Surgery of the male reprod tract Flashcards
Indications for sx of scrotum
- Trauma
- Neoplasia
- MCT, SCC
Indications for sx of the testes
- Cryptorchidism
- Testicular torsion
- Orchitis
- Neoplasia
What therapeutic/diagnostic indications for orchiectomy?
- Testicular Neoplasia
- Testicular Torsion
- Behavioural Modification
Indication for preventative/ELECTIVE orchiectomy
*Perineal hernia
*Perineal adenoma
*Prostatic hyperplasia
*Testicular neoplasia
*Prevention of genetic
linked disease
Obesity risk of neutering?
➢ Neutered animals = ↑ overweight
➢ It is not clear if age at neutering affects this
➢ Some studies, neutered animals have ↓ metabolic rate
➢ Others have found comparable metabolic rates
PROPER management important
What other risks of neutering?
» Osteosarcoma?
» Haemangiosarcoma?
» Lymphoma?
» MCT?
» CCl rupture?
» Hip dysplasia?
What alternative to castration?
Superlorin?
Benefits of neutering?
- Increased LONGEVITY
What other benefits maybe more relevant to cats?
» Population control
* Shelter population, euthanasia, neglect
* Increased adoption rates, reduced euthanasia
» Risks of reproduction
» Behaviour modification
» Reduced roaming/interdog agression
» ↓FeLV, FIV - cats
Dog Bhvr mods from castrating?
- castration
- ↓ roaming 90%,
- ↓ aggression between males 62%,
- ↓ urine marking 50%,
- ↓ mounting 80%
entire dogs more liekly to bite
Cat castration effect on bhvr?
- ↓ fighting
- ↓ urine spraying
- ↓ roaming
Summarise the overall benefits & risks of Neutering males
What are some complications of orchiectomy?
- Scrotal bruising and swelling
- Haemorrhage
- Scrotal haematoma
- Infection
- Self-trauma
What is the reported incidence of orchiectomy complications?
6.1% most minor
How can we avoid Haemorrhage/ Scrotal haematoma?
➢ Consider scrotal ablation in older dogs with pendulous scrotum
➢ Closed castration may decrease incidence of scrotal haematoma
➢ Open castration may provide more secure ligatures
➢ Double ligate/transfixing ligatures
➢ Check stumps
How to avoid infection/self trauma
Buster collar/ tshirt
How to manage scrotal haematoma
- analgesia and local cooling +/- sedation/limiting activity
- may progress to necrosis of scrotal skin → scrotal ablation
How to manage haemorrhage ?
Normally from tunic; self-limiting, causing incisional hemorrhage, bruising, scrotal hematoma
How to manage haemorrhage from the vascular pedicle
- may require a second surgery to explore
- dripping from wound vs haemoperitoneum (pale mm/tachycardia/slow recovery from anaesthesia)
- through original incision or caudal midline laparotomy – parapreputial
- US, coag, platelet count
Give some top tips for canine castrate
➢ Use the technique you are most comfortable with
➢ Don’t resect spermatic cord too far away testicle
➢ Strip away all fat/tissue prior to ligating the cord for closed castration
➢ Be careful when recommending castration for behavioural reasons
➢ For cat castration, take care not to damage the penis when incising the scrotum
➢ For most animals, 2-0, 3-0 synthetic absorbable
What surgical procedures of male reprod tract?
- Orchiectomy -> open, closed, cryptorchid, tumour
- Vasectomy
True/False Cryptorchidism is the msot common congenital defect of reprod tract in dogs
TRUE
Describe cryptorchidism
- Failure of one or both testes to descend
- normally between birth and six months
- abdominal, inguinal, prescrotal
- Sex-linked autosomal recessive
Who gets cryptorchidism?
- 7% in dogs, 1% in cats
- small breeds, boxer, GSD
- Right testicle more common in dogs (equal in cat)
- Bilateral → infertile
What risks are associated with cryptorchidism
- ↑ testicular neoplasia X10-13 in retained, occurs at earlier age
- increased in descended testicle as well
- ↑ risk of torsion
Cryptorchid Tx
- Orchiectomy
* palpation +/- ultrasound determine location - Technique of removal based on location
- +/- histology
- Laparoscopic removal if abdominal
How to deal with abdominal cryptorchid?
- Caudal ventral midline laparotomy
- Anywhere along the line of descent
- From caudal pole of the kidney to the inguinal canal
- Reflecting bladder can help to locate ductus deferens
What happens with torsion?
- more common if enlarged, neoplastic, intra-abdominal testis
- →occlusion of venous drainage; engorgement → necrosis
Diagnosing testicular torsion?
- Acute pain, enlarged, scrotal swelling, reluctance to stand or walk
- intra-abdominal →acute abdominal pain (beware bilateral cryptorchid)
- US
Tx of Torsion?
Surgical emergency
* Stabilise + orchiectomy without de-rotation of testicle
* + histopathology
What causes Orchitis/epididymitis?
