Male Repro Surgery Flashcards
What are some common surgical procedures of the TESTIS?
Castration
Vasectomy/Epididectomy
Cryptorchidism
What are some common surgical procedures of the PREPUCE?
- Penile/Preputial stricture
- Preputial erosion
- Preputial prolapse
- Preputial avulsion
What are some common surgical procedures of the PENIS?
- Penile hematoma
- Persistent frenulum
- Tumor removal
- Penile deviation
How are the Testes Oriented?
Vertically with prominent tail of epididymis
Where is the Epididymis and ductus deferents located in relation to the TESTES?
Along the caudo-medial surface of the testicle
What are the layers of the TUNICA VAGINALIS?
- visceral layer
- parietal layer
What two muscles are very important in thermoregulation of the testicles? HOW
- cremaster muscle
- Dartus muscle
Elevate and drop the testes in relation to the body.
What does the spermatic chord comprise of?
- nerves
- vessels
- lymphatics
What is the importance of properly lighting the Testicular ARTERY during castration?
Testicular artery is a branch of the abdominal aorta:
-life threatening hemorrage
In the Bull, what temperature is the testis in relation to the body?
Should be 4 degrees lower
The highest concentration of testosterone is in the _______?
Testes
-exchange of testosterone coming out of the testicle
-diffuses into the testicular artery, that takes it back to the testicle
——affecting testosterone and thermoregulation
What does the Pampiniform plexus contain?
- TORTUOUS artery
- Contorted vein
How old should calves, lambs and kids be when they are castrated?
1st month of life
Can you castrate animals older than 1 month of age?
YES, but not ideal:
- More prone to complications
- Difficult restraint
- Less effective in behavior control
How do you restrain a Lamb/Kid for orchidectomy?
- Head down between operators knees
- Head up with limbs on each side held together
How would you restrain a Calve (<30days, ideal age) for orchidectomy?
Lateral recumbency
How would you restrain older cattle/sheep/goats for orchidectomy?
- stocks
- chutes
- tilting table
T/F: there is proof that castrating an animal later will produce better meat
FALSE
No proof, common thought
T/F: there is proof that castrating an animal younger (within the first month) is easier, more effective and less associated with complications
TRUE
What is one of the most common mistakes for mix animal practitioner when castrating?
Mixing the xylazine used for Horses with the xylazine used for cattle
-Ruminants are MORE sensitive to Xylazine than horses
What dosage of Xylazine is used in:
- Horses
- Cattle
Horses:
100mg/ml
Cattle:
20mg/ml
Small Ruminants are even More sensitive
What would you expect to see in a Cow that received too much Xylazine?
Cardio vascular and Respiratory compromise
What is the toxic dose of lidocaine for Ruminants ?
4-6mg/kg
T/F: the dose of Xylazine used to sedate CATTLE is more or less 10% of the dose used in HORSES
TRUE
Which species is most sensitive to lidocaine toxicity?
GOATs stay below 4-6mg/kg
Why do we use intra-testicular administration of lidocaine instead of injection into the chord?
Due to possible hematoma development
-if that happens in the chord then hemostasis would be compromised
How much should you dilute your lidocaine for intra-testicular administration in a GOAT?
0.5-1% of toxic dose 5mg/kg
What are the 2 ways to castrate a Ruminants?
1) Scrotal apporach
2) blood less method
Describe the scrotal approach to castration
- excise the distal 1/3 of scrotum
- isolate spermatic cord
- ligate and transects/emasculation/Henderson castrating tool
- Push chord stump back into the inguinal canal
- SECOND intention HEALing
How do you use a Newberry knife?
- vertical incision in lateral aspect of scrotum
- placed midway cranial to caudal (below levels of testes)
- Rapidly pull distally —> cranial/caudal scrotal flaps
What is the most common castration technique in Ruminants?
Closed technique
What is the Henderson Castrating tool?
Twists spermatic chord until it breaks
What are the two most common emasculators used in Ruminants?
1) Reiner
2) Serra
What is extremely important to check when using a Serra emasculator and why?
Check that it is NUT to NUT because the Serra crushes and cuts at the same time
Why do you digitally stretch the scrotal incision following scrotal castration?
To enhance drainage
What is one of the most important complications of castration?
Serous chord formation
Why / When would you perform a unilateral castration?
