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Small Animal Surgery > Urogenital Surgery, Pt. 2 > Flashcards

Urogenital Surgery, Pt. 2 Flashcards

1
Q

What are the 4 indications for canine castration?

A
  1. sterilization
  2. elimination of male characteristics (aggression; better early before it becomes learned behavior)
  3. treatment of prostatic disease (decreased testosterone = involution)
  4. cryptorhidism
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2
Q

What are some additional indications for castration?

A
  • perineal hernia (common in older males)
  • testicular torsion/abscesses
  • urethral obstruction (part of scrotal urethrostomy)
  • scrotal/testicular trauma
  • endocrine disorders
  • scrotal or inguinal hernias
  • testicular, scrotal, and perianal gland neoplasia
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3
Q

What are the 4 most common approaches to castration in dogs?

A
  1. pre-scrotal
  2. scrotal ablation
  3. perineal (caudal)
  4. scrotal
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4
Q

What are the 2 most common approaches to castration in cats?

A
  1. scrotal
  2. scrotal ablation as a part of perineal urethrostomy
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5
Q

What are the indications for pre-scrotal and scrotal approaches in canine castrations?

A

PRE-SCROTAL = routine/elective procedures

SCROTAL = scrotal/testicular neoplasia or trauma, scrotal urethrostomy, pendulous scrotum

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6
Q

What are the indications for inguinal/abdominal and perineal approaches to canine castrations?

A

I/A = cryptorchidism

PERINEAL = avoid repositioning when patient is already in a perineal position

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7
Q

How does surgical preparation for castrations compare in dogs and cats?

A

DOGS = aseptic, clip hair, chlorhexidine prep

CATS = “clean”, pluck hair from scrotum, chlorhexidine prep

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8
Q

What is a closed castration? How does it compare to an open one?

A

parietal vaginal tunic is not incised

  • less anesthesia time
  • less risk of abdominal infection
  • less secure ligation
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9
Q

What is an open castration? How does it compare to a closed one?

A

parietal vaginal tunic is incised and any attachements are broken down

  • more secure ligations
  • communication with the abdominal cavity
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10
Q

What are the 3 goals to castration?

A
  1. complete removal of both testicles
  2. secure ligations
  3. no post-op bleeding
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11
Q

How are bleeders taken care of? How is the testicle brought out of the incision?

A

sponge + pressure or hemostats

apply pressure caudally and sideways to pop it out —> will have a shiny, smooth surface

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12
Q

What is done after the testicle is elevated?

A

pull up and slide other hand holding gauze down to bluntly disrupt the scrotal ligament, allowing for the release of the testicle

  • strip fat and SQ tissue until the spermatic cord is completely isolated
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13
Q

How is the testicle ligated? What is included in the clamps?

A

3 clamp technique —> first ligature (circumferential) in the distal crush, second (transfixing) in distal to the middle clamp, then transected between the remaining 2 clamps

parietal tunic and cremaster muscle

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14
Q

Why is the order of the ligations important?

A

circumferential is placed first in the distal crush to avoid bleeding into the abdomen

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15
Q

How is an open castration performed?

A
  • once the testicle is released, find a window between parietal tunic, cremaster muscle, and vas deferens/testicular arteriy and vein and pierce them
  • clamp across the tunic to the tail of the epididymis and separate the attachment
  • push the vaginal tunic down
  • ligate together or separately (if large)
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16
Q

Open castration

A

pushing down the vaginal tunic

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17
Q

Open castration, clamps:

A

3 clamp technique

  • each portion can be ligated separately or together, depending on size
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18
Q

What is important to be cautious for when making the initial incision of pre-scrotal neuters?

A

pre-scrotal approach - fibrous tubular structure of the urethra will be present —> do not penetrate by cutting or with bites!

  • don’t include retractor penis muscle either!
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19
Q

How is the castration incision closed?

A

spermatic fascia and SQ are sutured as a single layer to reduce dead space

  • intradermal
  • simple interrupted
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20
Q

What post-operative care is recommended following a castration?

A
  • cold pack to surgical site for 10-15 mins
  • E-collar
  • restrict exercise for one week to decrease chances of developing a seroma
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21
Q

What are the 4 most common complications associated with castrations? In what animals is this most common?

A
  1. hemorrhage/bleeders
  2. scrotal irritation or bruising
  3. scrotal hematoma
  4. infection

dogs —> cats heal by second intention

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22
Q

What is the recommended treatment for scrotal swelling or hematomas following a castration? What is avoided?

A

compress and wide-spectrum antibiotics

opening and draining leads to abscess formation —> check back in 3-5 days

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23
Q

What do complications with scrotal castrations lead to?

A

debridement of pedicles and removal of remaining scrotum

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24
Q

How is a castration with scrotal ablation done?

