Infertility & reproductive pathologies in male dogs Flashcards

1
Q

Causes of reduced fertility. (10)

A
  • Age
  • Infections
  • Blocage of the epididymis
  • Retrograde ejaculation
  • Diseases of the prostate
  • Cystitis
  • Endocrine disturbances
  • Immune mediated
  • Medical treatment as suprelorin, some antifungal, steroids
  • Anatomical abnormalities (inherited/congenital)
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2
Q

After bad breeding management, what is the second most frequent cause of missing pregnancy in bitches, presented for
infertility.

A

reduced semen quality

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3
Q

Define the following:
Azoospermia =
Aspermia =
Teratospermia =
Asthenozoospermia =
Oligospermia =

A

Azoospermia = no sperm in the ejaculate

Aspermia = complete lack of semen with ejaculation (not to be confused with azoospermia, the lack of sperm cells in the semen)

Teratospermia = presence of sperm with abnormal morphology that affects fertility

Asthenozoospermia = sperm with low motility

Oligospermia = low sperm count

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4
Q

Fertility examination for the male dog should include: (6)

A

 General clinical examination
 Standard blood/urine/T4

Genital exam
* Palpation of the testis/epididymis
* Release of the penis behind the bulbus glandis

 Digital rectal palpation of the prostate
 Semen collection and evaluation

 Ultrasound (testis, epididymis ,prostate, bladder)

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5
Q

Semen quality deteriorates as the dog gets older (breed dependent) → after what age?

A

6 years of age +/-

Often some degree of benign prostate hyperplasia (BPH) after 6 years of age → can effect semen quality.

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6
Q

Frozen semen to preserve valuable genes → has to be done when

A

the dog is still young to get the best freezing result.

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7
Q

Orchitis/epididymitis

Acute?
Chronic?
Pathogenesis?

A

Usually occurs in young dogs (2-4 years).

Acute:
❖ Pain, swelling, fever, hindleg lameness, scrotal edema, purulent discharge

Chronic:
❖ Non-painful enlargement of the scrotum (soft or very firm)
❖ Sometimes atrophy of the unaffected testis

Pathogenesis:
infection or autoimmune destruction

❖ Retrograde infection from the prostate or lower urinary tract
❖ Hematogenous spread
❖ Penetrating wounds

❖ Brucella Canis, E.Coli, Strep spp, Staph spp

Chronic inflammation, normally results in testicular/epididymal degeneration and fibrosis.

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8
Q

Diagnosis of Orchitis/epididymitis. (4)

A

Clinical symptoms (size, temp, pain, firmness of testes)

Fine needle aspirate for
- Cytology
- Culture (anaerobic, aerobic and mycoplasma)

-ALL dogs presented with scrotal enlargement should be tested for Brucella Canis (RSAT/AGID or culture from semen)

Ultrasound- differentiation of structures that are not palpable.

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9
Q

Treatment of orchitis/epididymitis.

A

 Antibiotics alone only for acute infections when the blood/testis-barrier is not intact.

 NSAIDs

 Removal of the affected testis also if bilateral.

 For valuable stud dogs → remove the affected testis as fast as possible in
combination with antibiotics (always antibiogram) → decreases the risk of
changes in the contralateral testis.

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10
Q

Describe Retrograde ejaculation.

A

The semen is delivered in the bladder instead of through the urethra.

If azospermia → always take an urine sample just after the collection.
 neurologic problem
 urolith
 inflammation in the sphincter muscle
 trauma
 prostate hyperplasia

Therapy: Propanolamine ( propalin)→ sympathomimetic

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11
Q

Signs of Brucella in males. (4)

A

Orchitis/epididymitis

scrotal dermatitis

Oligozoospermia (decreased number of spermatozoa in the semen)

infertility

Brucellosis can also be reported to cause:
 Uveitis
 Meningitis
 Osteomyelitis

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12
Q

Diagnosis of Brucellosis in males. (3)

A

Same as for the female but remember:

Serological tests (RSAT, TAT, ELISA): high sensitivity → points out negative animals.
❖ Not for the first (45-60 days)

AGID: golden standard (high specificity → points out positive animals).
❖ Used if positive RSAT/TAT
❖ Can be used after 8-12 weeks

Culture of the organism from
❖ Semen, Blood, lymph node aspiration, bone marrow, infected tissue
❖ Can be done before day 30, most accurate in this period→ difficult to culture.

