Neutering Flashcards
The testicle is the male _______ gland that produces _____.
reproductive, sperm
What are the terms used to describe the surgical removal of both testicles [regardless of location.
– Neuter
– Castration
– Orchiectomy
– Orchidectomy
Why Neuter?
- Sterilization
- Population control
- Permanent birth control - Elimination of male characteristics
◦ Removes primary source of
testosterone
- Prostate gland; under testosterone, prostate gland enlarges over time, some dogs may never have a problem, others are affected in terms of comfort level, issues defecating. Prostate of an intact male mostly in dog predisposes them to infection, any type of infection in the prostate is impossible to clear up.
◦ Roaming behaviors (go off to try and find female)
◦ Aggression [cats vs. dogs]
◦ Odor or urine [cats]
- Tend to live longer, fewer behavioral problems, less likely to be relinquished back to a shelter. - Disease control/treatment
Two situations in which you Neuter:
- Routine/Elective
◦ Usually young, happy, healthy
patients
◦ No clinical signs - Medical Treatment
* Patients with some sort of disease
process
* Typically involving testicles and/or
epididymis
* Clinical signs relate to underlying disease process and treatment of choice tends to be neutering
When do you Neuter your pet?
- Happy Healthy Pets!
◦ Canine
◦ 6 months – 2 years* - Feline
◦ 6 months - 1 year in a cat
Usually at 6 months for cats because likelihood of people bringing their cats back is slim.
Dogs: depends on breed, lifestyle. Shelter med always does as soon as possible b/c we don’t want them to end up back in shelters or contributing to increase in population. Bigger dogs/large breed dogs should be neutered later in life due to bone development. For females, if you wait longer they are going to go through a heat cycle.
GS, GR = 12 to 18 month mark
Cryptorchidism
◦ ____ or ___ testicles do not descend from the _____
◦ Retained testicles can be either:
◦ _____
◦ _____
*Need to be neutered _____; there is a _____ component. The one that is retained has a greater risk of testicular ____ (_____ cell tumor that secrete ____ –> ______ gland development, more ______ behaviors in a male dog)
–> Physical examination
◦ You may be able to palpate testicle in the ______ ____.
◦ Some may present as an abdominal ____
◦ If secondary to Sertoli cell tumor, you can find ______ and ______ mammary glands
◦ ______ may be helpful to make surgery plan.
One, both, abdomen, Inguinal, Abdominal, ASAP, genetic, cancer, sertoli, estrogen, mammary, feminine, inguinal, canal, mass, alopecia, enlarged, Ultrasound
When to Neuter?
◦ Testicular ______/_____
◦ Usually there are __ clinical signs unless associated to certain _____
◦ _____ development
◦ __________
◦ Becomes ______ in size; you see _______ changes
Hypoplasia, Atrophy, no, neoplasia, Poor, Degeneration, smaller, microscopic
Cryptorchid
When to Neuter?
◦ Scrotal or Testicular ____
◦ May show scrotal _____ or _______, testicular _____
or _____, _____, and/or pain
Trauma, swelling, discoloration, swelling, discoloration, hemorrhage
When to Neuter?
◦ Testicular _______
◦ Spermatic chord ______ on itself which leads to _______ tissue
◦ Acute scrotal/testicular _____
◦ _____
Torsion, rotates, ischemic, swelling, Painful
When to Neuter?
1. Prostatic Diseases (3)
2. What is the driving source of these prostatic diseases?
–> Clinical Signs
◦ ______
◦ Straining to ______ [______]
◦ _____ pain
◦ ______ to urinate
◦ _____/______ of urine
- ◦ Prostatitis
◦ Prostatic cyst and abscess
◦ Prostatic hypertrophy (one of the most common ones in intact male dogs).
◦ Prostatic cancers; can happen secondary to transitional cell carcinomas in the bladder. Priary may be in bladdder and prostatc cancer secondary to that - rare, but possible. - Testosterone
Constipation, defecate, tenesmus, Abdominal, Straining, Hematuria, discoloration
When to Neuter?
1. Neoplasia. List the examples.
–> Variety of clinical signs
◦ Enlargement of __ or ____ testicles
◦ Enlargement of ______
◦ ____
◦ ____ loss
◦ Mammary gland _______ depending on what is going on.
