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1. VSC410 Surgery Exam Prep > Male Reproductive Surgery > Flashcards

Male Reproductive Surgery Flashcards

1
Q

4 components of the reproductive tract

A

Testes
Penis
Prepuce
Prostate

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2
Q

5 indications for castration

A

Elective sterilisation (open/ closed)

Treatment of testicular neoplasia

Orchitis (inflammation +/- bacteria)

testicular torsion

Cryptorchidism (retained testicle, hereditary)

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3
Q

Tradeoff of open castration

A

Better ligature security but more bleeding

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4
Q

Things to be mindful of about hairy scrotum

A

Sensitive skin - need to be mindful of clipper rash and antiseptic dermatitis

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5
Q

How do you advance the testicle to the prescrotal position?

A

Cover with drape
Apply pressure through the drape

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6
Q

How to remove the scrotal ligament

A

Grip the tail of epididymis with fingers and thumb
Grasp the ligament with haemostatic forceps
Apply a shear force to separate the two (good haemorrhage control)

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7
Q

The scrotal ligament is also know as the

A

Remnant of the gubernaculum

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8
Q

What type of clamps do you use in a castration

A

Rochester carmalts

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9
Q

What do you need to check for in a closed castration?

A

Ensure no abdominal contents are within the vaginal canal

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10
Q

What type of ligature is used in a closed castration?

A

Transfixing suture ligature - palpate the cremaster muscle and anchor a stich through it then continue around the cord (vascular plexus and vas)

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11
Q

What type of knot is used in a dog less than 10kgs?

A

Square knot

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12
Q

Cat open castration incision

A

Cranial to caudal skin incision over each testicle

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13
Q

Cat open castration - what do you need to separate the testicle from?

A

parietal tunic

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14
Q

Where do you transect the ductus deferens?

A

Near the testicle

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15
Q

How to tie off an open cat castration

A

tie 2-3 square knots with the ductus deferens and the spermatic vessels

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16
Q

6 complications of castration

A

Scrotal bruising
Swelling
Seroma
Haemorrhage
Haematoma
Infection

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17
Q

What is scrotal ablation?

A

a surgical procedure that involves the complete removal of the scrotum

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18
Q

5 indications for scrotal ablation ?

A

Neoplasia (sometimes with urethrostomy to create permanent opening in the urethra)

Trauma (dog fights)

Abscess

Ischaemia (blood supply problem)

Pendulous (appearance)

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19
Q

What type of incision do you do around the scrotum during ablation?

A

elliptical incision (watch how much skin is left for closure later)

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20
Q

How to stop the bleeding during scrotal ablation?

A

Digital pressure, ligation or electrocautery (but not on scrotal tissue)

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21
Q

What else do you need to break down during scrotal ablation?

A

Scrotal medium septum

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22
Q

What is cryptorchidism?

A

Failure of one or both testes to descend into the scrotum
- an inherited defect

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23
Q

What happens to spermatogenesis in cryptorchidism?

A

Spermatogenesis is absent

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24
Q

What is testicular torsion?

A

ACUTE EMERGENCY
Twisting of the cord that supplies blood to testicles.
This causes sudden and usually severe pain and swelling.

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25
Q

How to treat testicular torsion ?

A

Surgical removal is best

Need to ultrasound and look for other torsion

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26
Q

Treatment for cryptorchidism

A

Castration
- Inguinal (groin) approach (ultrasound first to distinguish from fat)
- Laparotomy (abdominal) - 2nd option as bigger procedure

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27
Q

3 types of testicular neoplasia

A

Seminoma
Interstitial cell
Sertoli cell

all occur in equal numbers

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28
Q

Clinical sign of testicular neoplasia

A

May cause feminising signs (oestrogens)

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29
Q

What is the prognosis of testicular neoplasia

A

Good prognosis <10% metastases prior to detection

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30
Q

4 characteristics of testicular trauma

A

Significant bleeding

Sperm granuloma (lump of leaked sperm that appears along the vas deferens or epididymides in vasectomized individuals)

Fibrosis

Possible infertility

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31
Q

What is hypospadias ?

A

developmental abnormality - failure of fusion of the genital folds

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32
Q

What is required in hypospadias is severe enough?

A

Urethrostomy

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33
Q

What breed is hypospadias common in?

