Surgery of the Male Equine Urogenital Tract

Question 1

When is castration done?

Answer 1

1-2 years

Question 2

What should you make sure is done when you castrate?

Answer 2

that the animal is vaccinated–don’t want them getting tetanus

Question 3

What must you remember about the inguinal ring?

Answer 3

it is only the external ring, there is also an inguinal canal and a vaginal ring on the peritoneal side. It is not the size of the external ring (that you can palpate) that is important with regards to herniation, it is the vaginal ring that is important and you cannot palpate that from the outside

Question 4

What is another name for vaginal tunic?

Answer 4

parietal tunic

Question 5

WHat must you remember when you cut through the vaginal tunic?

Answer 5

you are in the abdminal cavity–abdominal peritoneal fluid

Question 6

Why will all castrated animals end up with a degree of inflam peritonitis?

Answer 6

because you are entering the abdominal cavity technically
so if horse is really sick and you do an abdominal tap then you will get abnormal results even if the horse is not sick due to a peritonitis

Question 7

If a testicle is intrabdominal at birth will it go to a normal position?

Answer 7

no

Question 8

Why is important to know proper anatomy for cryptorchids?

Answer 8

need to remove testicle! not something else

Question 9

What does the proper ligament join?

Answer 9

tail of epidydmdus to testicle

Question 10

What does ligament of tail join?

Answer 10

tail of epididymus to vaginal tunic

Question 11

What is castration NOT a treatment for?

Answer 11

bad behaviour

Question 12

How is routine sharp surgery done?

Answer 12

standing-sedation

recumbent-GA

Question 13

Which is preferable, standing or recumbent?

Answer 13

recumbent

Question 14

What are the benefits of standing castration

Answer 14

less expense
less assistance (not necessarily and need good handling)
less time consuming (not really)

Question 15

What animals should you avoid standing castration in?

Answer 15

donkeys, mules, short horses–less working space
have a habit of kicking
donkeys and mules bleed more

Question 16

Why should you always palpate the testicles?

Answer 16

if one much larger than the other or think neoplastic process you want to know that because may bleed more or not prepared to deal with that.
Make sure there are two!!!

Question 17

Right retained testicles are typically what? Left?

Answer 17

right–inguinal

left–abdominal

Question 18

What plants horse feet better than rompin?

Answer 18

detomidine

Question 19

What do horses react to more when with detomidine than xylazine?

Answer 19

flies/light touch

Question 20

What do you have to inject lidocaine into?

Answer 20

1. spermatic cord
2. testicle
3. scrotum
   he doesn’t like to inject into spermatic cord into GA is because it creates puncture, when applying traction can rupture at that point

Question 21

What should you expect when injecting lidocaine into testi le?

Answer 21

a bad reaction

Question 22

Why do you have to watch out for the penis while doing a standing castration?

Answer 22

it is always dirty

Question 23

What does open and closed refer to with castration?

Answer 23

Whether or not you open the vaginal tunic

Question 24

What side do you want to crush, what side do you want to cut with emasculators?

Answer 24

crush the horse side, cut the testicle side
Want crushing so get hemostasis and cut the other side
Double check!!!!

Question 25

What is the increased rate of complication with standing?

Answer 25

30%

Question 26

What do you use for GA for castratrion?

Answer 26

Rompun and ketamine and diazepam for recovery

Question 27

What does he have in the jugular?

Answer 27

a needle with a half dose of rompun and ketamine--can tell owner to push in if horse starts to wake up

Question 28

Where could you put a top up dose of rompun and ketamine other than neck?

Answer 28

have on surgery pack aseptically and give in groin--big vessels

Question 29

With an open castration what is incised?

Answer 29

scrotum and parietal tunic

Question 30

When do you ligate?

Answer 30

before you apply the emasculators (otherwise pressure high and then when take emasculator off then ligature is loose)

Question 31

how long do you leave emasculator on?

Answer 31

a minute per year plus 1 minute

Question 32

If you ligate, do you leave the emasculator on?

Answer 32

no

Question 33

IF see a trickle of blood, where is it usaully coming from? if it is coming from where else then you are worried?

Answer 33

scrotal incision. worried if coming from depths

Question 34

IF you leave your incision open what should you do?

Answer 34

cut or emasculate tissue that is left hanging. if you can pull it out while horse is on back then it will definitely come out when he is standing cut off now! not when standing

Question 35

When should you check for hemorrhage?

Answer 35

not only immediately after emasculating but also in 15-20 seconds because there is arteirovasospasm when you crush/cut. if not appropriately ligated/thrombosed then get relaxation of the vasospasm and will start to bleed

Question 36

Is it necessary to take out the median raphe?

Answer 36

not usually | he doesn't do it because it bleeds

Question 37

What is the aftercare for castration?

Answer 37

restricted activity for 24hrs excerised--forced (+/- hydrotherapy--but may push bacteria in!!!) isolate from mare-1wk

Question 38

Why should you isolate castrated animal for 1 wk from mares?

