Male Reproductive Disorders Flashcards
orchitis
inflammation of the testes
often INFECTIOUS
always r/o brucella canis
epididymitis
inflammation of the epididymis
testicular torsion
rotation of the testes on its stalk
can be intraabdominal (if cryptorchid) or scortal
what are types of testicular neoplasia
sertoli cell tumor, leydig cell tumor, seminoma
how does orchitis appear on ultrasound
enlarged testes w/ hypoechoic or mottled texture
tunica is thickened and hyperechoic
when doing an ultrasound for an enlarged testicle, what should you always look for
check for prostate, urinary tract, and peritoneal infection
orchitis is often associated with ascending infection
how does epididymitis appear on ultrasound
enlarged epididymis with hyper or hypoechoic changes
epididymis should be 1/8 the size of the testes
how does testicular torsion appear on ultrasound
if descended –> enlarged testes within the scrotum
if cryptorchid –> mass effect
hypoechoic to mottled texture
how does testicular neoplasia appear on ultrasound
altered echogenicity with mineralization
irregular/variable border
if functional tumor –> causes atrophy of the contralateral testicle
workup and management for enlarged, painful testicle
- ultrasound - r/o torsion, neoplasia, herniation
- FNA of testicle - submit for cytology and culture
- empiric antibiotics
- antibiotics based on C&S testing
- determine fertility prognosis
what empiric antimicrobials should be used for orchitis/epididymitis
enrofloxacin AND ampicillin
- enro: good tissue penetration
- ampicillin: good gram negative coverage
what causes decreased fertility from orchitis/epididymitis
heat damage - heat from inflammation causes decreased spermatogenesis; will take time to return to normal sperm count
sperm autoantibodies
sperm autoantibodies
inflammation causes breakdown of blood-testis barrier causing immune access to sperm –> production of antibodies –> permanent decrease in sperm production
what are the most common disorders of the inguinal canal
cryptorchidism
herniation w/ incarceration
cryptorchidism
unilateral or bilateral testes that fail to descend into the scrotum
can be inguinal or intraabdominal
(can be found anywhere from ipsilateral kidney and inguinal canal)
when should the testes be fully descended
by 6 months of age (dogs)
by birth (cats)
what does cryptorchidism predispose to
neoplasia and torsion (esp once neoplastic)
can cryptorchid testes produce sperm
NO
can cryptorchid testes produce testosterone
yes
fertility and libido of a unilateral cryptorchid
fertile
normal libido & male behavior
fertility and libido of a bilateral cryptorchid
infertile w/ normal libido and male behavior
fertility and libido of an incompletely castrated cryptorchid
(only the descended testicle gets removed)
infertile w/ normal libido and male behavior
how to check if testosterone is present in a cat
check for spines on the penis
what is herniation with incarceration
movement of abdominal viscera into the scrotum via the inguinal canal
OR
movement of the testicles into the abdomen via the inguinal canal
can cause incarceration (entrapment) of the herniated contents
how does inguinal hernia appear on ultrasound
mass of soft tissue/fluid within the inguinal area
how does scrotal herniation appear on ultrasound
increased fluid and tissue surrounding the testicles
may see bowel loops or omentum in the scrotum
testicles should be normal in size/structure
how are inguinal disorders treated
surgically
inguinal hernia: placement of the viscera and repair the hernia
cryptorchidism: removal of the testes
what are the main 4 disorders of the prostate
- benign prostatic hyperplasia
- cystic BPH
- prostatitis/prostatic abscess
- prostatic neoplasia
benign prostatic hyperplasia
normal process in older, intact dogs
bilaterally symmetric prostate
non painful
cystic BPH
normal process in older, intact dogs
similar as BPH but involves the development of blood filled cysts in the prostate - predisposes to bacterial abscess so you want to treat (unlike BPH)
bilaterally symmetric and non painful
prostatic abscess/prostatitis
inflammation/infection of the prostate
often associated with infection of the bladder/lower urinary tract
asymmetrical prostate
HIGHLY painful
prostatic neoplasia
prostatic adenocarcinoma
asymmetrical prostate
HIGHLY painful
hemospermia
frank blood in the ejaculate
most often originates from the PROSTATE
does hemospermia affect fertility
NO - if natural breeding or fresh
DOES affect fertility if frozen
ddx for hemospermia
- BPH
- cBPH
- prostatic neoplasia
- coagulopathy
- brucellosis
ALWAYS screen for brucella
BPH on ultrasound
symmetrical enlargement of the prostate
striated echotexture
cBPH on ultrasound
symmetrical enlargement of the prostate with mildly heterogenous echogenicity
cysts appear as hypoechoic nodules within the prostate
prostatic neoplasia on ultrasound
irregular margins
mineralization
heterogenous parenchyma
treatment for BPH
none indicated
cBPH treatment
finasteride
5a reductase inhibitor that acts ONLY on the prostate to decrease production of fluid without affecting testes or fertility
priapism
chronic, non-sexual erection
can be ischemic or nonischemic (more common in animals)
nonischemic priapism
caused by high arterial blood flow into the penis
nonpainful
etiologies of priapism
most commonly associated with spinal cord disease of the lumbosacral area
IVDD, myelitis, spinal trauma, spinal malformations
how to diagnose priapism
confirm with physical exam to differentiate from paraphimosis
ID neurologic disease if present
priapism on ultrasound
horizontal echogenic striations indicating dilated blood vessels
treatment of priapism
- terbutaline
- gabapentin
- sympathomimetics (ephedrine, pseudoephedrine)
terbutaline
beta 2 agonist
first line choice for dogs and cats
gabapentin
NMDA antagonist; stimulates GABA and inhibits Ca channels
second line choice if terbutaline fails
ephedrine, pseudoephedrine
sympathomimetics
last resort if the first two treatments fail
do not use in cats due to hypersensitivity
does neutering help treat priapism
NO - erection is not sexually stimulated so castration will not reduce
paraphimosis
penis stuck outside the prepuce
phimosis
penis stuck inside the prepuce