Treatment/prevention
❖ As for the female dog

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13
Q

If Azospermia in a patient, you should do the following: (4-5)

A

Be sure that you have collected the full semen fraction → check ALKP of the semen → ALKP is very high in the epididymis (normal >(5-)10000 ng/ml).

❖ If low → blockage of the semen from the epididymis OR inconsequent delivery.

Check a urine sample just after the collection for spermatozoa to make sure
there is no retro-ejaculation.

If the testicles are smaller than average for the breed and softer/harder in texture than expected → bad prognosis.

If nothing else is found → new collection in 8-10 weeks → new generation of
spermatozoa.

For prognosis of future fertility → testicle biopsies for histopathology.

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14
Q

Prostatitis→ can be secondary to…?

Signs of acute vs chronic prostatitis?

A

BPH.

Acute:
❖ Febrile, anorectic, lethargic
❖ Urethral discharge
❖ Pain if palpated rectally

Chronic:
❖ Recurrent urinary infection
❖ May be asymptomatic

❖ May have hematuria, poor semen quality, varying urinary discharge

❖ GI symptoms
❖ Usually no pain by rectal palpation

If abscessation → fever, abdominal pain.

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15
Q

Diagnosis of Prostatitis, diagnosis. (4)

A

Bloodwork:
❖ Neutrophilia with left shift in acute prostatitis and increased CRP.

Urinanalysis:
❖ Hematuria, pyuria and bacteriuria OR may be normal.

Ultrasound:
❖ Focal or diffuse hypoechoic changes – ”moth-eaten” appearance.
❖ Mineralization in chronic cases

Definitive diagnosis:
❖ Stick a needle in there → FNA → culture and bacteriogram.

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16
Q

Prostatitis, treatment

A

In acute prostatitis
❖ the blood-prostate barrier is disrupted → choose treatment from the culture and
sensitivity

❖ Treat for 4-6 weeks!

In chronic prostatitis (the barrier is intact → less penetration of AB)

❖ Empiric antibiotics while culture are pending → Trimethoprim/sulfa (TMS)

❖ High lipid solubility → allows for crossing the lipid membrane.
(TMS and fluoroquinolones)

Castration may shorten the mean duration of infection.

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17
Q

Cryptorchidism is…

A

a Developmental defect in which decent of one or both testes into the scrotum does not occur by 6 month of age.

The testicles in dogs will normally be at the inguinal ring at 10 days of age and in the scrotum at 42 days.

Inguinal canal closes at 6 month age and only few percent of the testicles descent after week 14.

Incidence:
small breeds > medium breeds > large breeds

Often unilateral and more often is the right testes involved. Can be inguinal or abdominal (72%/28%). Are inherited so don’t use these dogs for breeding.

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18
Q

Etiology of Cryptorchidism.

A

Inherited→ autosomal recessive trait carried by BOTH male and female.

Pathogenesis unknown → hypotheses:
❖ Inadequate secretion of GnRH, LH, testosterone.
❖ Early closure of the inguinal canal.

Retained testes are smaller than scrotal → no spermatogenesis. Predisposition to neoplasia = 9,2-13,6 times. Predisposition to torsion of the spermatic cord.

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19
Q

Diagnosis and differentiation between cryptorchidism and castrated dog:

A

❖ Ultrasonography (normally very easy to find)

❖ Evaluation of the prostate (smaller in castrated dogs)

Testosterone-stimulation test
▪ Blood sample → GnRH (receptal®) 1ml/10kg im/iv → blood sample after 60 min

▪ LH test (ELISA snap), will be elevated in castrated dogs.

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20
Q

Cryptorchidism Treatment:

A

❖ Bilateral castration

❖ Orchiectomy of the cryptorchid testis

❖ Orchidopexy → should always do vasectomy at the same time because dog should not be used for breeding.

❖ Medical: GnRH (receptal®) 1ml/10kg day 1,3,5 week 1+3+5, or hCG (Chorulon® 100- 300IU/dog) twice/week, 3-4 times but these have not been validated.

Prevention:
❖ Don´t use cryptorchid animals for breeding!

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21
Q

Penile frenulum

A

Thin band of connective tissue between the ventral glans penis to the corpus of the penis or the prepuce.

  • Not inheritable
  • ALWAYS check penis and prepuce before a young dog can be used for breeding.
  • Surgical resection → very easy
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22
Q

Describe Hypospadias

A

Abnormal termination of the penile urethra along the ventral surface of the penis
proximal to the normal urethral opening.