A

SCROTAL APPROACH - make an elliptical incision at the neck of the scrotum and remove it, then suture SQ to close the dead space

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25
Q

What manipulation may be necessary when approaching retained testicle(s)? How are the testicles ligated?

A

move bladder caudally

2 ligatures —> in deferens and in vascular pedicle of the testicle

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26
Q

How do undescended testicles compare to normal testicles?

A

usually smaller, softer, and lighter in color due to compression and increased temperature in the abdomen

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27
Q

What is the approach like with one undescended testicle?

A

use the proper abdominal/inguinal approach to the pathologic testicle first

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28
Q

How can a cryptorchid testicle be confirmed following possible palpation?

A

ultrasound

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29
Q

What are the 3 most common testicular neoplasias? What do they cause?

A
  1. Sertoli cell tumor
  2. seminoma
  3. interstitial cell tumor

testicular enlargement

30
Q

How do most testicular neoplasias act? How are they treated?

A

malignant, with low rate of metastasis to regional LNs

castration

31
Q

What increases the risk of developing testicular neoplasia? Which neoplasia in particular is common in this case?

A

cryptorchidism

Sertoli cell tumors —> secrete estrogen, which can block erythropoiesis in the bone marrow = anemia

32
Q

How is testicular neoplasia diagnosed?

A
  • palpation*
  • ultrasonography or radiology
  • presence of paraneoplastic syndromes: hyperestrogenism (Sertoli cell)
33
Q

What are the 6 most common signs of testicular neoplasia?

A

signs of hyperestrogenism

  1. alopecia
  2. gynecomastia
  3. testicular atrophy
  4. penile atrophy, pendulous prepuce
  5. prostatic cysts, prostatic atrophy
  6. reduced male behavior with possible attraction of males
34
Q

What is pseudohermaphroditism? How do animals typically present?

A

incomplete formation of both gendered reproductive tract, typically a penis/vulva with ovaries or undescended testes in the abdomen

chronic UTIs

35
Q

What are the 4 indications for feline castration?

A
  1. sterilization
  2. urethral obstruction (as a part of perineal urethrostomy)
  3. testicular or scrotal trauma
  4. elimination of male characteristics, like urine odor and fighting
36
Q

How do feline testicles need to be handled before they are able to be exteriorized?

A

caudal traction placed on testicles until the scrotal ligament breaks

37
Q

What approach is preferred for feline castrations?

A

SCROTAL —> incision over both testicles (or in the middle of the scrotum)

38
Q

How should felines be positioned for castrations?

A

cranial movement of legs forward to properly visualize scrotal sac and urethra

39
Q

What surgical techniques are used in feline castrations?

A
  • open or closed
  • proper circumferential, then transfixing ligations
  • separate ductus deferens and tie to vessels with 2 square knots
  • use absorbable ligature or hemoclip
40
Q

What are other options other than suture material?

A
  • overhand auto-ligation
  • ductus deferens tie
  • hemoclips
41
Q

What are the pros and cons to using the ductus deferens tie for castrations?

A

PRO: no foreign material used

CONS: tie can be thin and easily unraveled, plucking of hair makes hair contamination common which leads to fistula formation, must be sinched extremely tight

42
Q

How are scrotal incisions in feline castrations managed?

A

second intention —> leave incisions open to drain and heal

  • owners should use shredded paper or un-popped corn (?) instead of litter for a few days to decreases changes of infection
43
Q

What complication is most common in feline castrations?

A

perineal fistula formation due to loose hair from plucking of the scrotal sac

44
Q

What is a vesicourachal diverticulum? What does this cause? How is it treated?

A

persistence of part of the urachus (used to communicate with umbilicus for waste removal in fetus) at the apex of the bladder

detrusor muscle does not cover it, so urinary stasis with occur here, making it more prone to persistent UTIs

partial cystectomy (diverticulectomy) with remove of part of the apex

45
Q

Macroscopic vesicourachal diverticulum:

A

nipple-like outpouching at the apex

46
Q

What are the 2 most common types of trauma that cause bladder rupture? How do they cause rupture?

A
  1. BLUNT - impact on abdominal wall while bladder is full (males = females)
  2. PENETRATING

both result in acute increase in abdominal pressure

47
Q

What are the 3 most common causes of spontaneous bladder rupture?

A
  1. urethral obstruction
  2. tumor
  3. severe cystitis
48
Q

What are the 3 most common causes of iatrogenic bladder rupture?

A
  1. improper catheterization - can poke hole through thin walls
  2. cystocentesis (not common)
  3. manual expression of the bladder - common in patients with neurological disease that require manual expression multiple times a day
49
Q

How does a ruptured bladder affect biochemistry results? How quickly do patients need to be treated?

