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VSC410 EOS Exam > Male Reproductive Surgery > Flashcards

Male Reproductive Surgery Flashcards

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1
Q

4 components of the reproductive tract

A

Testes
Penis
Prepuce
Prostate

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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
What is testicular torsion?
ACUTE EMERGENCY Twisting of the cord that supplies blood to testicles. This causes sudden and usually severe pain and swelling.
25
How to treat testicular torsion ?
Surgical removal is best Need to ultrasound and look for other torsion
26
Treatment for cryptorchidism
Castration - Inguinal (groin) approach (ultrasound first to distinguish from fat) - Laparotomy (abdominal) - 2nd option as bigger procedure
27
3 types of testicular neoplasia
Seminoma Interstitial cell Sertoli cell all occur in equal numbers
28
Clinical sign of testicular neoplasia
May cause feminising signs (oestrogens)
29
What is the prognosis of testicular neoplasia
Good prognosis <10% metastases prior to detection
30
4 characteristics of testicular trauma
Significant bleeding Sperm granuloma (lump of leaked sperm that appears along the vas deferens or epididymides in vasectomized individuals) Fibrosis Possible infertility
31
What is hypospadias ?
developmental abnormality - failure of fusion of the genital folds
32
What is required in hypospadias is severe enough?
Urethrostomy
33
What breed is hypospadias common in?
Boston terriers
34
What is this?
Hypospadias
35
What is persistent penile frenulum?
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
36
What is this ?
Persistent penile frenulum
37
Characteristics of a dog bifid penis?
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
Dog bifid penis
39
Surgical treatment for dog bifid penis
Amputate and suture the defect formed in the urethra, tunica albuginea and mucosa
40
What is this
Malicious penile strangulation
41
6 causes of penile trauma
Stick injuries Wire fences Mating injuries Kicks Bite wounds Strangulation
42
Results of lacerations/ bite wounds
severe haemorrhage Fracture of os penis
43
Treatment for penile lacerations
Suture fresh lacerations Antibiotics - topical and systemic Amputation if severe Urethrostomy
44
8 Steps of penile amputation
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
Catheterise urethra and apply torniquet
46
Penile amputation
47
what is this
Urethral prolapse
48
What is phimosis
an inability to protrude the penis beyond the preputial opening (restricted in exteriorisation)
49
Causes of phimosis
Persistent frenulum Hypoplasia of preputial opening Trauma with secondary scarring small preputial orifice
50
Signs of phimosis
Often distended prepuce Don't urinate with a normal steady stream
51
Treatment of phimosis
Resect fibrous tissue Widen preputial opening
52
How to treat phimosis due to small preputial orifice
Wedge resection from the dorsal prepuce Suture preputial mucosa to the skin or circumferential excision and suture
53
What is paraphimosis ?
Permanent protrusion of a flaccid penis (can't be pulled back up into penile sheath
54
4 causes of paraphimosis in dogs
Small preputial opening (disruption to blood flow) Matted preputial hair (excessive licking) Congenitally short prepuce May have self-trauma to penile tip
55
Treatment for paraphimosis
Surgically enlarge preputial opening Amputate distal end of penis Preputial advancement
56
What is this?
Paraphimosis
57
How to complete preputial advancement
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
What type of gland is the prostate?
Bi-lobed
59
Where do the vasa deferentia enter ?
Enter the prostate gland dorso-caudally
60
Blood supply of the prostate gland
Dorsolateral capsule
61
Sympathetic innervation of prostate gland
Hypogastric nerve
62
Parasympathetic innervation of prostate gland
Pelvic nerve
63
5 surgical conditions of the prostate
Benign hyperplasia Prostatitis / abscessation Prostatic cysts and paraprostatic cysts Prostatic neoplasia Prostatic (squamous) metaplasia (rare)
64
What is benign prostatic hyperplasia
Benign enlargement of the prostate increased number and size of cells - pressure causes pressure on urethra and colon
65
incidence of benign prostatic hyperplasia
Intact male dogs 60% incidence in dogs over 5 yrs - 8-9 most common
66
Clinical signs of benign prostatic hyperplasia
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
Diagnosis of benign prostatic hyperplasia
Rectal exam- non painful, smooth, symmetrical enlargement of prostate Radiographs, ultrasound, CT Histopath can be definitive
68
Differential diagnosis of benign prostatic hyperplasia
Squamous metaplasia Prostatic cysts or paraprostatic cyst Prostatitis or abscess Neoplasia
69
Treatment for benign prostatic hyperplasia
Castration Faecal softeners Oestrogen therapy Anti-androgens (Tardak)
70
Why does squamous metaplasia occur ?
Occurs when excess oestrogens (iatrogenic - exogenous administration) or (sertoli cell tumours) resulting in feminising syndrome so need to remove source of oestrogens
71
What is prostatitis ?
Infection of the prostate gland +/- abscess the prostatic parenchyma has purulent material accumulated
72
Clinical signs of prostatitis
Depression (lethargy) Pain Vomiting Poluria, polydipsia Haematuria Incontinence Straining (and pain) Ascending infection (UTI) Pyuria Straining to defecate & irregular pattern
73
5 ways to diagnose prostatitis ?
Rectal - enlarged, painful (sometimes asymmetrical) Radiology Prostatic wash FNA Ultrasonography
74
Diagnosis ?
Prostatitis
75
Prostatitis treatment
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
How to drain prostatitis abscessation?
evacuate cavities breakdown septae within gland Place drain (penrose, foley, mushroom) SAMPLE FOR BACTERIOLOGY AND HISTO
77
Why the omentum in prostatitis treatment ?
Provides drainage adhesions induces neovascularisation functions in presence of infection Promotes immune function - T and B lymphocytes
78
Signalment for prostatic neoplasia
Rare, older dogs and cats Occurs in entire and neutered dogs
79
Types of prostatic neoplasms
Mostly adenocarcinomas Otherwise, poorly differentiated carcinomas, squamous cell carcinomas, leiomyosarcomas, transitional cell carcinomas
80
Clinical signs of prostatic neoplasm
Tenesmus (feeling need to pass stools) Dysuria (pain urinating) Stranguria(small volume, want to pass more) Urethral bleeding Lumbar pain Lameness Emaciation
81
Treatment for prostatic neoplasm
Total prostatectomy Intraoperative radiotherapy Permanent tube cystostomy Castration Oestrogen therapy
82
5 sites of early metastases of prostatic neoplasia
Lymph nodes Bladder Lungs Rectum Bone
83
Prostatic neoplasia prognosis
GRAVE! Mean survival time - 3 months
84
What is a prostatic cyst?
Aetiology unknown but common Fluid-filled (colourless-brown), non septic cyst with calcified walls within or communicating with the prostate
85
Signalment for prostatic cysts
Entire males Large Breeds
86
Treatment of prostatic cysts
Castration Excision Drainage Marsupialization Omentalization
87
7 steps of a prostatic wash
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
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
Prostatic adenocarcinoma

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