Male reproductive tract Flashcards
What is the definition of cryptorchidism?
- Failure of either testicle to descend
- Monorchidism–absence of one testicle
- Anorchidism–absence of both testicles
What are the characteristics of cryptorchid testicles?
- Sterile
- Suppress spermatogenesis in normal testicle
- Highly prone to neoplastic transformation
- Often atrophied
What age should testicles be descended?
- Usually descended by 30-40 days
- Anecdotally delayed in some breeds
- Unequivocal diagnosis after 6 months
T/F: Cryptorchidism is genetically transmitted
TRUE
How do you find prescrotal testicles?
- Usually palpable in SQ
- Between inguinal ring and scrotum
- To remove, incise directly over testicle
How do you find inguinal and abdominal testicles?
- Abdominal U/S to locate
- Exploratory laparotomy
- To remove abdominal testicle–caudal celiotomy incision
- Skin incision adjacent to prepuce
- Divide preputial muscle, vessel
- Midline incision
- Follow testicular artery or vas deferens
How is testicular torsion diagnosed?
- More common with abdominal testicles
- Clinical signs vary
- Mild signs (anorexia, lethargy)
- Acute abdomen (marked pain, shock)
- Diagnosis by U/S, palpation
T/F: Testicular torsion is fatal without surgical treatment
TRUE
Surgical emergency!
T/F: Prognosis of testicular torsion is poor, even after surgery
FALSE
Prognosis good after surgery
Are cryptorchid testicles prone to neoplastic transformation?
YES
Can neoplastic testicles be functional?
YES
- Feminism syndrome–sertoli cell
- Alopecia, prostate disease, gynecomastia
- Bone marrow suppression–poor prognosis
- Testosterone–interstitial cell
- Perineal hernia
- Perianal adenoma/adenocarcinoma
What staging workup should be performed with testicular neoplasia?
- CBC/chem/UA
- 3-view thoracic rads to check for metastasis
- Abdominal rads/ultrasound to check for metastasis
What is the likelihood of metastatic disease in canine testicular neoplasia?
Metastasis is rare (<10%)
Which surgical procedures are recommended for treatment of un-metastasized neoplasia?
Bilateral castration with scrotal ablation (complete removal of the scrotum)
What is the prognosis with surgical treatment of un-metastasized neoplasia?
If no mets, surgery may be curative
What is scrotal ablation?
Complete removal of the scrotum
T/F: Scrotal ablation requires castration
TRUE
What is hypospadias?
- Incomplete formation of the penile urethra
- Most common developmental anomaly of the external male genitalia
What species is hypospadias most common in? What are the signs?
- Most common in Boston Terriers
- Signs dependent on location
- Minimal signs
- Urine scalding
What is paraphimosis?
Inability to retract penis into prepuce
What are the congenital causes of paraphimosis? What are the acquired causes?
- Congenital
- Narrowed orifice
- Shortened prepuce
- Acquired
- Trauma
- Infection
- Priapism (persistent and painful erection)
What are the medical treatments for paraphimosis?
- Lube
- Hyperosmolar solutions–reduce swelling
- Cold/heat
- Prognosis dependent on duration
What is phallopexy?
- Surgical treatment for paraphimosis–recurrent cases
- Paired incision made in mucosa
- Dorsal midline of the penis
- Dorsal midline of the prepuce
- Close defects to each other–tack the penis into the prepuce
- 3-0 or 4-0 absorbable monofilament
- Simple interrupted or continuous pattern
- If there is necrosis of the penis you will have to amputate
What procedure is indicated for tumors of the penis?
- Penile amputation
- Indicated for most causes of trauma or neoplasia
- Resection dependent on location/extent of disease
What are the common tumor types arising from the penis?
- TVT–not usually treated surgically
- Papilloma
- Squamous cell
- Mast cell tumor
T/F: TVT is not treated surgically
TRUE
T/F: Preputial MCT’s are the least malignant MCT sites
FALSE
What are the 2 components necessary for reconstruction of the prepuce?
Epithelial surface (local, haired skin)
Mucosal surface (usually oral cavity)
What are the PE findings and clinical signs of benign prostatic hyperplasia (BPH)?
