Male Reproductive Disorders

Question 1

orchitis

Answer 1

inflammation of the testes
often INFECTIOUS

always r/o brucella canis

Question 2

epididymitis

Answer 2

inflammation of the epididymis

Question 3

testicular torsion

Answer 3

rotation of the testes on its stalk

can be intraabdominal (if cryptorchid) or scortal

Question 4

what are types of testicular neoplasia

Answer 4

sertoli cell tumor, leydig cell tumor, seminoma

Question 5

how does orchitis appear on ultrasound

Answer 5

enlarged testes w/ hypoechoic or mottled texture

tunica is thickened and hyperechoic

Question 6

when doing an ultrasound for an enlarged testicle, what should you always look for

Answer 6

check for prostate, urinary tract, and peritoneal infection

orchitis is often associated with ascending infection

Question 7

how does epididymitis appear on ultrasound

Answer 7

enlarged epididymis with hyper or hypoechoic changes

epididymis should be 1/8 the size of the testes

Question 8

how does testicular torsion appear on ultrasound

Answer 8

if descended –> enlarged testes within the scrotum

if cryptorchid –> mass effect

hypoechoic to mottled texture

Question 9

how does testicular neoplasia appear on ultrasound

Answer 9

altered echogenicity with mineralization

irregular/variable border

if functional tumor –> causes atrophy of the contralateral testicle

Question 10

workup and management for enlarged, painful testicle

Answer 10

1. ultrasound - r/o torsion, neoplasia, herniation
2. FNA of testicle - submit for cytology and culture
3. empiric antibiotics
4. antibiotics based on C&S testing
5. determine fertility prognosis

Question 11

what empiric antimicrobials should be used for orchitis/epididymitis

Answer 11

enrofloxacin AND ampicillin

• enro: good tissue penetration
• ampicillin: good gram negative coverage

Question 12

what causes decreased fertility from orchitis/epididymitis

Answer 12

heat damage - heat from inflammation causes decreased spermatogenesis; will take time to return to normal sperm count

sperm autoantibodies

Question 13

sperm autoantibodies

Answer 13

inflammation causes breakdown of blood-testis barrier causing immune access to sperm –> production of antibodies –> permanent decrease in sperm production

Question 14

what are the most common disorders of the inguinal canal

Answer 14

cryptorchidism
herniation w/ incarceration

Question 15

cryptorchidism

Answer 15

unilateral or bilateral testes that fail to descend into the scrotum

can be inguinal or intraabdominal
(can be found anywhere from ipsilateral kidney and inguinal canal)

Question 16

when should the testes be fully descended

Answer 16

by 6 months of age (dogs)
by birth (cats)

Question 17

what does cryptorchidism predispose to

Answer 17

neoplasia and torsion (esp once neoplastic)

Question 18

can cryptorchid testes produce sperm

Answer 18

NO

Question 19

can cryptorchid testes produce testosterone

Answer 19

yes

Question 20

fertility and libido of a unilateral cryptorchid

Answer 20

fertile
normal libido & male behavior

Question 21

fertility and libido of a bilateral cryptorchid

Answer 21

infertile w/ normal libido and male behavior

Question 22

fertility and libido of an incompletely castrated cryptorchid

Answer 22

(only the descended testicle gets removed)

infertile w/ normal libido and male behavior

Question 23

how to check if testosterone is present in a cat

Answer 23

check for spines on the penis

Question 24

what is herniation with incarceration

Answer 24

movement of abdominal viscera into the scrotum via the inguinal canal
OR
movement of the testicles into the abdomen via the inguinal canal

can cause incarceration (entrapment) of the herniated contents

Question 25

how does inguinal hernia appear on ultrasound

Answer 25

mass of soft tissue/fluid within the inguinal area

Question 26

how does scrotal herniation appear on ultrasound

Answer 26

increased fluid and tissue surrounding the testicles may see bowel loops or omentum in the scrotum testicles should be normal in size/structure

Question 27

how are inguinal disorders treated

Answer 27

surgically inguinal hernia: placement of the viscera and repair the hernia cryptorchidism: removal of the testes

Question 28

what are the main 4 disorders of the prostate

Answer 28

1. benign prostatic hyperplasia 2. cystic BPH 3. prostatitis/prostatic abscess 4. prostatic neoplasia

Question 29

benign prostatic hyperplasia

Answer 29

normal process in older, intact dogs bilaterally symmetric prostate non painful

Question 30

cystic BPH

Answer 30

normal process in older, intact dogs similar as BPH but involves the development of blood filled cysts in the prostate - predisposes to bacterial abscess so you want to treat (unlike BPH) bilaterally symmetric and non painful

Question 31

prostatic abscess/prostatitis

Answer 31

inflammation/infection of the prostate often associated with infection of the bladder/lower urinary tract asymmetrical prostate HIGHLY painful

Question 32

prostatic neoplasia

Answer 32

prostatic adenocarcinoma asymmetrical prostate HIGHLY painful

Question 33

hemospermia

Answer 33

frank blood in the ejaculate most often originates from the PROSTATE

Question 34

does hemospermia affect fertility

Answer 34

NO - if natural breeding or fresh DOES affect fertility if frozen

Question 35

ddx for hemospermia

Answer 35

- BPH - cBPH - prostatic neoplasia - coagulopathy - brucellosis ALWAYS screen for brucella

Question 36

BPH on ultrasound

Answer 36

symmetrical enlargement of the prostate striated echotexture

Question 37

cBPH on ultrasound

Answer 37

symmetrical enlargement of the prostate with mildly heterogenous echogenicity cysts appear as hypoechoic nodules within the prostate

Question 38

prostatic neoplasia on ultrasound

Answer 38

irregular margins mineralization heterogenous parenchyma

Question 39

treatment for BPH

Answer 39

none indicated

Question 40

cBPH treatment

Answer 40

finasteride 5a reductase inhibitor that acts ONLY on the prostate to decrease production of fluid without affecting testes or fertility

Question 41

priapism

Answer 41

chronic, non-sexual erection can be ischemic or nonischemic (more common in animals)

Question 42

nonischemic priapism

Answer 42

caused by high arterial blood flow into the penis nonpainful

Question 43

etiologies of priapism

Answer 43

most commonly associated with spinal cord disease of the lumbosacral area IVDD, myelitis, spinal trauma, spinal malformations

Question 44

how to diagnose priapism

Answer 44

confirm with physical exam to differentiate from paraphimosis ID neurologic disease if present

Question 45

priapism on ultrasound

Answer 45

horizontal echogenic striations indicating dilated blood vessels

Question 46

treatment of priapism

Answer 46

1. terbutaline 2. gabapentin 3. sympathomimetics (ephedrine, pseudoephedrine)

Question 47

terbutaline

Answer 47

beta 2 agonist first line choice for dogs and cats

Question 48

gabapentin

Answer 48

NMDA antagonist; stimulates GABA and inhibits Ca channels second line choice if terbutaline fails

Question 49

ephedrine, pseudoephedrine

Answer 49

sympathomimetics last resort if the first two treatments fail do not use in cats due to hypersensitivity

Question 50

does neutering help treat priapism

Answer 50

NO - erection is not sexually stimulated so castration will not reduce

Question 51

paraphimosis

Answer 51

penis stuck outside the prepuce

Question 52

phimosis

Answer 52

penis stuck inside the prepuce