SA Repro Flashcards
Give some indications for an elective ovariohysterectomy
- Eliminates unwanted pregnancies
- Eliminates inconvenience of oestrus
- Decreased risk of mammary neoplasia
Give some indications for an ovariohysterectomy that isn’t elective
Prevention and treatment of: -Pyometra -Metritis -Ovarian/uterine neoplasia -Sub-involution of placental sites -Vaginal hyperplasia -Vaginal prolapse -(Uterine torsion/prolapse-rare) Control of certain diseases: -Diabetes mellitus -Epilepsy -Certain dermatoses (eg generalised Demodex)
What are the benefits of spaying a bitch prior to her first season?
Reduced incidence of mammary neoplasia
Uterine/ovarian vessels are small (les haemorrhage)
Reduced anaesthetic/operating time?
Reduced inconvenience to owner (no seasons)
Likely to have less abdominal fat
What are the disadvantages of spaying a bitch prior to her first season?
Anaesthetic considerations (v. small patients)
Juvenile behaviour? (no evidence)
Juvenile/hypoplastic vulva (caused by obesity, not much of a problem)
Give some contra-indications for spaying before a first season
Juvenile vaginitis (treat conservatively, no ABs) Juvenile USMI (urethral sphincter mechanism incontinence, should resolve after first season)
When in the oestrus cycle should you spay a bitch?
Between seasons, in anoestrus, at least 12 weeks after oestrus
How long after parturition should you spay a bitch?
> 6-8 weeks postpartum (preferably >3 weeks post-weaning)
Could be combined with caesarean
Why should you avoid spaying a bitch that is in season?
Because of increased:
- Size of uterine vessels
- Uterine turgidity
- Bleeding tendency
How does cystic endometrial hyperplasia (pyometra) occur?
Progesterone stimulates growth and activity of endometrial glands, and reduces myometrial activity
Colonisation of abnormal uterus with bacteria -> pyometra
Which stage of the oestrus cycle does pyometra occur in?
When else may is occur?
Luteal phase (ovarian progesterone production) Also, exogenous progestin therapy
Give some clinical signs of pyometra
Signs tend to be more severe with closed Purulent vulval discharge (open) Inappetence Lethargy PUPD Vomiting Pyrexia Dehydration Palpably enlarged uterus
Why is an open pyometra less severe than a closed one?
Bacteria is discharged so does not become systemic
Owner is more likely to notice clinical signs
How do you diagnose pyometra?
History
Biochem (may have raised urea and creatinine)
Haematology (may have mild anaemia)
Urinalysis
Vaginal cytology (will probs see bacteria/neutrophils)
Abdominal radiographs and US (to confirm diagnosis)
How would you identify a closed pyometra on an abdominal US?
Tubular fluid-filled structures with echogenic debris
How do you treat pyometra?
Prompt and aggressive
IVFT
Antibiotics (broad spectrum, bactericidal)
Ovariohysterectomy (same day ASAP)
‘Open’ and ‘closed’ pyometra refers to what?
Whether the cervix is open or closed
How and when would you medically treat pyometra?
Not recommended
Could consider if breeding animal has open pyometra
Prostaglandin therapy (can get adverse reactions)
If treatment is successful, breed at next cycle as likely to develop another pyo
Recurrence is common
How does uterine stump pyometra occur?
Must have progesterone source (endogenous eg incomplete removal of ovaries or exogenous progestational compounds)
When may you suspect incomplete removal of ovarian tissue?
How would you confirm this?
If there’s recurrent oestrus post ovariohysterectomy
Confirm with stimulation tests
Give some causes of a uterine stump granuloma?
Poor aseptic technique
Excessive remaining uterine body
Ligatures of non-absorbable suture material
How do you treat uterine stump granuloma?
Resect remaining uterine body and cervix
How does vaginal hyperplasia/prolapse occur?
Oedematous enlargement of vaginal tissue during pro/oestrus
Mass may be seen protruding from vulval lips
Prolapsed tissue promotes straining
Oedema spontaneously resolves after follicular phase but recurrence likely at next pro/oestrus
How do you treat vaginal hyperplasia/prolapse?
Mild cases can be treated conservatively (collar, lubricate mass, reduce prolapse with purse-string suture around vulva?)
Large masses may require resection
What is an episiotomy?
An incision of the vulval orifice to allow access to the vagina/vestibule
Give some indications for episiotomy?
