Male Reproductive Surgery

Question 1

reasons to neuter cryptorchids

Answer 1

1. it is heritable
2. increases risk of neoplasia
3. increases risk of testicular torsion

Question 2

how to locate inguinal cryptorchids

Answer 2

examine the scrotum and inguinal area under anesthesia

palpate along inguinal area - palpate just off of midline, push the descended testicle cranially and see which side it deviates to to figure out which side is the cryptorchid

• if unable to find, use ultrasound
• if unable to find on US, use AMH testing

Question 3

how to locate intraabdominal cryptorchids

Answer 3

ultrasound (not palpable)

Question 4

cryptorchidectomy steps

Answer 4

1. caudal celiotomy
2. dx inguinal vs intraabdominal testes
3. ligate and divide pedicles

Question 5

what incison should be used for the caudal celiotomy

Answer 5

parapreputial incision

incise lateral to the prepuce through the skin and SQ

once linea is visualized –> push the prepuce laterally and incise the linea along midline (do NOT make incision into the body wall lateral to the linea)

make incision long enough to see all structures

Question 6

how to ID inguinal vs intraabdominal testes

Answer 6

once in the abdomen - look for the testicular vessels and spermatic cord extending through the inguinal ring –> indicates testicular descent into the scrotum

if no testicular vessels or spermatic cord going through inguinal ring –> testes is intraabdominal

Question 7

where are most intraabdominal testes located

Answer 7

lateral or cranial to the bladder

Question 8

risk factors for testicular neoplasia

Answer 8

common in cryptorchid testes; usually an incidental finding

even if the other testicle is not enlarged - remove anyway because can be neoplastic

Question 9

clinical signs of testicular neoplasia

Answer 9

enlarged or asymmetric testicles

Question 10

types of testicular tumors and are they metastatic

Answer 10

• sertoli cell tumor
• leydig cell tumor
• seminomas

NONE are very metastatic

Question 11

what are signs of a sertoli cell tumor

Answer 11

feminization syndrome
- alopecia
- gynecomastia
- pendulous prepuce
- prostatic dysfunction

caused by imbalance of estrogen to testosterone

Question 12

diagnostics for testicular tumors

Answer 12

abdominal ultrasound - want to evaluate for LN involvement

Question 13

surgical management of testicular tumors

Answer 13

bilateral orchiectomy

if scrotal –> perform a closed castration with scrotal ablation

Question 14

scrotal ablation

Answer 14

elliptical incision around the scrotum –> tie off the pedicles –> remove and reappose the skin edges

Question 15

indications for scrotal ablation

Answer 15

1. postoperative neuter scrotal hematomas
2. testicular neoplasia
3. testicular torsion
4. older dogs w/ pendulous scrotum

Question 16

what causes postop neuter scrotal hematomas

Answer 16

subcutaneous bleeders from the incision

if not severe - can be treated with icing and warm packing + analgesics (does not always need scrotal ablation

Question 17

indications for penile surgery

Answer 17

1. trauma (most common)
2. neoplasia
3. congenital (hypospadias)

Question 18

penile neoplasia

Answer 18

mast cell tumors
SCC

less common: HSA, transmissible venereal tumors

Question 19

surgery for removing penile neoplasia

Answer 19

complete penile amputation

requires a scrotal urethrostomy to reroute urine passage

Question 20

why perform urethrostomy at the scrotum

Answer 20

widest part of urethra
closest contact with the skin

Question 21

hypospadia

Answer 21

urethral folds fail to close –> urethra doesn’t form a complete tube

if mild/asymptomatic - does not require repair

if symptomatic - requires penile amputation and urethrostomy

Question 22

steps of penile amputation

Answer 22

1. place large bore red rubber catheter - aids with making incision into the urethra
2. incise around the penile base and lift off of the body wall
3. oversew the penile stump (cannot do simple ligation)
4. close incision by suturing the skin to the penile mucosa

always perform with scrotal urethrostomy

Question 23

how to diagnose prostatic disease

Answer 23

1. digital palpation - assess size, symmetry, discomfort
2. lab sampling - prostatic wash, FNA
3. imaging - radiographs, US, CT

Question 24

prostatic abscess etiology

Answer 24

ascending infection up the urethra

bacteria:
- e. coli
- staph
- strep
- proteus
- klebsiella

Question 25

clinical signs of prostatic abscess

Answer 25

dyschezia dysuria pyrexia signs of septic peritonitis (if ruptured prostatic abscess)

Question 26

diagnosis of prostatic abscess

Answer 26

ultrasound

Question 27

surgical treatment of prostatic abscess

Answer 27

caudal celiotomy (parapreputial approach) 1. find prostate and palpate for abscess 2. open up pockets and aspirate out fluid 3. ALWAYS submit for culture and biopsy 4. open the prostatic capsule and omentalize 5. place a drain that extends CRANIO-VENTRALLY under the liver

Question 28

function of omentalization

Answer 28

omentum contains high lymphatic drainage - aids in clearing ongoing bacteria after closure

Question 29

paraprostatic cyst

Answer 29

cysts that arise from the prostate - can get very large leading to a mass effect in the abdomen

Question 30

clinical signs of paraprostatic cyst

Answer 30

dysuria dyschezia constipation

Question 31

diagnosis of paraprostatic cyst

Answer 31

ultrasound - large fluid filled structure radiographs

Question 32

surgical treatment of paraprostatic cysts

Answer 32

subtotal excision and omentalization - open and drain the cyst - resect 85% of the cyst wall and omentalize do NOT resect the entire cyst - very close and associated with the ureters so do not want to ligate accidentlly

Question 33

what is the most common prostatic neoplasia? metastasis? is neutering preventative?

Answer 33

adenocarcinoma HIGHLY metastatic - bone, LNs, lungs castration is NOT protective for developing prostatic cancer

Question 34

diagnosis of prostatic adenocarcinoma

Answer 34

FNA of the prostate

Question 35

medical treatment of prostatic adenocarcinoma

Answer 35

piroxicam (NSAIDs)

Question 36

surgical treatment of prostatic adenocarcinomas

Answer 36

prostatectomy LESS COMMON than medical management and interventional procedures do not want to remove entire prostate since it is the sign of high pressure/resistance in the urethra --> total prostatectomy will cause urinary incontinence

Question 37

interventional procedures for prostatic adenocarcinoma

Answer 37

urethral stenting + NSAIDs relieves the obstruction of the mass - similar incontinence rate as prostatectomy

Question 38

urethral prolapse

Answer 38

protrusion of the distral urethral mucosa occurs in young, male, intact brachycephalics

Question 39

etiologies of urethral prolapse

Answer 39

excessive mating UTIs urinary stones urinary obstruction secondary to increased intraabdominal pressure

Question 40

surgical treatment of urethral prolapse

Answer 40

urethropexy OR urethral R&A

Question 41

is recurrence common with surgical treatment of urethral prolapse

Answer 41

yes regardless of surgery type

Question 42

recommendations for reducing recurrence

Answer 42

castration + treating upper airway obstruction (if boas)

Question 43

urethropexy

Answer 43

pexy the prepuce to the urethra with TEMPORARY sutures need to be removed once scar forms

Question 44

urethral R&A

Answer 44

full thickness incision through the prolapsed tissue partially around the circumference --> place interrupted sutures of absorbable 4-0 or 5-0 monofilament between mucosa and penile opening PERMANENT - do not want sutures removed