Is classsificated as:
- glandular (least severe)
- Penile
- Scrotal
- Perineal

No breed predisposition (Boston terrier overrepresented though).

Causes: intersex animal, progestins to the dam during pregnancy, Vit A deficiency.

Treatment: none if asymptomatic, amputation of penis, scrotal or perineal scrotal
urethrostomy → castration recommended.

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23
Q

Testicular neoplasias are the Second most common type of tumor in the dog after

A

skin tumors.

 Mean age at diagnosis of affected dogs is 10 years, range of 2-19 years.
▪ Increased for boxers, 7 years

 Breeds at decreased risk are Dachshund, beagle, Labrador retriever, and mixed-bred dogs.

 More common in retained testicles than in descended testicles.

 May be unilateral or bilateral
▪ Bilateral is reported in 45% of cases

 Multiple types may be present

 Three most common types:
sertoli cell tumors, seminona, leydig cell
tumor (interstitial)

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24
Q

Sertoli cell tumor (SCT)

A

44% of testicular tumors are of this type. It is the most common tumor in retained testicles. It´s a neoplasia of the sertoli cells of the testis.

 Mean age of diagnosis is 7 years

 Boxers and weimaraner have an increased risk

 Malignancy is low (2%)

Testicles with SCT (that are palpable) are enlarged and firm and atrophy of the
contralateral testis may be present due to hyperestrogenism.

Diagnosis: ultrasound → hypoechoic to anechoic area within the testis.