Surgical exploration of vagina
Excision of vaginal masses
Repair of vaginal lacerations post-mating
Treatment of strictures or congenital defects
Exposure of the urethral papilla
Facilitation of manual foetal extraction
What is episioplasty?
Reconstructive procedure to remove excess skin folds around the vulva
Why might you perform an episioplasty?
To remove excess skin folds which have caused peri-vulval dermatitis (rare consequence of speying prior to a first season)
What are the 3 general categories of ovarian neoplasia?
Epithelial (eg papillary adenoma/adenocarcinoma)
Sex-cord stromal cell (most common, eg granulosa cell tumour)
Germ cell (least common, eg teratoma)
What can papillary adenocarcinomas of the ovaries cause?
Malignant abdominal effusions
Give some consequences of a sex-cord stromal cell ovarian tumour
Ability to produce progesterone (pyometra) Ability to produce oestrogen: -Persistent oestrus -Serosanguinous vulval discharge -Vulval enlargement -Alopecia -Aplastic pancytopenia
Give some clinical signs of ovarian neoplasia
Often asymptomatic until develop signs referable to an abdominal mass Hormonal dysfunction (depending on tumour type) Malignant effusion
How can you investigate ovarian neoplasia?
?Palpable mid-abdominal mass Haem/biochem Radiography (plain abdominal, thoracic, IV urogram) Abdominal US Abdominocentesis Exploratory coeliotomy
How do you treat ovarian neoplasia?
Ovariohysterectomy
? Chemotherapy depending on histological type of tumour
The majority of canine uterine neoplasias are of which origin?
Mesenchymal
85-80% are leiomyomas
Give some clinical signs of uterine neoplasias
May compress adjacent viscera causing associated clinical signs
May rarely cause secondary vaginal discharge/pyometra
How would you diagnose canine uterine neoplasias?
Abdominal and thoracic radiographs
Abdominal US
How would you treat canine uterine neoplasia?
Ovariohysterectomy
Removal of metastatic foci
Feline uterine neoplasias are mainly which tumour type?
Adenocarcinoma
What is the commonest tumour in the bitch?
Mammary neoplasia
Majority of malignant tumours are carcinomas
Caudal mammary glands most affected
Incidence of canine mammary neoplasia increases after how long?
6 years old
Describe inflammatory carcinomas
Difficult to diagnose from mastitis on clinical exam and cytology
Rapid growth, invade cutaneous lymphatics
Usually poor demarcation, oedema, inflammation
Often ulceration, rash-like appearance
Poor prognosis
What % of feline mammary tumours are malignant?
Most are which tumour type?
95%
Adenocarcinomas
Describe the activity and appearance of feline mammary tumours
Often poorly defined, grow rapidly, metastasise to lymph nodes and lungs early on
Mainly in intact females
Commonest in cranial glands
Poor prognosis
How do you diagnose feline mammary tumours?
Clinical exam Biochem/haematology Radiography (thoracic, abdominal) Abdominal US FNA/exfoliative cytology? Excisional biopsy
Give the differential diagnoses for a mammary mass
Mammary neoplasia Other neoplasia (eg lipoma, mast cell tumour) Mammary hypertrophy Mastitis Foreign body Cyst Granuloma
Give some surgical options for a mammary mass
Lumpectomy (pea sized nodules) Simple mastectomy Partial radical mastectomy Radical mastectomy (removal of tumour with all ipsilateral glands +/- nodes) Bilateral radical mastectomy
What is the only accessory sex gland in a male dog?
Prostate
Describe the different positions of the prostate throughout the early life of a dog
Abdominal position until birth
At 2 months old: puberty -> pelvic position
Becomes abdominal due to gradual hypertrophy
Prostate disease is more common in which kinds of dogs?
Mid-older male entire dogs
How common in prostate disease in cats?
Rare
Give some general clinical signs of prostatic disease
Urinary: dysuria (due to enlarged prostate compressing urethra), dripping blood from penis (rare)
Defecatory: tenesmus, flattened faeces (descending colon sits dorsal to prostate, enlarged prostate compresses colon causing the above signs), constipation
Hind limb stiffness/pain
How can you investigate prostatic disease?
