Genital Surgery - Male

Question 1

What is a phallectomy/penectomy?

Answer 1

Surgical removal of the penis

Question 2

What is paraphimosis?

Answer 2

Foreskin becomes trapped behind the glans penis, leaving the penis out and unable to return to the sheath

Question 3

What is phimosis?

Answer 3

Foreskin too tight to be pulled bak over the head of the glans penis

Question 4

What is posthioplasty/reefing?

Answer 4

Surgical reconstruction of the prepuce

Question 5

What is priapism?

Answer 5

Persistent abnormal erection

Question 6

What is a phallopexy?

Answer 6

Permanent adhesion between the dorsal preputial mucosa and the dorsal surface of the penile shaft

Question 7

What aspect of the testicle is the cremaster muscle attached to?

Answer 7

Lateral

Question 8

What aspect of the testicle is the head of the epididymis on?

Answer 8

Cranial

Question 9

What is the out-pouch of the peritoneum that covers the testicle?

Answer 9

Vaginal tunic

Question 10

What is the cremaster muscle attached to?

Answer 10

Vaginal tunic

Question 11

What aspect of the testicle is the body of the epididymis located?

Answer 11

Lateral

Question 12

Castration steps 1-3

Answer 12

1. Wipe scrotal injection sites with alcohol
2. Inject each testicle with local anesthetic until full (20-50 mL/testicle) and check for CM paralysis
3. Aseptic preparation of surgical site and surgeon

Question 13

Castration steps 4-6

Answer 13

4. Make two parallel scrotal incisions 2 cm from median raphe
5. Incise into cranial portion of vaginal tunic of testicle; place finger in tunic; place Kocher forceps firmly over tunic and tail of epididymis
6. Apply firm tension of tunic/testicle; use other hand to strip away connective tissue and fat covering tunic and cremaster muscle

Question 14

Castration steps 7-9

Answer 14

7. Divide cremaster from vaginal tunic; clamp with angiotensin and section with electrosurgery distal to clamp
8. Expose pedicle from inside tunic; bluntly puncture mesorchium to separate into vascular and non vascular portion
9. Clamp with angiotribes and ligate vascular portion and section with electrosurgery; not right at clamp - you can go over again

Question 15

Castration steps 10-11

Answer 15

10. Replace lighted vascular portion inside tunic
11. Clamp and ligament tunic and section with electrosurgery preventing inside and outside world communication

Question 16

Castration steps 12-13

Answer 16

12. Repeat 5-11
13. SQ closure for scrotal incisions and/or invert scrotum and glue

Question 17

In order to justify closing skin, must have perfect ____. If not, leave open for drainage.

Answer 17

Homeostasis

Question 18

Name the instrument

Answer 18

Serra curved handles

Question 19

Name the instrument

Answer 19

Kosher/Oschner forceps

Question 20

What are these?

Answer 20

Reimer emasculators

Question 21

What are these?

Answer 21

Modified white Haussmann/white franks

Question 22

What are these?

Answer 22

Ferguson Angiotribe Forceps

Question 23

What should aftercare for a castration look like?

Answer 23

24-36 hours of being quiet then exercise 2X/day for 20 minutes for 2 weeks

Question 24

What are three possible castration complications?

Answer 24

1. Hemorrhage
2. Scirrhous cord - hard, dense cancerous growth usually arising from connective tissue
3. Eventration vs evisceration

Question 25

What do ponies need prior to castration?

Answer 25

Heavy sedation prior to induction of anesthesia with ketamine to avoid muscle rigidity and to ensure adequate duration of anesthesia

Question 26

How do you prevent hemorrhage when castrating?

Answer 26

Ligate the cord on mules, donkeys, and mature stallion Crush cord for 6 minutes prior to removal of emasculator on draft horses Cross clamp cord for 24 hrs with right angle clamp

Question 27

What should you make sure you do if you ligate during castration

Answer 27

Maintain sterility

Question 28

How do you prevent visceral prolapse?

Answer 28

Ligate cord in all horses with predisposition to inguinal hernias and/or large vaginal rings and horses with history of inguinal swelling Horses with predisposition to inguinal hernias: draft horses, some standardbred lines, gaited horses

Question 29

How do you treat visceral prolapse?

Answer 29

Anesthetize horse, replace bowel and suture superficial ring and skin Anesthetize horse, suture skin incision Pack canal and close skin Pack canal and wrap groin REFER

Question 30

What are the classifications of a cryptorchid?

Answer 30

1. Inguinal: testicle and epid are out of the abdomen t but not in the scrotum 2. Abdominal: Partial - testicle in abdomen, epid outside Complete - testicle and epid in abdomen

Question 31

What type of cryptorchid can eventually descend?

Answer 31

Inguinal Abdominal cryptorchid will never descend

Question 32

Are R or L cryptorchid more likely?

Answer 32

Equal in occurrence

Question 33

Are unilateral or bilateral cryptorchids more likely?

Answer 33

Unilateral 9X more likely than bilateral

Question 34

If a horse has the right testicle descended, but not the left, what type of chryptorchid is it most likely to be?

Answer 34

75% likely abdominal

Question 35

If a horse has the left testicle descended, but not the right, what type of cryptorchid is it most likely to be?

Answer 35

60% likely to be inguinal

Question 36

Are bilateral abdominal or bilateral inguinal cryptorchids more likely to occur?

Answer 36

Bilateral abdominal 2.5X more likely

Question 37

What are the surgical approaches for cryptorchids?

Answer 37

Inguinal Parainguinal Flank Ventral midline Laparoscopic (GOLD STANDARD)

Question 38

What are the indications for a partial phallectomy?

Answer 38

Intractable paraphimosis Traumatic penile injury Squamous cell carcinoma

Question 39

What is the most important aspect of the William’s technique?

Answer 39

Hemostasis

Question 40

What do you transect when doing a perineal urethrostomy on a horse?

Answer 40

Corpus spongiosum

Question 41

What are the 7 steps of William’s technique?

Answer 41

1. Place catheter in urethra 2. Remove triangular piece of skin w/base toward end of penis 3. Make incision into urethra 4. Directly attach urethral tissue to skin 5. Transect distal end of penis 6. Take tunic and close with simple interrupted 7. Take urethral mucosa saved and attach to end of penis

Question 42

What is the Boltz technique used for?

Answer 42

Treatment of paraphimosis

Question 43

What are the steps of the Boltz technique?

Answer 43

1. Manually retract to far end of sheath 2. Not so far that they urinate in their sheath but so frost bite or trauma are less likely to damage it

Question 44

Why is priapism considered an emergency?

Answer 44

Blood can clot Damage to the penis