◦ Testicular Neoplasia
◦ Scrotal Neoplasia
◦ Perianal Gland Adenoma is very common. Neuter the dog, fix the problem.
1, both, scrotum, Pain, Hair, enlargement
Testicular neoplasia
When to Neuter?
1. Orchitis
◦ _______/______ of testicle
2. Epididymitis
◦ Inflammation/infection of _______
–> Clinical signs:
◦ Testicular/scrotal ____ and _____
(4)
Inflammation, infection, epididymis, pain, swelling, ◦ Depression
◦ Lethargy
◦ Fever
◦ Anorexia
When to Neuter?
1. Perineal Hernia
◦ Secondary to ______ weakness and failure
of the ______ ______;
Usually occurs in intact males, so if you neuter at a reasonable age chances of this is less likely; actual correlation is unknown, only a handful of cases in neutered male dogs.
◦ ______ or _____
–> Clinical signs:
◦ Swelling _____ to the rectum
◦ ______
◦ Straining to _______
◦ Straining during _____
In both cats and dogs
progressive, pelvic diaphragm, Unilateral, bilateral, adjacent, Constipation, defecate, urination
Label accordingly
What are the Canine Neuter Approach Options?
What do you do in the case of a cryptorchid patient?
- Prescrotal
◦ Routine/elective neuter - Scrotal
◦ Routine/elective neuter
◦ Faster than Prescrotal - Scrotal Ablation
◦ Removal of scrotum
Scrotal/testicular neoplasia or trauma
◦ Secondary to non-resolving scrotal hematoma
(pendulous scrotum)
–> Cryptorchid Patients
◦ Inguinal vs. abdominal approach
Differences between prescrotal and scortal?
Prescrotal
- heal in ___-___ days
- _________ acceptable way to neuter
- encapsulating ______, _____ runs through it so if it is in closure –> _______. High possibility.
Benefits to scrotal?
- studies coming out and is now more popular
- _______ approach than prescrotal
- if in a high volume shelter, _____ is everything; older dog, ____ is everything
Cons to scrotal?
More ________ from incision site than with prescrotal. (Post-op drainage).
If there is a _______, don’t want to take infected tissue into surgery site.
Prescrotal
- heal in 10-14 days
- original acceptable way to neuter
- encapsulating prepuce, urethra runs through it so if it is in closure –> complications. High possibility.
Benefits to scrotal?
- studies coming out and is now more popular
- faster approach than prescrotal
- if in a high volume shelter, time is everything; older dog, time is everything
Cons to scrotal?
More discharge from incision site than with prescrotal. (Post-op drainage).
If there is a pyoderma, do ont want to take infected tissue into surgery site.
Surgical Preparation
◦ _____ technique
◦ ____ hair carefully
◦ Avoid razor ____
◦ _______ + _____ skin prep
◦ ______ testicular block (___ mg/kg dose, split between both testicles). Once you feel _______, stop administering.
Aseptic, Clip, burn, Chlorhexidine, alcohol, Lidocaine, 2, firmness
There are two Neuter Techniques: Closed and Open.
1. Closed
◦ Is the Parietal vaginal tunic incised?
◦ ___ time?
◦ Less post-op _____/ ____
◦ ___ or __ ligature to tie
2. Open
◦ Is the Parietal vaginal tunic incised?
◦ ____ visualization of individual
components of testicle
◦ Communication with _____
cavity
◦ More risk of abdominal _______? Not established.
◦ ___ to ___ ligature to tie
Ligating individually? in which option?
It is not incised
Less, swelling, oozing, 1, 2
It is incised
Direct, abdominal, infection, 2, 4
Draped patient
Describe the Pre-Scrotal Approach:
◦ 1. Isolate testicle with non-dominant hand and push upwards away from scrotum and towards prepuce
◦ 2. Make incision on median raphe directly over testicle
◦ Testicle shouldn’t move while making incision b/c if you do, run risk of knicking prepuce and if go too deep, the urethra is under there.
◦ Use a 10 – 15 blade
- Incise subcutaneous tissue
◦ This will expose testicle to clamp, tie it off, and remove.
◦ Mosquitos sometimes used to control subcutaneous bleeders
◦ Metzenbaums used sometimes to widen area.