A
  • uremia
  • dehydration, hypovolemia
  • electrolyte abnormalities

withing 36-48 hrs

50
Q

How does the peritoneal fluid and serum compare in cases of suspected bladder rupture? Why?

A
  • urea in peritoneal fluid = serum urea
  • creatinine in peritoneal fluid > serum creatinine

urea molecules equilibrate rapidly across peritoneum, but creatinine molecules are too large to cross the membranes

51
Q

In what 4 ways can ruptured bladders be diagnosed?

A
  1. free fluid in peritoneal cavity seen on radiographs/ultrasound
  2. creatinine in peritoneal fluid exceeds serum creatinine
  3. IV pyelogram (upper) or cystogram
  4. exploratory celiotomy
52
Q

Does voluntary urination always indicate the bladder is intect?

A

NO —> if rupture is small, the bladder may fill partially, allowing the animal to void voluntarily

53
Q

How are patients stabilized before surgery to fix ruptured bladders?

A

correct uremia, hypovolemia, and electrolyte abnormalities with IV fluids or urethral/peritoneal catheters, peritoneal dialysis (severe uremia)

54
Q

What is done on exploratory celiotomies in cases of bladder rupture?

A
  • debride tear in bladder and suture
  • peritoneal lavage
  • maintain urethral catheters for several ays
55
Q

What conservative treatment of bladder rupture can be done to avoid surgery?

A

catheter or needle holes to keep bladder compressed, which allows for healing

56
Q

What is the most common indication for cystotomies in dogs and cats? How are they treated?

A

cystic calculi

surgery —> calculi not medially soluble, risk of urethral obstruction is high

  • submit urine, bladder mucosa, and calculus for culture and sensitivity
57
Q

What is laser lithotripsy? What are 3 differences compared to cystotomy?

A

minimally invasive, safe, and effective removal of calculi in the bladder and urethral of dogs by breaking down stone to allow them to pass naturallu

  1. hospitalization is shorter
  2. procedure time longer in females
  3. anesthesia cost is higher
58
Q

Are all filling defects in the bladder calculi?

A

NO —> ultrasound can be used to differentiate blood from air

59
Q

What approach is used for cystotomies?

A

ventral midline approach to the caudal abdomen

  • stay sutures or Babcock forceps to elevate bladder (leave room to close!)
  • pack off bladder
60
Q

What ligaments of the bladder can be excised? Which cannot?

A

ventral

lateral —> contain ureters

61
Q

What is done before the bladder is cut into? Where is the incision made? How can edema be avoided?

A

empty it by compression or by aspiration of urine with a small needle

avascular area on ventral surface to avoid trigone (near apex to remove possible patent urachus)

avoid tissue handling

62
Q

How are cystotomies closed? What 3 patterns are used?

A

1 or 2 with absorbable sutures

  1. Cushing - Lembert
  2. simple continuous in submucosa
  3. simple interrupted in submucosa
63
Q

How can a bladder incision closure be leak tested? When is this not necessary?

A

compress the neck of the bladder while injecting saline

if the bladder is already filling with urine

64
Q

What must be done before and after cystotomies?

A

placement of a urethral catheter with flushing

65
Q

When will only a 1 layer closure be done on the bladder?

A

if there is intense fibrosis and edema of the bladder wall that makes multiple layers too difficult

(submit biopsy just in case, stones, neoplasia, and cystitis present the same)

66
Q

What is the most common benign and malignant neoplasias of the bladder?

A

papilloma + hyperplasia

TCC (most common overall)

67
Q

What commonly mimics bladder neoplasia in dogs?

A

inflammatory polyps

(polypoid cystitis)

68
Q

What signalment most commonly presents with TCC in the bladder? What is thought to be its etiology?

A

female Scottish Terriers

MULTIFACTORIAL = insecticide exposure, obesity, genetics

(most commonly will have metastasized by the time of diagnosis)

69
Q

What are the 3 most common diagnostics for TCC?

A
  1. UA - exfoliates well into urine and sediment (dogs without tumors can also have epithelial cells!)
  2. rectal palpation and transurethral biopsy
  3. bladder tumor antigent test
70
Q

How are survey radiographs and ultrasonography used to diagnose TCC?

A
  • r/o prostatic disease and urolithiasis
  • allows examination of sublumbar LNs, vertebrae, and pelvis for metastasis
71
Q

What treatments are recommended for resectable and nonresectable tumors in the bladder?

A

partial cystectomy

Piroxicam - decreases angiogenesis of tumor

72
Q

Where is TCC most commonly found in the bladder? What does this mean for surgical treatment?

A

often at trigone and seeded into other tissue

salvage procedure with partial cystectomy +/- urethral stenting

Small Animal Surgery (34 decks)

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