25
Feminizing paraneoplastic syndrome → caused by estrogen secretion. Signs in male dogs: (8)
❖ Bilaterally symmetrical alopecia of the trunk and flanks and hyperpigmentation of inguinal skin. ❖ Gynecomastia ❖ Attractive to other male dogs ❖ Keratinization of the preputial mucosa ❖ Bone marrow suppression → non-regenerative anemia ❖ Squamous metaplasia of the prostate and prostatitis ❖ Pale mucous membranes ❖ Hematuria, melena, epistaxis Make a preputial smear on these patients→ > 20% superficial cells.
26
Seminoma
Origin: germ cells.  31% of the testicular tumors  More common in retained testes  Mean age of diagnosis 10 years  German shepherds are predisposed  Malignancy is considered low
27
Describe Interstitial Leydig cell tumors
 25 % of all testicular tumors  More common in scrotal testes (99%)  Mean age of diagnosis 10 years  No breed disposition  Usually small lesions (<1cm)  Low malignancy  Paraneoplastic syndromes due to either hyperestrogenism or hypertestosteronism ❖ Elevated testosterone leads to prostate disease, perianal adenoma, perianal gland hyperplasia, perineal hernia.
28
Torsion of the spermatic cord, clinical signs?
Is more often seen in abdominal retained testes. ❖ Acute abdominal pain ❖ Vomiting ❖ Lethargy ❖ Anorexia ❖ Dysuria/hematuria ❖ Swelling of scrotum or inguinal area ❖ Testicles that are attached to a torsed spermatic cord are usually enlarged, congested. Histology: ischemic necrosis, intravascular hemorrhage and edema. Therapy: surgical excision and orchiectomy
29
Scrotal neoplasia, scrotal mast cell tumor, mastocytoma
30
BPH = pathogenesis? (4)
Benign prostatic hypertrophy/ hyperplasia Influence of dihydrotestosterone + changes in estrogen:androgen ratio over time → hyperplasia/hypertrophy + increase in sensitivity towards estrogen → Estrogen → a structural change of the prostate cells (metaplasia) and increase the amount of androgen receptors in the gland → Cysts develops in the ductuli
31
the only accessory sex gland in the dog?
prostate * 97% of the total ejaculate comes from the prostate * At semen collection the 1. and 3. fraction comes from the prostate. * The function is controlled by testosterone/ dihydrotestosterone through the hypothalamic-pituitary-gonadal-axis.
32
BPH, typical patient?
* 80% of all male dogs over 5-6 years of age are affected clinically/subclinically * Develops spontaneously from 2-3 years of age. * Predisposes the male dog to prostatitis and subfertility. * Can be difficult to diagnose by measuring the size because of a big individual differences. * Nearly all intact male dogs will develop BPH if they live long enough.
33
Clinical symptoms of BPH.
Eccentric growth in dogs (concentric in humans) ❖ Tenesmus, flattened feces, constipation ❖ Stranguria/uncommon) ❖ Blood dripping from penis (not while urinating) Semen: ❖ Hematospermia – no effect on semen quality in early stages→ ❖ Later can occur asthenozoospermia (decreased motility) and teratospermia (increased morphologic defects, often tail defects)
34
Diagnosis of BPH. (3)
Rectal palpation – only possible to palpate the most caudal part. Ultrasonography: ❖ Good choice for most veterinarians in clinical practice. Good to visualize size and the context of the parenchyma but can´t diagnose early stages of BPH. CPSE: Canine prostate specific esterase
35
CPSE:
Canine prostate specific esterase  Prostate specific protein (arginine esterase)  Is secreted from the epithelial cells from the prostate  The release are under influence of androgens and decreases if the testosterone concentrations decreases.  is indicative for the prostatic status, related to BPH, when a marked increase in CPSE is registered. Can be used as a 1. choice for diagnosis of BPH and in early stages. Cut-off value > 70-90ng/ml is pathognomonic for BPH. In cases of elevated values → go for ultrasound.
36
Treatment BPH.
The goal is to decrease serum testosterone/ dihydrotestosterone to a minimum or prevent it´s effect on the prostate gland. Tx with Surgical castration Or with, Medical castration by implantation of deslorelin (Suprelorin® 4,7mg/9,4mg) every 6-12 months. To prevent the ”flair up effect”→ give osaterone for 1 week before implantation. (Ypozane every 5m → as an anti androgen→ works as an antagonist of the androgen receptors on the prostate and competitively prevents the binding of androgens to their prostatic receptors → blocks the transport of dihydrotestosterone/ testosterone into the prostate=
37
Describe Prostatic/paraprostatic cysts. (2-3)
Small intraprostatic cysts have been described and are associated with BPH → same diagnosis and treatment as for BPH. True retention prostatic cysts or paraprostatic cysts are:  Large cavitating lesions with a distinct wall, containing clear fluid either inside (retention) or outside (paraprostatic) the prostatic paranchyma.
38
Prostatic (retention) cysts can occur with
estrogen-secreting Sertoli cell tumors (SCT).
39
Paraprostatic cysts are often craniolateral to the prostate, displacing the
bladder or caudal to the gland within the pelvis. ❖ Hypothesized to be dilated embryonal remnants of wolffian ducts.
40
Symptoms of Prostatic/paraprostatic cysts.
Often in older, large breed dogs over 8 years old. Can be asymptomatic: - Detected by ultrasound Clinical signs can be: - Abdominal distension - Lethargy/anorexia - Dysuria/hematuria - Tenesmus - In dogs with SCT → feminization - GI symptoms NEVER forget to palpate the prostate!
41
Treatment of Prostatic/paraprostatic cysts.
