Neuter Flashcards
What is the testicle? What is a neuter?
male reproductive gland that produces sperm
surgical removal of BOTH testicles regardless of location
- castration
- orchiectomy
- orchidectomy
What are the 3 main reasons to neuter pets?
- sterilization - population control, less likely to be returned to the shelter
- removal of male characteristics - removes primary source of testosterone important for prostate health, decreases roaming behaviors, lowers aggression, decreases odor and urine spraying
- disease control/treatment - healthier with age
What is the difference between routine/elective neuters and neuters for medical treatment?
ROUTINE/ELECTIVE - young, happy, healthy patients with no clinical signs
MEDICAL TREATMENT - patients with some kind of disease process typically involving the testicles and/or epididymis with clinical signs relating to the underlying disease process
When are healthy canines and felines neutered?
CANINE: 6 months to 2 years depending on breed and lifestyle and tends to be earlier in shelter medicine (unlikely to see the dog after adoption)
FELINE: 6 months+
What diseases/conditions are commonly treated with a neuter?
- cryptorchidism
- testicular hypoplasia/atrophy
- scrotal or testicular trauma
- testicular torsion
- prostatic diseases
- neoplasia
- orchiditis/epididymitis
- perineal hernia
What is cryptorchidism? What are the 2 types?
one or both testicles do not descend from the abdomen (undescended = prone to cancer, genetic predisposition and should not be bred)
- inguinal - made it through abdomen
- abdominal - inside
What are 2 common presentations upon physical exam with cryptorchidism?
- may be able to palpate the testicle in the inguinal canal (ultrasound if you cannot for surgical planning)
- abdominal mass
What neoplasia is cryptorchidism commonly secondary to? What are 2 clinical signs of this?
Sertoli cell tumors
- alopecia
- enlarged mammary glands
What is testicular hypoplasia/atrophy?
poor development or degeneration of the testicles, typically without clinical signs unless associated with neoplasia
How does scrotal/testicular trauma present? What is the most common cause?
scrotal/testicular swelling or discoloration, hemorrhage, and/or pain
blunt force trauma
What is testicular torsion? How does it typically present?
spermatic chord rotates on itself, which leads to ischemia
- necrosis
- acute scrotal/testicular swelling
- pain**
What 4 prostatic diseases can be treated with a neuter? Why does this work?
- prostatitis
- prostatic cyst and abscess
- prostatic hypertrophy (most common in intact males)
- prostatic cancer
testosterone increases prostatic size and neutering will cut off the supply of testosterone
What are 5 clinical signs associated with prostatic disease?
- constipation
- straining to defecate (tenesmus)
- abdominal pain
- straining to urinate
- hematuria/urine discoloration
What 3 neoplasias require a neuter for treatment?
- testicular neoplasia
- scrotal neoplasia
- perianal gland adenoma
What are 5 common clinical signs pointing to neoplasia requiring neuter for treatment?
- enlargement of 1 or both testicles
- enlargement of scrotum
- pain
- hair loss
- mammary gland enlargement
What is the difference between orchitis and epididymitis? What are 5 clinical signs?
- ORCHITIS: inflammation/infection of the testicle
- EPIDIDYMITIS: inflammation/infection of epididymis
- testicular/scrotal pain and swelling
- depression
- lethargy
- fever
- anorexia
What are perineal hernias secondary to?
progressive weakness and failure of the pelvic diaphragm (displaced pelvis allows organs to fall through gap)
- high likelihood in intact males, likely due to hormone imbalances
What are 4 clinical signs of perineal hernias?
- swelling adjacent to rectum
- constipation
- straining to defecate
- straining to urinate
Testicle anatomy:
Neuter incision site:
What are the 3 canine neuter approaches? When are they used?
- PRESCROTAL: routine/elective
- SCROTAL: routine/elective (fast)
- SCROTAL ABLATION (scrotum removal) - scrotal/testicular neoplasia or trauma, non-resolving scrotal hematoma (pendulous)
How are neuter approaches different in cryptorchid patients?
inguinal vs. abdominal depending on the site of the retained testicle(s)
What 4 things are part of the surgical preparation for neuters?
- aseptic technique
- clip hair carefully to avoid razor burn
- chlorhexidine + alcohol skin prep
- lidocaine testicular block for comfort (firms up the area)
What are the 2 types of neuter techniques?