- Hydrocele
- Hematocele
- testicular tumor
- Abcess
- varicocele
How long would you have to wait after performing a unilateral orchidectomy to see if the remaining testicle is functional?
up to 2 months (60day) post-op
T/F: unilateral orchidectomy can cause compensatory hypertrophy and increase sperm production in the remaining testicle.
TRUE
What type of castration technique should be used for unilateral orchidectomy?
OPEN castration technique
- vertical skin incision through parietal vaginal tunic
- involves closure of tunic,SC and Skin with absorbable suture
What is the ratio for fusiform incisions?
4: 1
3: 1
What is the Bloodless castration?
Dependent on ischemia of testis—->atrophy/necrosis
- elastrator
- callicrate bander
- burdizzo emasculotome
T/F: the prevalence of tetanus following bloodless castration is much higher than the other approaches
TRUE
Can an Elastrator bander be used on an adult ruminant?
No must be <1 month of age
-testes and scrotum slough in ~3 weeks
Where should the Elastrator bander be placed?
Right at the neck of the scrotum
- remove wool/hair first
- monitor these animals
What age group and animals can Callicrate banders be used in ?
Also known as EZ bander
- bulls up to 400kg
- Adult small Ruminants
How does the Burdizzo emasculotome work?
Bloodless castration
- crushes the spermatic chord
- crush one chord at a time
Is cryptorchidism common in ruminants?
No (less common than in other species)
What is the most common location of cryptorchidism in ruminants?
ECTOPIC > inguinal> abdominal
Which is more common in Cattle bilateral orchidectomy or unilateral orchidectomy?
Unilateral
Retain:
Cattle Left > right
Goats Right > left
How do you diagnose cryptorchidism in ruminants?
-inspection/palpation of inguinal area and scrotum
-US of SQ inguinal First!!!!
(Then inguinal and abdominal areas)
-TR palpation
Where would you find ECTOPIC cryptorchidism in ruminant?
In SQ in the inguinal area
- on either side of penis
- 15-30cm from base of scrotum (palpation/US)
- oriented with long axis parallel to penis
What type of healing should be done for Ectopic cryptorchidectomy?
2nd intention
How long does it take for Epididymectomy/vasectomy to cause infertility?
3~ weeks post op
- to create TEASERS
- allows mating —> no prevention of VDs
*better combine with prepuce relocation
What is Epididymectomy?
Removes the tail of the epididymis
-to produce teasers
Describe the Vasectomy approach
1) 1-2 cm vertical incision in neck of scrotum (cranial)
- Continued through vaginal tunic
- 1 incision per side
2) Prolapse spermatic cod through incision
- with curved hemostats
- identify ductus deferents (RIGID and WHITER)
- ligation + transaction
3) skin closure
Why is it better to combine vasectomy and epididymectomy with prepuce relocation?
It will prevent mating and the transmission of venereal disease
What does the PUDENDAL Nerve block do?
Relaxation and desensitization of Penis and Prepuce
*for STANDING surgical procedures!!!
Describe the components of the PREPUCE
1) Lamina externa
- skin
- reflected at the Preputial orifice
2) Lamina interna
- lining of Preputial cavity
- attached to penis (10cm from tip)
- elastic —> lie along body of penis when exteriorized
What does Penile/Prepuce relocation do?
1) prevents INTROmission (teaser production)
- improved heat detection (better timed AI)
When can Penile/Prepuce relocation be performed?
FROM 1 month of age
- increased complication in large bulls
- some learn to achieve intromission despite relocation
- therefore it is GOOD to combined with Vasectomy/Epididymectomy
Where do we normally relocated the Prepuce to?
Normally the LEFT flank
-can be done on the RIGHT flank
How is a Penile/Preputial relocation performed?
1) circumferential incision 2-4cm around orifice
2) extend caudally along midline until 5 cm from scrotum
What Nerve block should be performed to Relax (exteriorize) and desensitize the PENIS for STANDING procedures?
PUDENDAL NERVE block
What is Prepuce avulsion?
Avulsion of the Lamina INTERNA from penile integumentary
What is the most common cause of Prepuce avulsion in Cattle?
-Exclusive of bulls collected with artificial vagina
What type of healing should be done for Prepuce avulsion?
1) 2nd intention
- time consuming (6-12months)
- adhesion formation
2)surgical repair
What is the best treatment for Prepuce avulsion and why?
