Lecture 36

Question 1

What are the benefits of castration?

Answer 1

-reduced roaming and indoor urine marking
-prevention or treatment of testicular neoplasia/torsion/infection
-resolution of 95% of perianal adenomas
-resolution of benign prostatic hyperplasia
-adjunct treatment for prostate infection, cysts, and abscesses

Question 2

What are the steps of a castration?

Answer 2

-prescrotal or scrotal incision over testicle
-break down attachments to scrotum and stretch cremaster muscle
-occlude vessels via ligation or pedicle tie
-possible tissue closure

Question 3

What are the characteristics of scrotal vs prescrotal castration?

Answer 3

-cat castration performed with two scrotal incisions
-dogs can be done via single prescrotal or scrotal incision
-puppy castrations are easier via scrotal incision
-self trauma is 2 times greater with prescrotal castration
-pre-scrotal castrations take 1.4 times longer than scrotal

Question 4

What are the characteristics of closed castration?

Answer 4

-can be performed on any size dog as long as the cord has been stripped down to a small diameter
-usually effective in cats as long as “knot” is tight

Question 5

What are the characteristics of open castration?

Answer 5

-allows direct ligation of vessels in dogs
-dogs may have more post-op swelling
-cord knots in cats are bulky and can bleed if hitched

Question 6

What are the characteristics of autoligation/pedicle ties?

Answer 6

*cats:
-outcomes are similar for cord ligation with suture, closed castration with single throw autoligation, and open castration with vas deferens-to-vessel ties

*dogs:
-if testicles are </= the size of a cat’s, a single throw pedicle tie can be used in a sutureless scrotal castration

Question 7

What are the common castration complications?

Answer 7

-swelling
-bruising
-self-trauma
-dermatitis
-infection
-hemorrhage

Question 8

What are the treatment options for serious post-op hemorrhage following castration?

Answer 8

-determine severity and cause with serial PCVs, coag. panel, abdominal ultrasound, and fluid analysis
-laparotomy if persistent intra-abdominal bleeding
-sedation, pressure, and monitoring for persistent scrotal bleeding (inguinal in cats, scrotal in dogs)
-scrotal ablation in case of scrotal hematoma

Question 9

What are the indications for scrotal ablation?

Answer 9

-severe dermatitis
-trauma
-infection
-aesthetics
-masses

Question 10

What is the recommended margin for scrotal mast cell tumors?

Answer 10

2 cm

Question 11

What are the potential complications of scrotal ablation?

Answer 11

-tension from excessive skin removal
-swelling
-infection

Question 12

What are the steps to a scrotal ablation?

Answer 12

-incise scrotum circumferentially near the base, leaving plenty of tissue for closure
-ligate or cauterize skin vessels; then free sides of scrotum from testes
-transect septal attachment and remove scrotum
-castrate dog if intact
-close subcutis and skin

Question 13

Why should subQ tissue tack down NOT be done in a scrotal ablation?

Answer 13

can lead to ligation or damage of the urethra

Question 14

What are the characteristics of phimosis?

Answer 14

-preputial orifice is too small to allow extrusion of the penis
-diagnosed via physical exam
-treated by enlarging the opening

Question 15

What are the clinical signs of phimosis?

Answer 15

*dogs:
-inability to breed
-urine retention
-balanoposthitis
-UTI
-ulceration
-paraphimosis

*kittens:
-stranguria
-pollakiuria
-dysuria

Question 16

What is paraphimosis?

Answer 16

inability to retract penis into prepuce:
-penis too large
-preputial opening too small
-prepuce too short
-preputial lining inflamed or dry

Question 17

What are the congenital causes of paraphimosis?

Answer 17

-preputial hypoplasia
-hypospadias
-phimosis

Question 18

What are the acquired causes of paraphimosis?

Answer 18

-trauma
-balanoposthitis
-neoplasia
-persistent erection
-foreign body
-weak muscles
-vascular or neurologic conditions

Question 19

What are the clinical signs of paraphimosis?

Answer 19

-penile swelling
-irritation
-dryness
-ischemia
-urinary tract obstruction

Question 20

What is the treatment for a reducible, non-painful, non-inflamed paraphimosis?

Answer 20

-lubrication to return penis to prepuce
-prescribe topical steroid/antibiotic cream

Question 21

What is the treatment for moderate penile swelling in paraphimosis?

Answer 21

-sedation/anesthesia
-cold compress and hyper-osmolar solution
-lubrication
-enlarge preputial orifice if phimosis
-narrow preputial orifice if too large
-preputial advancement to improve coverage

Question 22

What is the treatment for penile necrosis or neoplasia in paraphimosis?

Answer 22

-amputation
-urethrostomy

Question 23

What are the characteristics of hypospadias?

Answer 23

-abnormal urethral opening
-most common in males with other abnormalities
-penile/prepuce amputation and urethrostomy are performed for aesthetics and to prevent UTI/urine scald
-castration recommended

Question 24

What are the characteristics of cryptorchidism?

Answer 24

-congenital failure of one or both testicles to descend by two months of age
-heritability unknown
-often right inguinal in dogs
-inguinal more common than abdominal in cats

Question 25

What can happen to the affected testicles in cryptorchid cases?

Answer 25

-may atrophy -continue to produce hormones -undergo neoplastic transformation

Question 26

How is cryptorchidism diagnosed?

Answer 26

-palpation of inguinal testes -ultrasound -barbs on cat penis with no history of recent castration -positive AMH test in sexually mature, intact, and cryptorchid dogs and cats -testosterone < 1 ng/ml in bilaterally cryptorchid adult dogs -testosterone > 1 ng/ml in unilaterally cryptorchid adult dogs

Question 27

What are the steps to removing an inguinal cryptorchid testicle?

Answer 27

-incise over the palpable testicle or inguinal ring -incise subQ tissues parallel to long axis of the body to expose testicle -strip fascia and ligaments to free testicle -ligate and transect vessels -close subcutis and skin

Question 28

Where is the incision made for an abdominal cryptorchid testicle?

Answer 28

*unilateral in dog: -incise lateral to last nipple midway along prepuce *cat or bilateral dog: -midline abdominal

Question 29

How is the testicle found when in the abdomen?

Answer 29

find and follow the vas deferens or testicular artery

Question 30

Why is it important to accurately identify an abdominal cryptorchid testicle?

Answer 30

-can be difficult to differentiate from prostate; can lead to prostatectomy/urethectomy -do NOT use spay hook to find abdominal testicle if you cannot differentiate prostate from testicle

Question 31

What are the characteristics of testicular torsion?

Answer 31

-surgical emergency -can affect intra-scrotal or cryptorchid testicles -diagnose via ultrasound or exploratory surgery -stabilize the patient and castrate

Question 32

What are the clinical signs of testicular torsion?

Answer 32

-acute abdomen -pain -shock -vomiting -testicular enlargement

Question 33

What are the characteristics of canine testicular tumors?

Answer 33

-seen in 7-17% of intact males -cryptorchid testicles have high incidence of sertoli cell tumors and seminomas -metastatic rate reportedly around 10% -can cause hyperestrogenism