- CLOSED: parietal vaginal tunic is NOT incised; associated with post-op swelling and oozing
- 1 to 2 ligatures - OPEN: parietal vaginal tunic IS incised, giving direct visualization of individual components of the testicle
- 3 to 4 ligatures to ligate each individual component
Why is there a possible risk of abdominal infection with open neuters?
incision of parietal vaginal tunic causes a communication with the abdominal cavity to develop
Draped patient:
How is the prescrotal approach began? Where should the incision be made? What blades are used?
isolate the testicle with non-dominant hand and push upwards away from the scrotum and toward the prepuce
median raphe directly over the testicle; cranial to the scrotum and at the caudal end of the penis
- keep the testicles from moving so the prepuce is not knicked
- 10 to 15 blades
What is done after the prescrotal incision has been made? What can help with bleeders?
incise subcutaneous tissue
- mosquitos
- dab with gauze
What precaution needs to be done while incising the subcutaneous tissue? What can point towards being in the correct position?
avoid incising internal spermatic fascia and parietal vaginal tunica
shiny appearance
What is done after the subcutaneous tissue has been incised? How is this done?
dissect the scrotal ligament using either gauze or blunt dissection with a blade to release the testicle and continue stripping fat and subcutaneous tissue until the spermatic chord is isolated
grab spermatic cord at the caudal end of the incision and pull the testicle cranially
What is the 3 clamp technique?
3 hemostats are applied proximal to the testicle with 2 ligatures applied and the testicular pedicle is transected
- circumferential
- transfixing (can only be the most distal)
- 1 to 2 for small dogs, minimum of 2 for large dogs
What should be noted when using curved hemostats for the 3 clamp technique?
make sure they are pointing upwards toward the testicle
Where is the 1st ligature placed in the 3 clamp technique? What ligature is typically places here?
placed on crushed tissue once the proximal hemostat is removed
circumferential- Miller’s, modified Miller’s, surgeons knot, square knot
Where is the 2nd ligature places in the 3 clamp technique? How is this done? What 2 kinds knots are typically used?
placed between 1st ligature and middle hemostat
loosen the forceps while the first 2 throws of ligature are being secured (flash) and reclamp
- circumferential - Miller’s, modified Miller’s, square
- transfixing - 2 knots
Where is the testicular pedicle transected after the 2 ligatures are placed?
between the 2 remaining clamps
What 3 things are done after both testicles have been removed?
- check for bleeders
- subcutaneous tissue closure - simple continuous
- skin closure - intradermal, simple interrupted
Why is it important to close the subcutaneous tissue before the skin is closed? What should be avoided at this step of the neuter?
prevents scrotal hematomas
including the retractor penis muscle
In what 2 instances is the scrotal approach used in a neuter? In what 2 ways does it does differ to the prescrotal approach?
- routine/elective neuters
- underage dogs/puppies
- faster
- associated with more oozing
Where is the scrotal incision done? What technique is preferred?
on the scrotum, slightly lateral to the median raphe, where the testicle will be removed through
CLOSED - 1 to 2 ligations for small dogs, minimum 2 for large dogs
How are scrotal incisions closed? What is normal to see after the incision is closed?
1 single buried subcutaneous suture in the scrotal incision +/- tissue glue
small amount of oozing
What are 3 important aspects of post-operative care after a neuter?
- exercise restriction for 10-14 days with suture removal at 10-14 day recheck
- E-collar on for at least a week
- NSAIDs - Carprofen (Rimadyl), Meloxicam (Metacam)
(can add Trazadone for calming effect and exercise restriction
What approach is always done for cat neuters? How are perineal urethrostomies treated?
scrotal approach directly over each testicle with a 15 or 10 blade
scrotal ablation
How does the ligation in cat neuters differ from canine neuters?
AVOID SUTURE - cats will likely have a tissue reaction
- use auto-ligation or a figure 8 tie
How are feline neuters different than canine neuters with regard to closure?
left open to drain and heal by second intention
What are 3 important aspects to post-operative care following feline neuters?
- use shredding paper or Yesterday’s News instead of regular litter to avoid crystals from getting in the surgical site
- NSAIDs - Onsior, Metacam (3 total doses)
- E-collar
What are 5 common neuter complications? In what species are they more common?
- hemorrhage
- scrotal irritation/bruising due to aggressive tissue handling
- scrotal hematoma most common with running or exercise within 24 hrs of surgery
- infection
- dehiscence
dogs > cats
