the artery of the ductus deferens,
the cremasteric artery,
the pampiniform plexus,
the tunica vaginalis, and
lymphatic vessels.
Closed castration method.
prescrotal incision that incises until parietal lamina of vaginal tunic but NOT through it.
It gets separated from surrounding tissues, and the testis with parietal lamina of vaginal tunic are removed.
The testis and spermatic cord remain covered with parietal lamina of vaginal tunic. Cavum vaginale remains closed.
When would you use the closed castration method?
with pathologies such as tumors so as not to leave any neoplastic cells behind
This method is used in case of various pathologies, e.g. invaginated and scrotal hernias, risk of intestinal prolapse, as well as necrosis or inflammation of the testis.
Usual castration may be also performed using the closed method.
Describe the open method for castration.
prescrotal incision
In case of the open method, both the scrotal wall and parietal lamina of vaginal tunic are cut through, opening cavum vaginale, and, thereafter, the exposed testis is removed.
This method is only used when there are no pathological changes are in the testes, vaginal tunic, or inguinal canal.
Anesthesia for castration.
General anesthesia combined with local anesthesia.
Infiltration of incision line and parenchyma of testis: a needle is
inserted above the incision line into the testis, bottom–up, ¾ of its depth and 2% lidocaine solution is injected into
parenchyma of the testis.
Thereafter, the tip of the needle is pulled below the skin, and incision line on the scrotum is anesthetized.
Castration of dogs and cats:
how are the testes oriented?
anatomical differences?
optimal age for castration?
The testes are small and their longitudinal axis is oriented diagonally.
In dogs, the scrotum is located between the thighs and is visible from behind.
In cats, the scrotum is located directly between the anus and penis in the perineal region. It is covered with hair.
Optimal age: 3–6 months (controversial; later may be recommended for large dogs)
Canine castration (closed) ligation step.
The cord is ligated with 0 or 2-0 multifilament absorbable suture material.
A second ligature is placed 0,5 cm distal to the first.
Hemostatic forceps are then placed on the cord distal to where the ligatures have been placed but proximal to where the cord will be cut.
The cord is cut, using the previously placed clamp as a cutting guide for the scalpel blade.
The free end of the cord is inspected and observed for any hemorrhage as it is allowed to return into the body cavity.
Feline castration steps.
One of the testes is selected and immobilized between the thumb and first finger of the left hand.
Make a 0.5- to 1-cm incision over each testicle at the end of the scrotum from cranial to caudal.
Incise the parietal vaginal tunic over the testicle and exteriorize the testicle.
Ductus deferens is separated from testicular blood vessels and testis using fingers or scalpel.
Ductus deferens is tied around testicular blood vessels with 5–6 knots and testis is cut off.
Or, other ligation technique can be utilized.
Post–castration complications (5)
Hemorrhage (most likely in dogs)
Wound secretion retention
Spermatic cord infection (funiculitis)
Omentum prolapse
Intestine prolapse
Describe Cryptorchidism is
an abnormal condition, where one or two testes have failed to descend into the scrotum and remain in either abdominal cavity or are located in canalis vaginalis.
It occurs most frequently in stallions, boars and dogs.
Abdominal (majorly in dogs, cats, and boars), inguinal (in stallions), or prescrotal (in dogs and cats) cryptorchidism are distinguished.
Cryptorchism is usually diagnosed in dogs, who are older than 6 months.
Cryptorchidism is commonly unilateral.
Bilateral cryptorchids are sterile.
Abdominal cryptorchidism castration.
If it is impossible to palpate the testis in pre-scrotal or inguinal region, a laparotomy is performed (ventral median or paramedian). If poss. ultrasound first to find it.
The testis of a cryptorchid are usually smaller than normal testes.
First, the sperm duct starting from the prostate gland needs to be found, and only then it is possible to find the testis (with the help of the spermatic duct).
Testicular blood vessels and the spermatic cord are ligated separately. The testis is removed.
Phimosis
Phimosis is the congenital inability to protrude the penis beyond the preputial orifice.
The penis of the animal suffering from this condition does not extrude of the prepuce during urination. Therefore,
urination is frequently painful and aggravated.
Phimosis surgery
is performed under general anesthesia.
To enlarge the opening, a V-shaped incision is made over the dorsal surface of the prepuce adjacent to the orifice.