A

Boston terriers

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34
Q

What is this?

A

Hypospadias

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35
Q

What is persistent penile frenulum?

A

Can’t extend penis well due to the persistence of a fibrous band from the ventral penis to the prepuce
- it usually ruptures at puberty

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36
Q

What is this ?

A

Persistent penile frenulum

37
Q

Characteristics of a dog bifid penis?

A

Young dog with congenital abnormality
Phimosis (a congenital narrowing of the opening of the foreskin so that it cannot be retracted) due to bifid penis
Smaller defect doesn’t have a urethra
Unable to mate as slips during mating (can’t lock)

38
Q
A

Dog bifid penis

39
Q

Surgical treatment for dog bifid penis

A

Amputate and suture the defect formed in the urethra, tunica albuginea and mucosa

40
Q

What is this

A

Malicious penile strangulation

41
Q

6 causes of penile trauma

A

Stick injuries
Wire fences
Mating injuries
Kicks
Bite wounds
Strangulation

42
Q

Results of lacerations/ bite wounds

A

severe haemorrhage
Fracture of os penis

43
Q

Treatment for penile lacerations

A

Suture fresh lacerations
Antibiotics - topical and systemic
Amputation if severe
Urethrostomy

44
Q

8 Steps of penile amputation

A
  1. catheterise urethra
  2. apply torniquet
  3. incise penis as bilateral flaps
  4. remove catheter, transect urethra
  5. ligate major vessels
  6. incise urethra and spatulate
  7. suture to penile mucosa (4/0 absorbable)
  8. +/- shorten urethra
45
Q
A

Catheterise urethra and apply torniquet

46
Q
A

Penile amputation

47
Q

what is this

A

Urethral prolapse

48
Q

What is phimosis

A

an inability to protrude the penis beyond the preputial opening
(restricted in exteriorisation)

49
Q

Causes of phimosis

A

Persistent frenulum
Hypoplasia of preputial opening
Trauma with secondary scarring
small preputial orifice

50
Q

Signs of phimosis

A

Often distended prepuce
Don’t urinate with a normal steady stream

51
Q

Treatment of phimosis

A

Resect fibrous tissue
Widen preputial opening

52
Q

How to treat phimosis due to small preputial orifice

A

Wedge resection from the dorsal prepuce
Suture preputial mucosa to the skin

or circumferential excision and suture

53
Q

What is paraphimosis ?

A

Permanent protrusion of a flaccid penis (can’t be pulled back up into penile sheath

54
Q

4 causes of paraphimosis in dogs

A

Small preputial opening (disruption to blood flow)

Matted preputial hair (excessive licking)

Congenitally short prepuce

May have self-trauma to penile tip

55
Q

Treatment for paraphimosis

A

Surgically enlarge preputial opening

Amputate distal end of penis

Preputial advancement

56
Q

What is this?

A

Paraphimosis

57
Q

How to complete preputial advancement

A

Lengthen the prepuce by removing a crescent shaped piece of skin cranial to the prepuce, shortening the preputial muscles and advancing the prepuce cranially

58
Q

What type of gland is the prostate?

A

Bi-lobed

59
Q

Where do the vasa deferentia enter ?

A

Enter the prostate gland dorso-caudally

60
Q

Blood supply of the prostate gland

A

Dorsolateral capsule

61
Q

Sympathetic innervation of prostate gland

A

Hypogastric nerve

62
Q

Parasympathetic innervation of prostate gland

A

Pelvic nerve

63
Q

5 surgical conditions of the prostate

A

Benign hyperplasia

Prostatitis / abscessation

Prostatic cysts and paraprostatic cysts

Prostatic neoplasia

Prostatic (squamous) metaplasia (rare)

64
Q

What is benign prostatic hyperplasia

A

Benign enlargement of the prostate

increased number and size of cells - pressure causes pressure on urethra and colon

65
Q

incidence of benign prostatic hyperplasia

A

Intact male dogs

60% incidence in dogs over 5 yrs - 8-9 most common

66
Q

Clinical signs of benign prostatic hyperplasia

A

Constipation
Tenesmus (feel of needing to pass stools, even if empty)
Ribbon like stools