Surgical repair
- because second intention healing can take up to 6-12months and causes a lot of adhesions (preventing the bull from mating again)
How would you diagnose a Preputial avulsion?
1) Preputial bleeding after semen collection
2) Extension and evaluation of penis
What is the typical presentation of a Preputial avulsion in cattle?
1) Preputial bleeding following semen collection
2) 2-5cm lesion circumferentially
What does surgical repair of a prepuce avulsion require?
1) suture closure (with simple interrupted, absorbable)
2) Avoid sexual stimulation (~30days)
3) re-assess
Which breed of cattle are more prone to Preputial injuries and WHY?
Bos Indicus
- because they have pendulous sheaths
- Preputial eversion
Where do Preputial abscesses usually occur?
Midway between the Preputial orifice and the scrotum
How do you treat Preputial injuries? How is this different from Prepuce avulsion?
1) try to decrease swelling
2) replace Preputial Lamina back into the Preputial cavity
3) wait 6-8weeks (let tissue declare itself)
* Prepuce avulsion should be surgically corrected immediately (primary intention)
What is Preputial prolapse?
Eversion of Lamina interna
What breeds of cattle is Preputial prolapse common in and why?
**Bos Indicus (pendulum prepuce)
*Polled breeds (vestigial caudal Preputial muscle)
What first aid can be used for Preputial prolapse?
- soak in salt water/hyperosmotic solution (softens scabs debris = decrease swelling)
- Massage prolapsed prepuce with LANOLIN, oil and antibiotics
- Replace prolapsed prepuce and support for 2 weeks
A Bos Indicus has a Preputial prolapse that remains prolapsed after 2 weeks following first aid treatment. What surgery should be performed?
Surgery only after swelling has resolved
Procedures:
- longitudinal incision
- Preputial amputation
- reefing
- Preputial stoma
What surgical procedure would you use for a simple Preputial stricture? (Prepuce prolapse)
- longitudinal incision of stricture @ Lamina interna
- transverse closure with interrupted sutures
- this increases the Lumen of the ring
You have a Bos Indicus with a lot of damage to the Lamina interna of the prepuce. What kind of surgical repair would you consider?
1) Preputial amputation
2) Reefing
Describe Preputial amputation
- Pudendal nerve block
- plastic case into Preputial cavity (60ml syringe case) for SUPPORT
- stabilize prepuce (2 long needles at right angles through healthy prepuce)
- Diagonal incision to excise stenotic prepuce
- suture edges of healthy portion of prepuce together (interrupted suture pattern)
- Tube + tape retention device (2 weeks)
Describe Reefing
*for large stricture in prepuce
-marks in both edges of healthy prepuce for alignment
-tourniquet
-circumferential incisions prox and distal to tissue to be excised
-connect with longitudinal incisions
-dissect tissue for removal
-suture remaining edges together (SI, absorbable)
SQ layer and Preputial integumentary
-SUPPORT
What is STOMA technique?
Novel technique, for semen collection
-Bulls with Phimosis due to stenosis
1) longitudinal elliptical incision on ventral aspect
- proximal to stenotic scar
- ~6cm long and 2 cm wide
- skin excised
- Incision through Lamina interna@ distal end of incision
- edges of incised Lamina interna are sutured to skin @ stoma
What causes Decubital ulcers in Rams?
Usually only show Rams
- Overweight
- confined, long recumbency
How would you treat a show Ram with a Preputial erosion/ulcer (decubital ulcer)
Requires surgical excision
-must resist conservative treatment (will not get better)
What is the etiology of Preputial erosions/ulcers in Cattle?
Hair clipped too short—> urine scolding (Preputial orifice)—>ulceration—>secondary infection—>stricture
How do you treat Preputial erosion/ulcers in cattle?
Same as Preputial injuries
-surgery
Where do the retractor penile Muscles attach in the penis?
Centrally at the DISTAL loop of the Sigmoid flexure
What are the important components of the Penis in the bull?
1) Sigmoid flexure
2) retractor penile Mscles
3) Mucosa diverticula
4) Corpus cavernosum
5) Apical ligament
Where is the Mucosa diverticulum located?
@ the is hail arch
-important for catheterization
What is the Corpus Cavernosum encased by?
Thick, INELASTIC tunica albuginea
Where is the Apical ligament?
Dorsal, Thick
What allows the bull to maintain a straight penis during INTROmission?
Apical ligament
-dorsal and think
What provides sensory information to the penis?
