Male Repro Surgery in Dogs and Cats

Question 1

what are indications for castration?

Answer 1

1. elective sterilization
2. hormone level modification
   -intact predisposes to prostatic diseases (BPH, cysts, abscesses, prostatitis), perianal adenoma, perineal hernia, urethral prolapse
3. urethral obstruction (perineal or scrotal urethrostomy)
4. orchitis
5. testicular neoplasia
6. behavioral modification
   -may improve some behaviors: roaming, mounting, urine marking, inter-male aggression
   -may not improve other forms of aggression or fearful behavior
7. increased lifespan
   -neutered cats live longer than intact cats

Question 2

describe closed castration in cats

Answer 2

scrotal incision; also called auto-ligation

1. spermatic fascia debrided with gauze
2. use hemostats to throw a knot with the spermatic cord
   -auto-ligation
3. after making the throw, clamp the cord
   -tighten the clamp all the way
   -clamp tissue at the end of the clamp
4. remove the testicle:
   -cut right against the clamp
   -cut AWAY from the looped tissue
5. tightening the throw:
   -slip looped tissue over the end of the hemostat, creating a knot
   -slide the knot down and make it as tight as you can (between thumb nail and finger)
6. remove the excess tissue: not too close to the knot!

Question 3

describe open castration in cats

Answer 3

1. uncommon
   -can be accidental if accidentally cut through parietal tunic when trying to do closed
2. parietal tunic is incised
   -creates communication with the peritoneal cavity
3. use the cat’s own tissue for ligation
4. in theory: less risk of hemorrhage
   -does bleed a bit more during surgery
   -do not accidentally incise the epididymis! will bleed more
5. split ductus deferens/cremaster muscle away from vascular cord
   -tie know using the two now separated parts of the spermatic cord (ductus deferens complex and vascular cord)
   -transect the tissue past the knot

Question 4

describe prescrotal closed castration in dogs

Answer 4

1. take a testicle, push cranially, make incision over testicle through subcutaneous tissue and spermatic fascia
2. break down ligament of the tail of the epididymis, use gauze for grip
3. use gauze to break down spermatic fascia and fat until spermatic cord is isolated
4. three clamp technique
   -esp for larger dogs
   -use carmalt forceps to crush tissue to allow ligatures to fully tighten
   -clamp closest to the dog is to crush tissue for encircling ligature (millers, whatevs)
   -second ligation between crush mark and middle clamp; leave enough space
   -cut between middle clamp and clamp farthest from dog
   -leave space between clamps!!! don’t want ligature close to a clamp!!!
5. place 2 ligatures: 2-0 or 3-0, depending on patient size
   -proximal (dog side): encircling in proximal clamp crush zone; release (flash) 2nd clamp while tying
   -distal: transfixing between encircling ligature and second clamp

-if you don’t release the 2nd clamp:
–1st ligature will not be tight, tissue will spread too much to tighten appropriately
–blood vessels may not be completely ligated
–can lead to severe hemorrhage post-op leading to need for additional surgery or patient death

6. cut between 2nd and 3rd clamp
   -2 ligations stay with the patient
   -controlled release to check for hemorrhage
7. closure:
   -deep fascia: monocryl or PDS, simple continuous, 3-0
   –buried knots! urethra directly below fascia in the middle (DO NOT entrap this); can take a very small bite of middle fascia
   -skin: monocryl or PDS, intradermal pattern, 3-0 or 4-0

Question 5

describe open castration in dogs

Answer 5

1. same as cat for breaking down spermatic fascia/fat
2. open parietal tunic
   -initially with blade over testicle, then continue with metzenbaum scissors
3. separate the tunic and cremaster from the ductus, testicular artery, and pampiniform plexus
4. ligate ductus/pampiniform/atery with two encircling ligatures
5. ligate tunic/cremaster with one encircling
6. controlled release, closure is same

good for bigger dogs to control vasculature better

Question 6

describe scrotal castration in dogs

Answer 6

1. single incision on scrotum at median raphe
2. closed or open castration
3. closure could be noting or one SQ suture

pros:
-more rapid
-less suture material
-maybe less hematoma
-preferred in shelter environment
-less self trauma

cons:
-open wound
-delayed healing

Question 7

describe complications of castration (7)

Answer 7

1. hemorrhage
2. anesthesia
3. patient induced site irritation
4. infection
5. seroma
6. obesity
7. scrotal hematoma
   -mild are common
   -can occur post-op; likely oozing from vessels or from SQ
   -treatment: ice pack for 24hrs, then warm compress after 24 hours
   -in severe cases, scrotal ablation may be required

Question 8

describe scrotal hematomas

Answer 8

1. mild are common
2. can occur post-op; likely oozing from vessels or from SQ
3. treatment: ice pack for 24hrs, then warm compress after 24 hours
4. in severe cases, scrotal ablation may be required

Question 9

describe scrotal ablation

Answer 9

indications:
-large scrotal hematoma
-scrotal neoplasia: commonly mast cell tumor
-pendulous scrotum in older dogs or hunting dogs

taking entire scrotum away

technique: in dorsal recumbency with legs spread = lots of tension on previous castration incision, may move legs together if needed

1. elliptical incision around base of the scrotum
2. if not castrated, perform castration
3. if castrated, dissect between scrotum and urethra
4. close SQ tissue and skin

Question 10

describe cryptorchidism

Answer 10

1. most common testicular defect
2. diagnosis by 6 months of age
3. uncommon in cats: persian cats predisposed
4. location:
   -prescrotal
   -inguinal
   -abdominal
5. a hereditary condition
6. 13.6x increased risk of testicular neoplasia
7. retain hormonal production
8. spermatogenesis fails bc of increased testicular temp!
   -so testicle is often smaller
9. if unilateral, ALWAYS address the cryptorchid first! never castrate the normal one and send somewhere else

Question 11

describe surgical options for cryptorchidism

Answer 11

1. pre-scrotal location: normal castration
2. inguinal:
   -requires separate incision
   -incise directly over palpable testicle
3. abdominal:
   -find testicle using:
4. ductus deferens
5. gubernaculum

Question 12

describe surgical approach for abdominal cryptorchid

Answer 12

1. approach can be parepreputial or ventral midline
2. ventral midline offers the most flexibility and access
3. parapreputial has less dissection and potentially smaller incision, but cuts through abdominal and muscle hard to extend incision
4. be prepared to fully explore if you need to find a cryptorchid
   -the easiest way to find (if can’t see right next to bladder), use vas deferens (located just deep to bladder, hopping over ureter), trace up to testicle
5. could remove laparascopically
6. make sure you don’t accidentally remove the prostate thinking it’s the testicle!