Haematuria (blood in urine) or urethral bleeding

Perineal herniae

Prostatic cysts

MAY HAVE NO SIGNS

67
Q

Diagnosis of benign prostatic hyperplasia

A

Rectal exam- non painful, smooth, symmetrical enlargement of prostate

Radiographs, ultrasound, CT

Histopath can be definitive

68
Q

Differential diagnosis of benign prostatic hyperplasia

A

Squamous metaplasia

Prostatic cysts or paraprostatic cyst

Prostatitis or abscess

Neoplasia

69
Q

Treatment for benign prostatic hyperplasia

A

Castration

Faecal softeners

Oestrogen therapy

Anti-androgens (Tardak)

70
Q

Why does squamous metaplasia occur ?

A

Occurs when excess oestrogens (iatrogenic - exogenous administration) or (sertoli cell tumours) resulting in feminising syndrome

so need to remove source of oestrogens

71
Q

What is prostatitis ?

A

Infection of the prostate gland +/- abscess

the prostatic parenchyma has purulent material accumulated

72
Q

Clinical signs of prostatitis

A

Depression (lethargy)
Pain
Vomiting
Poluria, polydipsia
Haematuria
Incontinence
Straining (and pain)
Ascending infection (UTI)
Pyuria
Straining to defecate & irregular pattern

73
Q

5 ways to diagnose prostatitis ?

A

Rectal - enlarged, painful (sometimes asymmetrical)

Radiology

Prostatic wash

FNA

Ultrasonography

74
Q

Diagnosis ?

A

Prostatitis

75
Q

Prostatitis treatment

A

Castration
Antibiotics for 4-6 weeks
Drainage
Subtotal prostatectomy (surgical removal of part of prostate)
omentalisation (placement of omentum around organs or within cavities to improve vascularization or drainage)

76
Q

How to drain prostatitis abscessation?

A

evacuate cavities
breakdown septae within gland
Place drain (penrose, foley, mushroom)

SAMPLE FOR BACTERIOLOGY AND HISTO

77
Q

Why the omentum in prostatitis treatment ?

A

Provides drainage
adhesions
induces neovascularisation
functions in presence of infection
Promotes immune function - T and B lymphocytes

78
Q

Signalment for prostatic neoplasia

A

Rare, older dogs and cats

Occurs in entire and neutered dogs

79
Q

Types of prostatic neoplasms

A

Mostly adenocarcinomas

Otherwise, poorly differentiated carcinomas, squamous cell carcinomas, leiomyosarcomas, transitional cell carcinomas

80
Q

Clinical signs of prostatic neoplasm

A

Tenesmus (feeling need to pass stools)

Dysuria (pain urinating)

Stranguria(small volume, want to pass more)

Urethral bleeding

Lumbar pain

Lameness

Emaciation

81
Q

Treatment for prostatic neoplasm

A

Total prostatectomy

Intraoperative radiotherapy

Permanent tube cystostomy

Castration

Oestrogen therapy

82
Q

5 sites of early metastases of prostatic neoplasia

A

Lymph nodes

Bladder

Lungs

Rectum

Bone

83
Q

Prostatic neoplasia prognosis

A

GRAVE!
Mean survival time - 3 months

84
Q

What is a prostatic cyst?

A

Aetiology unknown but common
Fluid-filled (colourless-brown), non septic cyst with calcified walls within or communicating with the prostate

85
Q

Signalment for prostatic cysts

A

Entire males
Large Breeds

86
Q

Treatment of prostatic cysts

A

Castration
Excision
Drainage
Marsupialization
Omentalization

87
Q

7 steps of a prostatic wash

A
  1. Catheterise bladder
  2. empty bladder
  3. flush bladder 5-10mls saline (pre-wash sample)
  4. Withdraw catheter tip to prostate
  5. Massage prostate
  6. inject 5-10mls saline
  7. Aspirate fluid from urethra and bladder (post wash sample)
88
Q

Diagnosis of histopath results of fibrous reaction + irregular acinar structures lined by hyperchromic epithelial cells
Clincial signs dripping puss from penis, nonresponsive to AB’s, restless, mild dysuria , enlarged painful prostate

A

Prostatic adenocarcinoma

89
Q

4 components of the reproductive tract

A

Testes
Penis
Prepuce
Prostate

1. VSC410 Surgery Exam Prep (8 decks)

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