Male Reproductive Surgery Flashcards
4 components of the reproductive tract
Testes
Penis
Prepuce
Prostate
5 indications for castration
Elective sterilisation (open/ closed)
Treatment of testicular neoplasia
Orchitis (inflammation +/- bacteria)
testicular torsion
Cryptorchidism (retained testicle, hereditary)
Tradeoff of open castration
Better ligature security but more bleeding
Things to be mindful of about hairy scrotum
Sensitive skin - need to be mindful of clipper rash and antiseptic dermatitis
How do you advance the testicle to the prescrotal position?
Cover with drape
Apply pressure through the drape
How to remove the scrotal ligament
Grip the tail of epididymis with fingers and thumb
Grasp the ligament with haemostatic forceps
Apply a shear force to separate the two (good haemorrhage control)
The scrotal ligament is also know as the
Remnant of the gubernaculum
What type of clamps do you use in a castration
Rochester carmalts
What do you need to check for in a closed castration?
Ensure no abdominal contents are within the vaginal canal
What type of ligature is used in a closed castration?
Transfixing suture ligature - palpate the cremaster muscle and anchor a stich through it then continue around the cord (vascular plexus and vas)
What type of knot is used in a dog less than 10kgs?
Square knot
Cat open castration incision
Cranial to caudal skin incision over each testicle
Cat open castration - what do you need to separate the testicle from?
parietal tunic
Where do you transect the ductus deferens?
Near the testicle
How to tie off an open cat castration
tie 2-3 square knots with the ductus deferens and the spermatic vessels
6 complications of castration
Scrotal bruising
Swelling
Seroma
Haemorrhage
Haematoma
Infection
What is scrotal ablation?
a surgical procedure that involves the complete removal of the scrotum
5 indications for scrotal ablation ?
Neoplasia (sometimes with urethrostomy to create permanent opening in the urethra)
Trauma (dog fights)
Abscess
Ischaemia (blood supply problem)
Pendulous (appearance)
What type of incision do you do around the scrotum during ablation?
elliptical incision (watch how much skin is left for closure later)
How to stop the bleeding during scrotal ablation?
Digital pressure, ligation or electrocautery (but not on scrotal tissue)
What else do you need to break down during scrotal ablation?
Scrotal medium septum
What is cryptorchidism?
Failure of one or both testes to descend into the scrotum
- an inherited defect
What happens to spermatogenesis in cryptorchidism?
Spermatogenesis is absent
What is testicular torsion?
ACUTE EMERGENCY
Twisting of the cord that supplies blood to testicles.
This causes sudden and usually severe pain and swelling.
How to treat testicular torsion ?
Surgical removal is best
Need to ultrasound and look for other torsion
Treatment for cryptorchidism
Castration
- Inguinal (groin) approach (ultrasound first to distinguish from fat)
- Laparotomy (abdominal) - 2nd option as bigger procedure
3 types of testicular neoplasia
Seminoma
Interstitial cell
Sertoli cell
all occur in equal numbers
Clinical sign of testicular neoplasia
May cause feminising signs (oestrogens)
What is the prognosis of testicular neoplasia
Good prognosis <10% metastases prior to detection
4 characteristics of testicular trauma
Significant bleeding
Sperm granuloma (lump of leaked sperm that appears along the vas deferens or epididymides in vasectomized individuals)
Fibrosis
Possible infertility
What is hypospadias ?
developmental abnormality - failure of fusion of the genital folds
What is required in hypospadias is severe enough?
Urethrostomy
What breed is hypospadias common in?
Boston terriers
What is this?
Hypospadias
What is persistent penile frenulum?
Can’t extend penis well due to the persistence of a fibrous band from the ventral penis to the prepuce
- it usually ruptures at puberty
What is this ?
Persistent penile frenulum
Characteristics of a dog bifid penis?
Young dog with congenital abnormality
Phimosis (a congenital narrowing of the opening of the foreskin so that it cannot be retracted) due to bifid penis
Smaller defect doesn’t have a urethra
Unable to mate as slips during mating (can’t lock)
Dog bifid penis
Surgical treatment for dog bifid penis
Amputate and suture the defect formed in the urethra, tunica albuginea and mucosa
What is this
Malicious penile strangulation
6 causes of penile trauma
Stick injuries
Wire fences
Mating injuries
Kicks
Bite wounds
Strangulation
Results of lacerations/ bite wounds
severe haemorrhage
Fracture of os penis
Treatment for penile lacerations
Suture fresh lacerations
Antibiotics - topical and systemic
Amputation if severe
Urethrostomy
8 Steps of penile amputation
- catheterise urethra
- apply torniquet
- incise penis as bilateral flaps
- remove catheter, transect urethra
- ligate major vessels
- incise urethra and spatulate
- suture to penile mucosa (4/0 absorbable)
- +/- shorten urethra
Catheterise urethra and apply torniquet
Penile amputation
what is this
Urethral prolapse
What is phimosis
an inability to protrude the penis beyond the preputial opening
(restricted in exteriorisation)
Causes of phimosis
Persistent frenulum
Hypoplasia of preputial opening
Trauma with secondary scarring
small preputial orifice
Signs of phimosis
Often distended prepuce
Don’t urinate with a normal steady stream
Treatment of phimosis
Resect fibrous tissue
Widen preputial opening
How to treat phimosis due to small preputial orifice
Wedge resection from the dorsal prepuce
Suture preputial mucosa to the skin
or circumferential excision and suture
What is paraphimosis ?
