Male Reproductive Surgery Flashcards
reasons to neuter cryptorchids
- it is heritable
- increases risk of neoplasia
- increases risk of testicular torsion
how to locate inguinal cryptorchids
examine the scrotum and inguinal area under anesthesia
palpate along inguinal area - palpate just off of midline, push the descended testicle cranially and see which side it deviates to to figure out which side is the cryptorchid
- if unable to find, use ultrasound
- if unable to find on US, use AMH testing
how to locate intraabdominal cryptorchids
ultrasound (not palpable)
cryptorchidectomy steps
- caudal celiotomy
- dx inguinal vs intraabdominal testes
- ligate and divide pedicles
what incison should be used for the caudal celiotomy
parapreputial incision
incise lateral to the prepuce through the skin and SQ
once linea is visualized –> push the prepuce laterally and incise the linea along midline (do NOT make incision into the body wall lateral to the linea)
make incision long enough to see all structures
how to ID inguinal vs intraabdominal testes
once in the abdomen - look for the testicular vessels and spermatic cord extending through the inguinal ring –> indicates testicular descent into the scrotum
if no testicular vessels or spermatic cord going through inguinal ring –> testes is intraabdominal
where are most intraabdominal testes located
lateral or cranial to the bladder
risk factors for testicular neoplasia
common in cryptorchid testes; usually an incidental finding
even if the other testicle is not enlarged - remove anyway because can be neoplastic
clinical signs of testicular neoplasia
enlarged or asymmetric testicles
types of testicular tumors and are they metastatic
- sertoli cell tumor
- leydig cell tumor
- seminomas
NONE are very metastatic
what are signs of a sertoli cell tumor
feminization syndrome
- alopecia
- gynecomastia
- pendulous prepuce
- prostatic dysfunction
caused by imbalance of estrogen to testosterone
diagnostics for testicular tumors
abdominal ultrasound - want to evaluate for LN involvement
surgical management of testicular tumors
bilateral orchiectomy
if scrotal –> perform a closed castration with scrotal ablation
scrotal ablation
elliptical incision around the scrotum –> tie off the pedicles –> remove and reappose the skin edges
indications for scrotal ablation
- postoperative neuter scrotal hematomas
- testicular neoplasia
- testicular torsion
- older dogs w/ pendulous scrotum
what causes postop neuter scrotal hematomas
subcutaneous bleeders from the incision
if not severe - can be treated with icing and warm packing + analgesics (does not always need scrotal ablation
indications for penile surgery
- trauma (most common)
- neoplasia
- congenital (hypospadias)
penile neoplasia
mast cell tumors
SCC
less common: HSA, transmissible venereal tumors
surgery for removing penile neoplasia
complete penile amputation
requires a scrotal urethrostomy to reroute urine passage
why perform urethrostomy at the scrotum
widest part of urethra
closest contact with the skin
hypospadia
urethral folds fail to close –> urethra doesn’t form a complete tube
if mild/asymptomatic - does not require repair
if symptomatic - requires penile amputation and urethrostomy
steps of penile amputation
- place large bore red rubber catheter - aids with making incision into the urethra
- incise around the penile base and lift off of the body wall
- oversew the penile stump (cannot do simple ligation)
- close incision by suturing the skin to the penile mucosa
always perform with scrotal urethrostomy
how to diagnose prostatic disease
- digital palpation - assess size, symmetry, discomfort
- lab sampling - prostatic wash, FNA
- imaging - radiographs, US, CT
prostatic abscess etiology
ascending infection up the urethra
bacteria:
- e. coli
- staph
- strep
- proteus
- klebsiella
clinical signs of prostatic abscess
dyschezia
dysuria
pyrexia
signs of septic peritonitis (if ruptured prostatic abscess)
diagnosis of prostatic abscess
ultrasound
surgical treatment of prostatic abscess
caudal celiotomy (parapreputial approach)
1. find prostate and palpate for abscess
2. open up pockets and aspirate out fluid
3. ALWAYS submit for culture and biopsy
4. open the prostatic capsule and omentalize
5. place a drain that extends CRANIO-VENTRALLY under the liver
function of omentalization
omentum contains high lymphatic drainage - aids in clearing ongoing bacteria after closure
paraprostatic cyst
cysts that arise from the prostate - can get very large leading to a mass effect in the abdomen
clinical signs of paraprostatic cyst
dysuria
dyschezia
constipation
diagnosis of paraprostatic cyst
ultrasound - large fluid filled structure
radiographs
surgical treatment of paraprostatic cysts
subtotal excision and omentalization
- open and drain the cyst
- resect 85% of the cyst wall and omentalize
do NOT resect the entire cyst - very close and associated with the ureters so do not want to ligate accidentlly
what is the most common prostatic neoplasia? metastasis? is neutering preventative?
adenocarcinoma
HIGHLY metastatic - bone, LNs, lungs
castration is NOT protective for developing prostatic cancer
diagnosis of prostatic adenocarcinoma
FNA of the prostate
medical treatment of prostatic adenocarcinoma
piroxicam (NSAIDs)
surgical treatment of prostatic adenocarcinomas
prostatectomy
LESS COMMON than medical management and interventional procedures
do not want to remove entire prostate since it is the sign of high pressure/resistance in the urethra –> total prostatectomy will cause urinary incontinence
interventional procedures for prostatic adenocarcinoma
urethral stenting + NSAIDs
relieves the obstruction of the mass - similar incontinence rate as prostatectomy
urethral prolapse
protrusion of the distral urethral mucosa
occurs in young, male, intact brachycephalics
etiologies of urethral prolapse
excessive mating
UTIs
urinary stones
urinary obstruction secondary to increased intraabdominal pressure
surgical treatment of urethral prolapse
urethropexy OR urethral R&A
is recurrence common with surgical treatment of urethral prolapse
yes regardless of surgery type
recommendations for reducing recurrence
castration + treating upper airway obstruction (if boas)
urethropexy
pexy the prepuce to the urethra with TEMPORARY sutures
need to be removed once scar forms
urethral R&A
full thickness incision through the prolapsed tissue partially around the circumference –> place interrupted sutures of absorbable 4-0 or 5-0 monofilament between mucosa and penile opening
PERMANENT - do not want sutures removed