Wedge of skin, subcutaneous tissue and preputial mucosa is resected.
Bleeding vessels are ligated or cauterized and preputial mucosa is sutured to the skin with simple interrupted fine sutures.
what does this depict
complete or severe phimosis which requires essentially circumcision surgery to create a properly sized preputial opening.
Paraphimosis is
a condition, where it is impossible to retract the penis back into the prepuce after it has extruded from the preputial ostium. It happens due to the changes of the prepuce. Not the same as penile prolapse.
This condition is also called „Spanish collar“.
The condition most frequently occurs in dogs and horses.
The condition is caused by mechanical or freezing injury of the penis.
In long–haired dogs and cats, the hair around the penis may impede its retraction.
Appearance and severity of the condition can vary greatly.
Paraphimosis surgery.
First, prolapsed and swollen penis needs to be cleaned and rinsed with antiseptic solution.
Then ventral and dorsal incisions penetrating all the layers are made into the prepuce, and mucous membrane is
attached to the skin with sutures.
A necrotic penis has to be amputated.
Ovaries are located
in the abdominal cavity caudally from the kidneys, close to the apex of the uterine horn.
How are the ovaries suspended/encased? (4)
They hang from mesovarium. Lymph and blood vessels, as well as nerves enter the ovary via mesovarium.
Cranial thickened edge of mesovarium
forms suspensory ligament of the ovary (lig.
suspensorium ovarii).
Bursa ovarica (bursa ovarica) surrounds the ovary and is located in the middle the latter, mesovarium, and mesosalpinx.
Utero–ovarian ligament (lig. ovarii
proprium) is a fibromuscular formation
located between the uterine side of the
ovary and the apex of the uterine horn.
What forms the suspensory ligament of the ovary?
Cranial thickened edge of mesovarium
forms suspensory ligament of the ovary (lig. suspensorium ovarii).
Utero–ovarian ligament (lig. ovarii
proprium) is a fibromuscular formation
located between the uterine side of the
ovary and the apex of the uterine horn.
Dog vs cat bursa ovarica.
In dogs, bursa ovarica is deep and rich in adipose tissue completely surrounding the organ.
In cats, bursa ovarica does not contain adipose tissue and only laterally covers the ovary.
The shortness of the suspensory ligament of the ovary in dogs, makes surgical removal of the ovary more complicated.
Unlike cats, the ligament in dogs is not vascularized.
Blood supple of the ovary.
ovarian artery, frequently – branches of
uterine artery
Uterus is a tubular organ comprising (3)
uterine horns, body and cervix.
Uterine cavity is inside uterine horns and body.
In carnivores, uterine cervix and body are relatively short.
Thin uterine horns start behind the ovaries and are located in the abdominal wall. They split at the body and form a Y – shaped structure.
The uterus attaches with the following ligaments: (2)
Mesometrium (mesometrium) attaches the uterus to pelvic dorsal wall and lumbar region.
Mesometrium, mesosalpinx, and mesovarium form broad ligament of the uterus (lig. latum uteri).
Round ligament of the uterus (lig. teres uteri) attaches to deep inguinal ring or vaginal process.
What forms the broad ligament of the uterus?
Mesometrium, mesosalpinx, and mesovarium form broad ligament of the uterus (lig. latum uteri).
Round ligament of the uterus attaches to
(lig. teres uteri) deep inguinal ring or vaginal process.
Blood supply of the uterus?
uterine artery starts from the pubic artery
and anastomoses uterine branches of ovarian and vaginal arteries.
Ovariohysterectomy Surgical technique,
ovary part.
Planned ovariohysterectomy (OHE) is performed during anestrous period.
The incision goes caudally along the median line starting from the umbilicus.
After opening the abdominal cavity, omentum is pushed in front of the intestines and either right or left ovary is found (using either fingers or special hook).
Suspensory ligament together with the blood vessels supplying the ovary are ligated and the ovary is removed.
Which ovary is easier to expose?
left is easier cause the right is further cranial and closer to the kidney so makes it deeper and harder to access.
Ovariohysterectomy Surgical technique,
uterus part.
After both ovaries are removed.
Uterine blood vessels are also ligated together with the uterine body and are cut through.
Ligation should be done on the cervical neck in dogs and not leave too much (not so precise in cats) as dogs can develop stump pyometra.