Permanent protrusion of a flaccid penis (can’t be pulled back up into penile sheath
4 causes of paraphimosis in dogs
Small preputial opening (disruption to blood flow)
Matted preputial hair (excessive licking)
Congenitally short prepuce
May have self-trauma to penile tip
Treatment for paraphimosis
Surgically enlarge preputial opening
Amputate distal end of penis
Preputial advancement
What is this?
Paraphimosis
How to complete preputial advancement
Lengthen the prepuce by removing a crescent shaped piece of skin cranial to the prepuce, shortening the preputial muscles and advancing the prepuce cranially
What type of gland is the prostate?
Bi-lobed
Where do the vasa deferentia enter ?
Enter the prostate gland dorso-caudally
Blood supply of the prostate gland
Dorsolateral capsule
Sympathetic innervation of prostate gland
Hypogastric nerve
Parasympathetic innervation of prostate gland
Pelvic nerve
5 surgical conditions of the prostate
Benign hyperplasia
Prostatitis / abscessation
Prostatic cysts and paraprostatic cysts
Prostatic neoplasia
Prostatic (squamous) metaplasia (rare)
What is benign prostatic hyperplasia
Benign enlargement of the prostate
increased number and size of cells - pressure causes pressure on urethra and colon
incidence of benign prostatic hyperplasia
Intact male dogs
60% incidence in dogs over 5 yrs - 8-9 most common
Clinical signs of benign prostatic hyperplasia
Constipation
Tenesmus (feel of needing to pass stools, even if empty)
Ribbon like stools
Haematuria (blood in urine) or urethral bleeding
Perineal herniae
Prostatic cysts
MAY HAVE NO SIGNS
Diagnosis of benign prostatic hyperplasia
Rectal exam- non painful, smooth, symmetrical enlargement of prostate
Radiographs, ultrasound, CT
Histopath can be definitive
Differential diagnosis of benign prostatic hyperplasia
Squamous metaplasia
Prostatic cysts or paraprostatic cyst
Prostatitis or abscess
Neoplasia
Treatment for benign prostatic hyperplasia
Castration
Faecal softeners
Oestrogen therapy
Anti-androgens (Tardak)
Why does squamous metaplasia occur ?
Occurs when excess oestrogens (iatrogenic - exogenous administration) or (sertoli cell tumours) resulting in feminising syndrome
so need to remove source of oestrogens
What is prostatitis ?
Infection of the prostate gland +/- abscess
the prostatic parenchyma has purulent material accumulated
Clinical signs of prostatitis
Depression (lethargy)
Pain
Vomiting
Poluria, polydipsia
Haematuria
Incontinence
Straining (and pain)
Ascending infection (UTI)
Pyuria
Straining to defecate & irregular pattern
5 ways to diagnose prostatitis ?
Rectal - enlarged, painful (sometimes asymmetrical)
Radiology
Prostatic wash
FNA
Ultrasonography
Diagnosis ?
Prostatitis
Prostatitis treatment
Castration
Antibiotics for 4-6 weeks
Drainage
Subtotal prostatectomy (surgical removal of part of prostate)
omentalisation (placement of omentum around organs or within cavities to improve vascularization or drainage)
How to drain prostatitis abscessation?
evacuate cavities
breakdown septae within gland
Place drain (penrose, foley, mushroom)
SAMPLE FOR BACTERIOLOGY AND HISTO
Why the omentum in prostatitis treatment ?
Provides drainage
adhesions
induces neovascularisation
functions in presence of infection
Promotes immune function - T and B lymphocytes
Signalment for prostatic neoplasia
Rare, older dogs and cats
Occurs in entire and neutered dogs
Types of prostatic neoplasms
Mostly adenocarcinomas
Otherwise, poorly differentiated carcinomas, squamous cell carcinomas, leiomyosarcomas, transitional cell carcinomas
Clinical signs of prostatic neoplasm
Tenesmus (feeling need to pass stools)
Dysuria (pain urinating)
Stranguria(small volume, want to pass more)
Urethral bleeding
Lumbar pain
Lameness
Emaciation
Treatment for prostatic neoplasm
Total prostatectomy
Intraoperative radiotherapy
Permanent tube cystostomy
Castration
Oestrogen therapy
5 sites of early metastases of prostatic neoplasia
Lymph nodes
Bladder
Lungs
Rectum
Bone
Prostatic neoplasia prognosis
GRAVE!
Mean survival time - 3 months
What is a prostatic cyst?
Aetiology unknown but common
Fluid-filled (colourless-brown), non septic cyst with calcified walls within or communicating with the prostate
Signalment for prostatic cysts
Entire males
Large Breeds
Treatment of prostatic cysts
Castration
Excision
Drainage
Marsupialization
Omentalization
7 steps of a prostatic wash
- Catheterise bladder
- empty bladder
- flush bladder 5-10mls saline (pre-wash sample)
- Withdraw catheter tip to prostate
- Massage prostate
- inject 5-10mls saline
- Aspirate fluid from urethra and bladder (post wash sample)
Diagnosis of histopath results of fibrous reaction + irregular acinar structures lined by hyperchromic epithelial cells
Clincial signs dripping puss from penis, nonresponsive to AB’s, restless, mild dysuria , enlarged painful prostate
Prostatic adenocarcinoma
4 components of the reproductive tract
Testes
Penis
Prepuce
Prostate