Cyst drainage Usually not recommended → recurrence of the cyst. Cyst resection ❖ Difficult to resect the large cysts and adhesions to surrounding structures. ❖ Omentalization may help to prevent recurrence. Marsupialization ❖ Allows drainage of large cyst to drain and collapse. Partial prostatectomy ❖ May be required with large cysts ❖ Complications involve urinary incontinence and urine leakage at the urethra. Castration ❖ In combination with aforementioned therapy. ❖ Effect on resolution and recurrence alone is not known.
42
Phimosis etiology
Inability to protrude the penis from the prepuce. Etiology: - congenital (intersex dogs) - Stricture of the preputial orifice → inflammation, edema, cicatricial after wound healing, neoplasia. Penis may or may not be normal in texture.
43
Phimosis tx
surgical enlargement of the prepuce, correction of primary problem
44
Paraphimosis
Inability to retract the erect penis into the preputial sheath. Etiology: - Balanoposthitis (penis inflammation) - Sexual arousal - Neurologic disease (encephalitis, intervertebral disc disease) - Fracture of the penis bone - Swelling of the penis due to trauma or neoplasia - Idiopathic Complications: - Ischemia - Drying out and excoriation
45
Paraphimosis, treatment
 Cold packs  Replacement (cleaning and lubrification)  Keep him away from bitches in estrus  Castration is only effective if it´s because of sexual arousal  Surgical widening of the preputial orifice  Penis amputation if penis necrotic
46
Priapism is
Persistent erection without sexual arousal. It often occurs due to parasympathetic stimuli → sympathetic (therapy) stimulation reverses the effect. * Neurologic disease (encephalitis,, intervertebral disc) * Neoplasia * Idiopathic Pathogenesis: * Prolonged parasympathetic stimulation * Has been reported: Decreased venous outflow from an occlusive thromboembolism/ mass → low oxygen + high carbon dioxide → edema, irreversible fibrosis and ischemic necrosis.
47
Priapism Treatment:
❖ Unfortunately often too late for recovery → necrosis → amputation of penis + urethrostomy ❖ Castration is NOT effective in these cases ❖ Draining and flushing of the corpus cavernosum penis with heparinized 0,9% saline solution AND infusion of sympathomimetic drugs (ephedrine) ❖ Surgical creation of fistulas within the penis to expand the venous outflow. ❖ Anticholinergics (atropine, glycopyrrolate) and antihistamines. There is no report of successful mating in dogs after treatment for priapism.
48
Urethral prolapse Etiology:
❖ Idiopathic ❖ Secondary to sexual excitement ❖ Urethral infection ❖ Genetic predisposition (often seen in English bulldogs) Dyspnea → increase of abdominal pressure→ prolapse Mean age at diagnosis → 20 months
49
Urethral prolapse Clinical signs:
❖ Pathognomonic sign: ”red pea” appearance at the tip of the penis ❖ Intermittent bleeding from penis (can be very intensive) ❖ Increased frequency of urination ❖ May occur only when the penis is erect
50
Treatment of urethral prolapse.
Medical: ❖ Tranquilizers (warning for brachycephalic dogs → may die from suffocation) ❖ Isolation from bitches in estrus ❖ Cage rest Surgical: ❖ Removal of the prolapse - different surgical techniques ❖ Castration → always recommended (100% recurrence if no castration, 50% if castrated) ❖ Surgical correction of the respiratory defect as well (BOAS)
51
Transmissible venereal tumor (TVT)
- ”Stickers tumor” or ”infectious sarcoma” - Transmission through mating, licking, sniffing, biting Affected areas : genitals, nose/lips - Low grade of metastasis except in puppies and immunocompromised dogs - Commonly seen in sexually active dogs in tropical and subtropical climates - Often young dogs and the tumors see a rapid growth (<2 months incubation time)
52
Transmissible venereal tumor (TVT) Clinical signs:
❖ Cauliflower-like appearance ❖ Discharge from prepuce ❖ Urinary retention due to blockage of urethra ❖ Nasal discharge/nose bleeds ❖ Enlargement of regional lymph nodes
53
Diagnosis of Transmissible venereal tumor (TVT)
visual inspection, cytology, immunochemistry Clinical appearance on penis/prepuce is very characteristic. Histological aspect: ▪ A high rate of nucleus in the cytoplasm ▪ Oval nuclei with one or two prominent nucleoli ▪ Pale blue cytoplasm containing distinct clear vacuoles ▪ Biopsy for immunochemistry
54
Tx and prognosis of TVT.
Treatment: ❖ Surgery may be difficult due to location of the tumor and often if used alone a high recurrence are noted. ❖ Chemotherapy is very effective and if combined with surgery the prognosis is excellent. ❖ Chemo drugs: Vincristine, vinblastine and doxorubicin ❖ Radiotherapy can be used if the chemistry doesn't work ❖ Cryotherapy can be used in small TVT Consider neutering the animal. Prognosis: Recurrence rate on 32-44% by 6 months → no recurrence if combined with chemotherapy.
55
Balanoposthitis is
inflammation of the glans penis (balanitis) with a contamination of the preputial mucosa (posthitis).
56
Etiology of Balanoposthitis (4)
❖ Bacterial infection often originate from the normal preputial flora (E.Coli, Strp species, Staph.aureus, Pseudomonas, Mycoplasma (M.Canis) ❖ Viral infection (herpes→ bullae, calicivirus) ❖ Behavioral self-licking ❖ Atopic dermatitis
57
Clinical signs of Balanoposthitis (3)
❖ Abnormal Preputial discharge. ❖ Mucosal edema and covered with purulent, hemorrhagic discharge ❖ Prominent penile lymphoid follicles and petecchiae
58
Balanoposthitis Diagnosis & Treatment:
❖ Bacterial culture (interpretation can be tricky) ❖ Viral isolation→ not easy to diagnose Treatment: ❖ Systemic and/or local antibiotics ❖ Flush with warm saline ❖ Allergic medical therapy if atopy ❖ If mutilation: antianxiety drugs