- Normal aging change
- Clinical signs
- dyschezia (difficult or painful defecation)
How do you diagnose BPH?
Palpation and U/S
- Palpation–symmetrically enlarged, pain-free prostate
- U/S shows characteristic homogenous enlargement of prostate
How do you differentiate BPH from other prostatic disease?
- Differentiate based on palpation and U/S
- All looks very uniform, unlike neoplastic conditions
How is BPH treated?
Castration
What are the 2 components in the etiology of prostatitis?
- Ascending infection from the urethra (E. coli most common organism)
- Pre-existing BPH required
What are the clinical signs of prostatitis?
- Dyschezia
- Pain on urination/defecation
- Purulent penile discharge
- Signs of illness: anorexia, lethargy, fever
- Severe cases: septic shock, peritonitis
How do you differentiate prostatitis from other prostatic disease based on ultrasound and palpation findings?
- Ultrasound
- Heterogenous prostate
- Pathognomonic flocculent fluid appearance
- Rectal palpation
- Bilobed, symmetrical prostate
- Prostate very painful
- Palpate carefully, do not rupture
What are the ramifications of severe cases of prostatitis?
- Might need aggressive resuscitation
- MIght need hospitalization
- Will have to go into abdomen to address the problem
What is the surgical treatment for mild cases of prostatitis?
- Systemic antibiotics
- Fluid support
- Castration
What is omentalization of the prostate?
Bringing omentum into or through abscess cavity
Omentum improves drainage
What is the typical signalment of a dog with prostatic cysts?
Older, intact male dogs
What are the clinical signs of a dog with prostatic cysts?
- Large, discrete mass in caudal abdomen
- May be asymptomatic–incidental finding
How do you differentiate prostatic cysts from other prostatic diseases based on ultrasound and clinical signs?
- “Double bladder” on ultrasound
- Fluid aspiration
- Brown, watery fluid
- May become secondarily infected
What procedure is indicated for smaller cysts or with limited attachment?
Surgical resection
Which procedure is indicated with large cysts or with capsular/urethral communication?
Partial resection and omentalization
T/F: Castration is indicated with any prostatic cyst
TRUE
What is the prognosis for treatment of prostatic cysts?
Good
Can surgery for the treatment of prostatic cysts result in urinary incontinence?
NO
Urinary incontinence is due to the cyst, NOT the surgery
Cyst causes anatomic changes in the urethra
What is the most common type of prostatic neoplasia?
- Usually malignant
- Adenocarcinoma, various subtypes
- 80% havfe metastasis on necropsy
T/F: Most patients with prostatic neoplasia have metastatic disease at the time of diagnosis
TRUE
What is the effect of castration on the incidence of and prognosis for prostatic neoplasia?
- Increased incidence
- Increased risk of metastasis
- Castration neither palliative nor effective
What are the clinical signs compatible with prostatic neoplasia?
- Dysuria
- Hematuria
- Urinary retention
- Dyschezia–renal compression
- Wt. loss, lethargy, pain
- Lameness common due to bone metastasis
Why is surgical treatment not typically pursued for prostatic neoplasia treatment?
Not an easy or straightforward procedure
Will usually introduce complications like incontinence
What is the palliative treatment for prostatic neoplasia?
Tube cystotomy or urethral stent
What is ligated and divided during vasectomy?
Prescrotal incision–>little incision in prepuce–>incise down to spermatic cord
Double ligate ductus deferens
Why does a vasectomy have no effect on testosterone-related disease?
Vasectomy only affects fertility
(Causes animals to ‘fire blanks’)
T/F: When neutering a cryptorchid patient, you should always remove the abnormal testicle first
TRUE
T/F: When ligating a testicle after testicular torsion, you should de-rotate the testicle prior to ligation
FALSE
Do NOT de-rotate the testicle
What are the indications for surgical treatment of paraphimosis?
- Recurrent condition
- Small diameter preputial opening
- Necrosis
How do you surgically treat congenital paraphimosis?
- Enlarge preputial orifice
- Advance prepuce
- Partial penile amputation may be necessary
How do you surgically treat acquired paraphimosis?
- Treat underlying condition
- Castration if intact (esp. for priapism)
- Phallopexy if persistent
- Penile amputation if necrosis present