◦ Make sure not to incise internal spermatic fascia/parietal vaginal
tunica
◦ Incise just up to it
◦ It has a slightly shiny appearance. - Dissect scrotal ligament [using either gauze or bunt
dissection with a blade] to release testicle. Use gauze to pull fascia down to tie ligatures. DONT grab skin
◦ Grab spermatic cord at caudal end of incision and pull testicle cranially - Once released, continue to strip the fat and subcutaneous
tissue until spermatic cord is isolated
3 Clamp Technique
◦ 3 hemostats are applied _____ to the testicle
◦ If using curved hemostats, make sure they are pointing ______ toward the testicle
◦ __ ligatures are applied: _______ OR _____
◦ Only on the most ____ ligature
◦ 1 – 2 ligatures for ____ dogs
◦ Minimum 2 ligatures for ____ dogs
◦ Testicular _____ is transected
proximal, upwards, 2 , Circumferential, Transfixing, distal, small, large, pedicle
3 Clamp Technique
Continued…
◦ 1 st Ligature (A)
◦ Placed on “crushed” tissue once proximal hemostat is removed
◦ Circumferential
◦ Miller’s knot
◦ Modified miller’s knot **
◦ Surgeons knot
◦ Square knot
What can be seen in the image below
2nd Ligature (B)
◦ Placed between 1st ligature and middle
hemostat
◦ Loosen the forceps while first 2 throws of ligature
are being secured (aka “flash) and then re-clamp
◦ Circumferential
◦ Miller’s knot
◦ Modified miller’s knot
◦ Square knot
◦ Transfixing - Only applied on most distal ligature
◦ 2 knots
◦ Transect testicular pedicle between 2
clamps
2nd Ligature (B)
◦ Placed between 1st ligature and middle
hemostat
◦ Loosen the forceps while first 2 throws of ligature
are being secured (aka “flash) and then re-clamp
◦ Circumferential
◦ Miller’s knot
◦ Modified miller’s knot
◦ Square knot
◦ Transfixing
◦ Only applied on most distal ligature
◦ 2 knots
◦ Transect testicular pedicle between 2
clamps
DO NOT CUT TESTICLE BEFORE PLACING LIGATURE.
- Check for bleeders after both testicles
have been removed - Subcutaneous tissue closure
◦ Helps prevent ______ _______
◦ Do not include ______ _____ muscle
◦ _______ ______ pattern - Skin closure
◦ __________
◦ Simple _________
scrotal hematomas, retractor penis, Simple continuous, Intradermal, interrupted
Watch video
https://www.youtube.com/watch?v=WJIhxr_fqv8&t=294s
The Canine Neuter Procedure using the Scrotal approach is:
◦ Used for _______/________ neuters
◦ _______ than Prescrotal
◦ Good technique for _______ dogs/puppies under ____ months of age.
◦ Associated with more “________” at the neuter site. Tell owners this so they are prepared.
General rule of thumb for puppies whether spermatic chord can be ligated using auto ligation or figure 8knot or if you need to use suture an throgh lig ther. if scrotum is not pendulous adn testicular size is no larger than you would see in a tom cat, then the techniue for auto ligtion is approrpiate. as they get larger, go ahead nad use suure becasue suture is more secure.
Routine, elective, Faster, Underage, 6, oozing
Which approach was used for this neuter procedure?
Scrotal
Which approach was used for this neuter procedure?
Scrotal
Stripping fascia down is not shown here.
After the initial incision, the steps are exactly the same for pre scrotal and scrotal.
Describe the prep for the scrotal approach to a neuter procedure.
Same as for the prescrotal appraoch.
Clip and scrub surgical site.
Prior to making scrotal incision, you drape the patient. The fenestration is directly over the scrotum. Before you make your incision, pull scrotal skin taught over the testicle before you make your first incision.
Where is the incision made during a scrotal approach neuter?
–> Scrotal incision
◦ Slightly lateral to median raphe
Once testicle is removed, you slide the other testicle through that SAME incision. Removing both through 1 incision.
Sometimes, one testicle may lie more cranial to the other. In this case, Remove more cranial testicle first because the second testicle has greater mobility when pushing it up toward the prepuce.
After you make the first incision, the first testicle is removed through ?
The scrotal incision.
The scrotal approach should ideally be performed as a ________ castration.
Closed
Open really happens acciedentally.
How many ligatures are used in the scrotal approach on SMALL dogs? What suture pattern would you use?
1-2 ligatures, Circumferential, transfixing.