» Bacteria infection
* trauma, retrograde via urine or prostatic secretions, bacteraemia, infected lymph
* Escherichia coli, Staphylococcus, Streptococcus, Mycoplasma
Diagnosing orchitis/ epididymitis?
- acute pain, scrotal swelling, reluctance to stand or walk
- may need to sedate to exam
- hyperthermia, pain on manipulation
- blood, urine & prostatic fluid → C&S
Tx forOrchitis/ Epididymitis
- stabilise, broad-spectrum antibiotics + castrate
- treat primary disease
- If orchiectomy not an option, ABs, analgesia, local cooling
- prognosis for preserving fertility is guarded
Hwo common is testicular neoplasia?
2nd most common location for neoplasia in male dogs
Describe the three types of testicular neoplasia?
➢ Sertoli
* slow-growing and non-invasive
* 10-20% malignant
* secrete oestrogen – feminisation syndrome
➢ Seminoma
* Benign
* 5–10% malignancy
➢ Interstitial cell/Leydig
* Benign
Dx of Test neoplasia?
- Asymmetry of testes +/- feminisation syndrome
- US
- Met check
Tx for test neoplasia?
- Closed Castration and scrotal
ablation - Chemotherapy
good Pg as low metastatic rates
What do we call Hyperoestrogenism?
Feminisation Syndrome
What are the signs of Feminisation Syndrome
Indications for Prostatic dx sx?
- Management of BPH - orchiectomy
- Management of Prostatitis - orchiectomy
- Abscessation
- Prostatic Cysts
- Biopsy
- Prostatic Neoplasia – Rare
Diagnosis of prostatic dx?
- US, Rads +/- Contrast
- Prostatic wash
- Ejaculate
- Traumatic catheterization- whilst massaging the prostate per rectum
- FNA/Trucut/Biopsy
BPH common. inwho?
- in entire aged dogs
- 80 % of 6 year old male entire dogs
- 95 % of 9 year olds
CLs of BPH?
- Constipation and Tenesmus
- Haemorrhagic urethral discharge
- Dysuria
- Palpation → symmetrical enlarged non painful prostate
- Check for concurrent testicular neoplasia or perineal hernia
Dx of BPH?
- Rectal examination
- Radiographs
- Ultrasound +/- FNA
Tx for BPH?
➢ Castration → reduction in size over 2-3 week
➢ Anti-androgen therapy not as effective at reducing size
Describe Rpostatic neoplasia
- more common in castrated males (predisposed by castration?)
- Adenocarcinoma
- Spread to Sublumbar LN, Lumbar vertebrae, Pelvis
- 70% have metastasis at presentation
> Clinical Signs
* Stranguria/haematuria, pain, HL lameness/neurological deficits
Dx for prostatic neoplasia
– palpable per rectum
* PAINFUL, irregular, asymmetric enlargement
* 70 % increase in ALP
* Ultrasound
* Prostatic fluid (wash, aspirate, ejaculate)
* FNA/ trucut/ catheter biopsies
* Urine analysis
Tx of Prostatic neoplaqia?
- Cox2 inhibitors increase survival to 6.9 months (from 0.7months)
- Little response to chemotherapy
- May be response to radiotherapy
- Total or subtotal prostatectomy attempted but high rate of complications (incontinence) and unlikely to increase survival
What sampling techniques for prostate?
➢ Transurethral-traumatic
catheterisation
➢ FNA – US guided
➢ 96% agreement with histopath
➢ seeding
➢ Biopsy – Trucut, open wedge,
laparoscopic
What are some indications for surgery of the penis and prepuce
- Hypospadias - failure of urogenital folds to fuse
- Fracture of the os penis
- Penile trauma
- Fractured os penis
- Penile neoplasia
- Preputial neoplasia
- Persistant penile frenulum
- Paraphimosis- inability to retract penis into the preputial sheath
- Phimosis – preputial orifice absent/too small
- Priapism
- Urethral prolapse - seen with UTI or excessive sexual excitement
Describe penile neoplasia
- Common in dogs, rare in the cat
- Mast cell tumours, squamous cell carcinoma, papilloma, lymphoma, osteosarcoma, chondrosarcoma
Cls & Dx fo penile neoplasia
» Clinical Signs;
swelling of prepuce, visible mass, abnormal preputial discharge, licking, prolapse, haematuria, dysuria
» Diagnosis: palpation, impression smear, FNA. Biopsy
Tx for penile neoplasia
Chemotherapy, radiotherapy, partial or complete penile amputation dependant upon type
Discribe paraphimosis
- inability to retract penis into prepuce
- excessive sexual activity, trauma, constriction by preputial hairs, preputial hypoplasia
- Differential; Priapism
Tx for paraphimosis
- lubrication and retraction +/- sedation
- cold compresses/massage
- hypertonic agents - sugar
- can enlarge the preputial opening if cannot retract via the above
- amputation if tissue not viable
- Preputial hypoplasia →preputial advancement/phallopexy + castration
What are some surgical techniques for the peis and prepuce
» Penile amputation
» Partial penile amputation
» Preputial advancement
» Preputial Reconstruction
» Phallopexy