Dorsal Nerve of the Penis (branch of Pudendal)
- key role in penetration
- unable to serve and ejaculate if damaged
T/F: the Pudendal Nerve has sensory and motor function
True
- motor (retractor penis muscle)
- sensory (Dorsal nerve of Penis)
Why is there a decreased risk of damage to the dorsal never of the penis in the free end of the penis?
There is distal branching
When would you anesthetize the Dorsal nerve of the Penis?
-analgesia of free part of the penis
(Minor Sx procedures (Frenula, Papilloma)
-Only in bulls <1 year old
(You can with draw penis from prepuce manually)
-
How do you anesthetize the Dorsal Nerve of the Penis?
- Lidocaine injected beneath Lamina interna of prepuce
- @ dorsal aspect of Preputial orifice
- Cover dorsal 1/2 of penis
What does examination of the penis involve?
1) inspection/palpation, prepuce distention
2)Extend penis
—manually (<1 year old bulls)
—sedation (xylazine, acepromazine
—Pudendal nerve block
3) view mating attempt!!!!!*
4) radiograph/ultrasound
What is the MOST common PENILE lesion in Bulls?
Penile Hematoma
-more common in young)
-due to bending of erected penis (rupture albuginea)
-in dorsal or lateral aspect of penis distal to distal curve of Sigmoid flexure
(Ventral attachement of retractor penis MSc)
Where do Penile Hematomas usually occur in the bull?
-Dorsal or lateral aspect of Penis distal to distal curve of “S”
(Ventral attachement of retractor penis muscle)
What are the clinical signs of Penile hematoma?
1) protrusion of Lamina interna (incomplete withdraw)
2) Paraphimosis
Why do you see paraphimosis with Penile Hematoma?
Due to the space occupying capacity of the hematoma
When is surgery required for a Penile Hematoma?
-Swelling >15cm
Should be performed within 10 days
- remove blood clots
- close albuginea defect its absorbable suture
- partial thickness to avoid leaking (erection)
When is surgery not required for a Penile Hematoma?
-how would you treat it?
Swelling <15cm
- 6weeks sexual rest
- hydrotherapy (cold/warm)
- Massage to reduce adhesions within prepuce
If you have a valuable bull with a penile hematoma what is the best treatment for it?
Surgery
-better recovery
What are the complications of Penile hematoma?
1) Adhesions **
—most likely in hematomas > 15cm
2) abscesses
3) Recurrence is common
What is a persistent frenulum?
Congenital condition
-Lamina interna of prepuce continuous with integumentary of penis
- separarteion completed at 9months
- more common in ventral aspect of penile rap he (last to separate)
- Bulls or rams may retain 1 or more bands
At what age should the Lamina interna of prepuce separate from the integument of the penis?
9months of age
-bulls
How do you treat a persistent frenulum?
Preputial separation
-anesthetize the DORSAL n of the penis
What is the most common neoplasia in BULLS?
Penile Fibropapilloma
What age group do we commonly see Penile fibropapilloma in? What is the significance?
Commonly affects young bulls
*if seen in older bulls ALWAYS submit for biopsy because it could be fribroSARCOMA that looks similar
T/F: penile Fibropapilloma is SElf-limiting.
TRUE
-often spontaneous regression
Affects mostly young bulls
- large number in group-housed cattle
- wart vaccine decreases incidence
What can you use to decrease the incidence of Penile fibropapilloma?
Wart vaccine!!!!
What is the pathogenesis of Penile fibropapilloma?
1) affects INTROmission
—pain
—mechanical
2)Affects SEMEN quality
—bleeding
Penile fibropapilloma can be treated with benign neglect, So why might you choose to have surgery instead?
To save TIME
What nerve needs to be anesthetize for Penile fibropapilloma surgery?
DORSAL penile N
-sharp dissection/electrobistury
When is spiral penis normal in bulls?
Spiral is normally @ ejaculation ONLY!!!!!!!
What is the cause of Premature spiral formation?
- slippage of APICAL ligament prior to intromission
- prevents intromission in 50-100% of attempts
What does Spiral deviation prevent?
INTROMISSION
How do you treat Spiral deviation?
1) anchoring the apical ligament to the penis
—to avoid lateral slippage
2)Implant to augment the apical ligament (DORSALLY)
—strip/s of fascia late
—synthetic fibers
*preferable under GA
Renders bulls useful again