Depending on size and patient, you can either do (small) auto ligate or do a figure 8, if (larger) put ligatures.
How many ligatures would use in the scrotal approach on a LARGE dog?
Minimum 2 ligatures
What approach is being used for this neuter procedure?
Scrotal
When closing a neuter, via scrotal approach, the surgeon uses how many knots? Where is the knot placed?
1 single buried subcutaneous suture in the scrotal incision.
When close scrotal approach, most veterinarians apply tissue glue in addition to the ligature to reinforce that incision.
Is oozing normal when using the scrotal approach?
Yes, a small amount of oozing is normal.
Canine Neuter [Scrotal Approach] video
https://www.youtube.com/watch?v=y_7jgpIkhzY
What does post-Operative care for a Closed neuter procedure?
- Exercise restriction
◦ At least 10 days, 14 days is ideal (but rarely happens).
◦ Suture removal at day 10 – 14 or recheck incision [if not sutures to be removed]. - E-collar
◦ Keep on at least 1 week! - NSAIDs to go home [~5 – 7 days]
◦ Carprofen (Rimadyl) for about 5 days, rarely send for longer + Trazodone on top of it to keep the patient calm during recovery to help owners with this process.
◦ Meloxicam (Metacam)
Cat Neuter
Always use a ______ approach
◦ Some cases, Scrotal ablation is necessary with ?
◦ Technically a “____ procedure” BUT what is the caveat with this?
◦ Two ways to remove hair from testicles and the surrounding areas: ____ hair vs. _____. ______ preference.
◦ Use ________ + _____ for skin prep.
scrotal, perineal urethrostomy (PU) surgery, Clean
it is not the same type of clean procedure compared to a spay or canine neuter.
Pluck, shave, Personal, Chlorhexidine, alcohol
In a cat Neuter Procedure, an incision made ________ over _____ testicle using a ___ or ___ blade. The surgeon then ________ the testicle, strips _______ _____ of excess tissue and/or fat.
Always try to use a ______ technique. ____ is more accidental.
Avoid using suture in this procedure because we do not want any foreign material since cats have a _____ reaction to suture than dogs. Therefore, you can use either ______-_______ [_____ Tie] or. _____ ___ Tie. Surgeon then ______ testicle. Once removed, leave scrotal incision(s) _____ to drain and heal by _____ intention.
directly, each, 15, 10, exteriorizes, spermatic chord
Closed, Open, greater, Auto-ligation, Cord, Figure 8 , transects, open, second
Cat Neuter video
https://www.youtube.com/watch?v=-omHp51D0ho
What technique is being used in the cat neuter procedure pictured?
Auto-ligation (cord tie)
What technique is being used in the cat neuter procedure pictured?
Figure 8 Tie
What does post-op care consist of for a Cat Neuter?
- Use shredded paper or Yesterday’s News
instead of regular littler - +/- NSAID
◦ Onsior (3 total doses)
- debate as to whether there is post-op pain.
◦ Metacam (3 total doses); Off label - +/- E-collar
- some owners do not want it.
What is pictured below?
Use shredded paper or Yesterday’s News
instead of regular littler for post-op recovery from cat neuter.
List the possible neuter complications.
◦ Hemorrhage
◦ Scrotal irritation/bruising
- when manipulating testicles or scrotal sac, be gentle!
◦ Scrotal hematoma
- Extremely painful, so provide pain management and icing/cold therapy.
- usually happens when dogs are very rambunctious and running around directly after surgery (within 24 hrs). This is where trazodone and gabapentin comes in.
◦ Infection
- patient not wearing e collar –> play/lick incision.
◦ Dehiscence
- patient not wearing e collar –> play/lick incision.
- rambunctious, running around.
◦ More common in dogs than cats
- Is important to discuss these complications with owner when they come in for their consultation.
Scrotal hematoma
Dehiscence
Infection
Hemorrhage
Skipped
TEST QUESTIONS COME FROM HERE
◦ What disease processes include neutering in their treatment plan?
◦ Why is neutering beneficial?
◦ When should pets be neutered?
◦ What are the different surgical approaches for a neuter procedure?
◦ How is a neuter procedure performed?
◦ What ligatures are used with a 3-clamp technique and where should
they be placed?
◦ What is the basic anatomy of the testicle?
◦ Are neuter complications common? If so, what are those complications?
