SURGERY - Male Reproductive Surgery Flashcards
What is the best age to neuter male animals?
There is no defined age at which to neuter male animals (it’s a big debate within the industry), there is pre-pubertal and post-pubertal neutering
What is pre-pubertal neutering?
Pre-pubertal neutering is castration before 6 months old
What are the cons of pre-pubertal neutering?
Pre-pubertal neutering can predispose animals to other complications such as obesity, developmental and musculoskeletal problems, neoplasia, immune mediated conditions, cognitive dysfunction syndrome
What is post-pubertal neutering?
Post-pubertal neutering is castration after 6 months old for small breed dogs and cats, and 12 to 18 months in large breed dogs
What are the main indications/benefits of a canine castration?
Eliminate risk of neoplasia
Cryptochidism
Benign prostatic hyperplasia
Prostatitis
Control sexual/aggressive behaviour
Population control
Increased life expectancy
What should you advice owners if they want to castrate their dogs due to behavioural reasons?
There is evidence that castration has little to no effect on sexual and aggressive behaviours in free-roaming dogs, and castration can actually worsen behaviours in fearful dogs. Overall, be aware that post-castration behaviour can vary greatly and the decision to castrate should be made on a case by case basis
What are the two possible approaches to canine castration?
Pre-scrotal castration (most common in UK)
Scrotal castration
What is the difference between open and closed canine castration?
Open canine castration is where you incise into the vaginal tunic and place the ligatures directly onto the spermatic vessels and vas deferens, whereas closed canine castration is where you do not incise the vaginal tunic and place the ligatures on the intact vaginal tunic with the spermatic cord inside
What are the indicators for open castration?
Open castration can be done on any dog, however this approach is particularly beneficial in large breed dogs
Don’t do open castration on a patient with testicular neoplasia
What are the indicators for closed castration?
Closed castration can be done on any dog, however it is indicated for testicular neoplasia
What is scrotal ablation?
Scrotal ablation is complete surgical removal of the scrotum
When is scrotal ablation indicated?
Scrotal ablation is indicated if there is a pendulous scrotum left after castration, usually seen in older dogs, dogs with testicular neoplasia or infection
What are the basic steps of a castration?
- Incise
- Exteriorise
- Ligate
- Transect
- Check
- Close
Which local anaesthetic blocks can be done in a castration (to provide additional analgesia)?
Incisional block
Testicular block
Check AAHA guidelines to learn how to do this
https://www.aaha.org/resources/2020-aaha-anesthesia-and-monitoring-guidelines-for-dogs-and-cats/local-anesthetic-techniques/for-castrations/
How do you carry out a pre-scrotal canine castration?
- Position your patient in dorsal recumbency
- Push the testicles cranially under the skin
- Make a skin incision with your scalpel directly over the testicle (be careful of the penis and urethra) and exteriorise the testicle (within the vaginal tunic) through the skin incision
- If doing a closed castration, do not incise into the vaginal tunic. Break down the fascia and gubernaculum to expose the spermatic cord (which is attached to the cranial pole of the testis) as much as possible
- If doing an open castration, incise into the vaginal tunic and exteriorise the testicle. Break down the ligament attaching the vaginal tunic to the testicle (at the caudal pole of the kidney) and expose the spermatic cord (which is attached to the cranial pole of the testis) as much as possible
- Place two clamps on the spermatic cord (trying to keep the clamps as close to the body as possible)
- Place a surgeons or millers ligature proximal to the clamp located closest to the body wall
- Remove the clamp closest to the body wall, and plave a surgeons or millers ligature in the groove left by the clamp (pre-clamping). Put the clamp above the other clamp
- Transect between the two clamps (pointing the scalpel blade away from the dog and yourself)
- Remove the clamp and hold onto the pedicle with serrated forceps (make sure you aren’t occluding the vessels or holding onto a ligature) and check for bleeding, before gently allowing the pedicle to go back into the body
- Repeat for the other testicle
- Close the vaginal tunic if an open castration with simple interrupted
- Close the subcutaneous tissue with simple continuous suture, making sure to include the median raphe in the bites
- Close the skin with intradermal sutures
What is the spermatic cord?
The spermatic cord contains the ductus deferens, testicular artery and vein (pampiniform plexus) and cremaster muscle
How can you do transfixing ligatures in a dog castrate?
You can do transfixing ligatures through threading the needle through the cremaster muscle (this can be useful for a large breed dog castrate)
What are the main indications/benefits of a feline castration?
Control sexual/aggressive/urine spraying behaviour
Reduce roaming
Reduce mating fights (which can spread disease and causes injury)
Reduce spread of infectious disease (through reducing mating fights)
Population control
Cryptochidism
Increased life expectancy
Reproductive disease is rare in male cats, castration usually done for behvioural reasons
What is the approach to feline castration?
Scrotal castration
What is the difference between open and closed feline castration?
Open feline castration is where you incise into the vaginal tunic and autoligate the blood vessels and vas deferens, and closed feline castration is where you do not incise into the vaginal tunic and autoligate with foreceps
How do you carry out a scrotal feline castration?
- Position your patient in lateral recumbency, making sure the tail is out of the way
- Clip and prep the testicles
- Make a skin incision with your scalpel into the ventral aspect of the scrotum (to allow for drainage)
- Exteriorise the testicle (within the vaginal tunic)
- Incise into the vaginal tunic and exteriorise the testicle
- Identify the spermatic cord and epididymis and use your thumbnail to keep them together
- Break down the attachment between the vaginal tunic and the testicle with your other thumb
- Seperate the epididymis from the testicle, making sure to leave the spermatic cord attached to the testicle
- Ligate the blood vessels with the epididymis using 5 - 6 single throws
- Leave the wound to heal by second intention
What is cryptorchidism?
Cryptorchidism is where one or both testicles fail to descend into the scrotum by approximately 6 months old
What are the two classifications of cryptorchids?
Inguinal cryptorchids
Abdominal cryptorchids
Which surgical approach should you take for inguinal cryptorchids?
Make an inguinal incision over the testicle and do an open castration (may or may not have a tunic) with a two layer closure. Castrate other testicle as normal (if descended into the scrotum)
Which surgical approach should you take for abdominal cryptorchids?
Make a midline or paramedian incision and do an open castration (remember the testicle won’t have a tunic until it descends into the scrotum), with a three layer closure. Castrate other testicle as normal (if descended into the scrotum)
Why is it so important to castrate cryptorchid males?
It is important to castrate cryptorchid males as they are at an increased risk of neoplasia and torsion
(T/F) You can breed from cryptorchid males
FALSE. You should not breed from cryptorchid males as this condition is hereditary
What are the potential immediate surgical complications for castrations?
Haemorrhage (ligature slips)
Subcutaneous haemorrhage/haematomas
Urethral/penile trauma
What are the potential delayed surgical complications for castrations?
Bruising
Infection
Swelling
Scrotal haematoma
Wound dehiscence
Suture reactions
Poor wound healing
Important to warn the owners of complications
What should you do if there is a ligature slip following a castration?
Make a midline abdominal incision if you cannot trace the bleed from the wound
Ask for help
Identify which ligature has slipped through sweeping through the abdomen so you can reclamp and place another ligature
Use swabs and lap swabs to help visualise
Supportive care
How can you manage mild postoperative haemorrhage following a castration?
Cage rest
IV fluid therapy
± Abdominal bandages
± Blood transfusion