Answer 38

because may have semen left over don't want them all excited--too much movement around scrotal tissue--blood drawn to region and moving thrombosed vessel around

Question 39

What are the indications for laparoscopic castration?

Answer 39

cryptorchid surgery | --"2nd look"---previous sx

Question 40

Why should you expect tools will fail?

Answer 40

because the emasculator may not work--e.g. keep a clamp on so when cut off have a clamp in case bleeding occurs--can pull cord back up

Question 41

What is the trendelenburg position?

Answer 41

15 degree head down position

Question 42

What do you want to avoid with laparoscopic castration?

Answer 42

the bladder

Question 43

What are complications of castration?

Answer 43

``` hemorrhage evisceration edema septic funiculitis septic peritonitis/clostridial dz penile damage/hydrocele continued masculine behavior ```

Question 44

What vessels bleed in castration?

Answer 44

usually testicular artery scrotal vessel--incomplete transection veins--but they have valves

Question 45

What is an issue with castrating an older animal?

Answer 45

have large testicles, may be difficult to get adequate crushing?

Question 46

WHat is treatment for hemorrhag during castration?

Answer 46

1) quiet for 20-30min 2) emasculate or clamp cord but can be very painful if cord not blocked, not under GA 3) pack incision (24hr) 4) GA and find the bleeder

Question 47

what is an issue with packing a bleeder?

Answer 47

don't know what is going on below it

Question 48

Why do you have to be careful clamping vessels?

Answer 48

nerves are often close to vessels--get kicked

Question 49

How do you treat evisceration (complication of castration)

Answer 49

1. protect and replace content | 2. treat for septic peritonitis

Question 50

What breeds may be predisposed to evisceration after castration?

Answer 50

standardbreds | drafts

Question 51

Where should you prevent internal organs from getting down to in evisceration?

Answer 51

below hocks

Question 52

Will an animal with evisceration always get septic peritonitis?

Answer 52

YES severity may vary

Question 53

Why should you do laparotomy for evisceration/castration?

Answer 53

can make sure the intestine is out of the canal and that it is still healthy

Question 54

Why is edema not usually considered a complication of castration?

Answer 54

normal and peaks on day 3

Question 55

What is the treatment for edema after castration?

Answer 55

1. exercise 2. hydrotherapy 3. drainage

Question 56

What is septic funiculitis?

Answer 56

infection of cord--inadequate drainage (not that much drainage)

Question 57

What is teatment for septic funiculitis?

Answer 57

1. abtibiotics 2. drainage!!!--is a very thickwalled abscess 3. excision of scirrhous cord until get above infected region but that can be deep and it bleeds a lot!!!

Question 58

What is a possible sequelae of septic funiculitis?

Answer 58

septic peritonitis

Question 59

Why do you not get a septic tunic with closed castration?

Answer 59

because it is gone

Question 60

How do you preven clostridial dz from castration?

Answer 60

vaccination

Question 61

What is treatment for septic peritonitis from castration?

Answer 61

antibiotics NSAIDs lavage

Question 62

What is a proud cut horse?

Answer 62

continued masculine behavior? epididymis left behind? psychic maturity not an issue

Question 63

what persent of left testicles are intrabdominal? what about right?

Answer 63

left: 75% right: 42%

Question 64

How do you diagnose cryptorchids?

Answer 64

1. inguinal palpation 2. rectal palpation 3. transabdominal ultrasound 4. exploratory 5. hormonal assays

Question 65

What is the inguinal approach for cryptorchidism?

Answer 65

incision over inguinal ring blunt dissection to ring locate vaginal process

Question 66

With an inguinal approach, why do you not want pull too hard on the tail of the epididymis to get the testicle?

Answer 66

could break off and the testicle will fall into the abdomen

Question 67

If you have to damage the internal ring during inguinal approach to cryptorchid what should you do?

Answer 67

close the external ring

Question 68

What is parainguinal approach to cryptorchid?

Answer 68

go through muscle, peritoneum into abdomen and fish with two fingers

Question 69

What are 3 other approaches to cryptorchidism (less common)

Answer 69

flank suprapubic? laparoscopic

Question 70

urolithiasis is what % of urinary tract diseases?

Answer 70

8%

Question 71

Where are stones usually?

Answer 71

bladder (60%) | urethra 24%

Question 72

What might be a cause of blood in urine post exercise?

Answer 72

stone in the bladdero | BUT could have rhabdomylosis or oxidation of urine on snow

Question 73

What is the best thing to do with horses with urolithiasis?

Answer 73

scope the bladder

Question 74

90% of stones are what?

Answer 74

spiculated CaCO3 (diffiuclt to get out!)

Question 75

10% of stones are what?

Answer 75

smooth

Question 76

What are clinical signs of cystolithiasis?

Answer 76

intermittent pain | hematuria

Question 77

What is the treatmennt for cystolithiasis?

Answer 77

1. retrieval-manual in female, endoscope with snare 2. surgical--laparotomy, perineal urethrostomy 3. stone reduction (lithotripsy, laser)