Rectal/abdominal paplation Urinalysis, culture and sensitivity Radiography (plain caudal abdomen, retrograde urethrogram, thoracic if neoplasia suspected) Prostatic massage (empty bladder first, cytology, culture and sensitivity) Prostatic biopsy (FNA, trucut, surgical) Abdominal US (prostate, liver, bladder, sublumbar LNs)
Do any specific blood tests pick up prostatic disease?
No
Where would you palpate the prostate on a rectal exam?
Caudal prostate gland should be ventral to your fingers
How does the prostate change as the dog ages?
Becomes larger and bi-lobed
Give some diseases of the prostate gland
- Benign prostatic hypertrophy (BPH; normal ageing process but can cause problems in some dogs)
- Prostatitis (usually bacterial infection)
- Prostatic abscessation (often associated with BPH)
- Prostatic cysts (retention cysts or paraprostatic cysts)
- Prostatic neoplasia
What is the treatment for benign prostatic hypertrophy?
Castration (should reduce in size after 2 weeks. If it doesn’t- suspect tumour)
How do you diagnose benign prostatic hypertrophy?
Rectal palpation of prostate (symmetrically enlarged, non-painful)
How would you diagnose an enlarged prostate gland on US?
Will have a more heterogenous appearance than normal
How do you diagnose prostatitis/ prostatic abscessation?
Often associated with BPH
Rectal palpation of prostate (asymmetrically enlarged, painful)
Give the clinical signs of prostatitis/ prostatic abscessation
Fever, depressed
Often stiff HL gait
Caudal abdominal pain
Rupture of abscess results in peritonitis
How would you identify prostatic abscessation on US?
Areas of black debris in prostate
How would you treat prostatic abscesses?
-Drainage at explorotory coeliotomy + castration
(Retract bladder cranially to pull prostate cranially, incise abscess and suction contents, omentalise prostatic abscess cavity, lavage abdomen)
-4-6 week course of antibiotics
-May need fluid therapy
Areas of white mineralisation are more common on US of which prostatic disease?
Neoplasia
Why is omentalisation used to treat abscesses of the prostate gland?
Omentum provides a source of blood supply to deliver antibiotics, white blood cells and angiogenic factors, and acts as a physiological drain
Give some clinical signs of prostatic cysts
Can cause defecatory and urinary signs, and/or abdominal distension/mass
What are the 2 types of prostatic cysts?
Retention cysts (usally seen with BPH, rarely cause a problem unless very large/infected) Paraprostatic cysts (unknown aetiology, external to prostate gland)
How would you identify prostatic cysts on US?
Black areas
How do you treat prostatic cysts?
- Excision (paraprostatic cysts)
- Surgical drainage and omentalisation (paraprostatic cysts)
- US-guided drainage (small cysts, may need repeated drainage)
- Marsupialisation (cyst wall is sutured to the skin to form a semi-permanent stoma)
- Plus castration
Which neoplasia type is most common in prostatic neoplasia?
How malignant are they?
How do they spread?
Adenocarcinoma
Highly malignant, 80% have metastasised by time of diagnosis
Spread via lymphatics to LNs, lungs, skeletal system (esp lumbar vertebrae)
Direct extension to colon, bladder
Give some clinical signs of prostatic neoplasia
Weight loss HL weakness/pain Defecatory tenesmus Lumbar pain Dysuria, stranguria Haematuria PUPD
How would you diagnose prostatic neoplasia?
- Radiography (wispy new bone on pelvis/lumbar veterbrae, mineralisation within prostatic parenchyma)
- US
- Biopsy
How do you treat prostatic neoplasia?
Poor prognosis
Castration? (as likely to have concurrent BPH)
Prostatectomy? Not recommended as if we remove the prostate gland, we disturb the nerve supply to the bladder)
Where does the nerve supply to the prostate gland run?
Comes in dorsally over prostate
Why do we castrate?
- Population control
- Reduces aggression, roaming etc
- Prevention of androgen-related diseases
- Testicular disease (neoplasia, trauma, torsion)
- Scrotal neoplasia, trauma abscess
- Scrotal urethrostomy
- Control of medical disease
What is scrotal ablation?
Removal of scrotum during castration, purely cosmetic, may be performed in older dogs with a pendulous scrotum
Adds another 20-30 mins to surgery time-worth it?
When may scrotal ablation be indicated?
Scrotal disease
Cosmetic (older dog with pendulous scrotum)
What is cryptorchidism?
Failure of testicle(s) to descend into scrotum, usually unilateral
Testicle can be inuinal or abdominal
Give some negative consequences of retained testicles
Predisposed to neoplasia
Cryptorchid testicle often small/soft/misshapen
What is recommended for retained testicles?
Bilateral castration
Inguinal testicles: if mobile, advance to pre-scrotal area. If non-mobile, incise over inguinal region
Give some differentials for testicular swelling
Testicular neoplasia (most common) Scrotal hernia Orchitis Testicular torsion Trauma Scrotal dermatitis
Which 3 neoplasia types are most common in testicular neoplasia?
Sertoli cell tumour (produces oestrogen)
Seminoma
Interstitial cell tumour
Give the clinical signs of a sertoli cell tumour
Produces oestrogen- feminisation Haematological abnormalities eg anaemia Atrophy of non-neoplastic testicle Enlarged prostate gland Abdominal distension (abdominally retained testicle)
Of the 3 neoplasia types of the testicles, which metastasise?
Sertoli cell tumour- does metastasise (low risk)
Seminoma- does metastasise (low risk)
Interstitial cell tumour- does not metastasise
Interstitial cell tumours of the testicle are thought to increase the incidence of what?
Peri-anal adenoma and perineal hernia (due to increased testosterone levels)
Crytorchid dogs are how many times more likely to develop seminoma or sertoli cell tumours?
13.6 times greater
How can you investigate testicular neoplasia?
- Haematology (assess oestrogen levels esp if tumour is large, abdominally retained or there is feminisation)
- Thoracic radiographs not cost-effective due to low metastatic potential
- Evaluate local LNs (radiography/US)
How do you treat testicular neoplasia?
- Castration
- Fresh whole blood transfusion if severly anaemic/thrombocytopenic
What is the prognosis for testicular tumours?
Excellent if no metastases/myelotoxicity
Improvement of haematological parameters may take months
Myelotoxicity may be fatal despite aggressive supportive care
What is phimosis?
Inability to protrude the penis from the prepuce
Why may phimosis occur?
Preputial opening may be too small, usually secndary to trauma/neoplasia/infection
Give a clinical sign of phimosis
Infection/irritation die to urine pooling in prepuce
How do you treat phimosis?
Conservative tx and ABs if infectious/inflammatory disease, urinary diversion via catheter, preputial lavage
If congenital abnormality/stricture: reconstructive surgery of preputial orifice
What is paraphimosis?
Inability to retract penis into prepuce
Give some causes of paraphimosis
Trauma Mating Penile haematoma, neoplasia Preputial foreign body Posterior paralysis Failure of preputial muscles
How do you treat paraphimosis?
Idenify underlying cause and relieve constriction Reduce oedema (massage, diuretics, corticosteroids) Flush prepuce with saline and lubricant Preputial reconstruction, partial penile amputation, castration
How would you treat a fracture of the os penis?
Conservative
Urethral catheter as stent
Stabilisation with plate/penile amputation
How would you treat a preputial/penile laceration?
Radiography to assess os penis and urethra?
Conservative treatment (eg most haematomas)
Surgical treatment
Which ligament is ligated during an ovariohysterectomy?
Suspensory ligament of ovary
Which ligature should you use when ligating the cervix during a spay?
Transfixion
Do you need to remove the whole cervix to prevent stump pyometra?
No-just all of the ovaries
Give some complications of ovariohysterectomy
- Haemorrhage
- Iatrogenic injury to urinary tract
- Uterine/ovarian granuloma or sinus tract formation
- Uterine stump pyometra
- Ovarian remnant syndrome
- ? Weight gain/obesity
- ? Urinary incontinence
Give some complications of coeliotomy
- Peritonitis
- Adhesions
- Wound haematoma/seroma formation
- Wound infection
- Wound dehiscence and herniation
- Tissue reaction to suture material
When should you suspect intra-op haemorrhage after ovariohysterectomy?
- If patient makes slow recovery after surgery
- Clinical signs associated with haemorrhage
- Bleeding from wound
How could you confirm intra-op haemorrhage after surgery?
Abdominocentesis/lavage
How can you manage intra-op haemorrhage?
Conservative: -Cage rest and observation -Belly bandage Surgical intervention if suspect haeomrrhage is ongoing: -Pre-op stabilisation (iv fluids) -GA and exploratory coeliotomy
