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Principles Of Surgery > Neuter/ Castration > Flashcards

Neuter/ Castration Flashcards

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1
Q

Why Neuter?

A

◦ Sterilization
◦ Population control
◦ Elimination of male characteristics
◦ Removes primary source of testosterone
◦ Roaming behaviors
◦ Aggression [cats vs. dogs]
◦ Odor or urine [cats]
◦ Disease control/treatment

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2
Q

What are other medical terms that mean neuter?

A
  • Neuter
  • Castration
  • Orchiectomy
  • Orchidectomy
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3
Q

What is a neuter?

A

Surgical removal of both testicles [regardless of location]

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4
Q

What are testicles?

A

◦ Testicle
◦ Male reproductive gland that produces sperm

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5
Q

What patients are usually undergoing routine/ elective neuters?

A
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6
Q

What is another reason patients would be neutered in a non routine way?

A
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7
Q

When would you neuter in happy healthy dogs?

A

6 months- 2 years

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8
Q

When would you neuter in happy healthy cats?

A

6 + months

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9
Q

What is cryptorchidism?

A

◦ One or both testicles do not descend from the
abdomen

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10
Q

In a cryptorchid patient, where can you usually find the retained testicles?

A

◦ Retained testicles can be either:
◦ Inguinal
◦ Abdomina

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11
Q

On physical exam what can retained testicles mimic?

A

May be able to palpate in the inguinal canal. Some may present as abdominal mass.

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12
Q

If secondary to a sertoli cell tumor, what can you see on physical exam?

A

Alopecia/ enlarged mammary glands

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13
Q

What is testicular hypoplasia/ atrophy? Are there clinical signs? What can you see in the testicles?

A
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14
Q

What is scrotal or testicular trauma? What may be seen?

A
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15
Q

What is testicular torsion? What can be seen?

A
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16
Q

What are prostatic diseases that would indicate the patient should be neutered?

A
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17
Q

What are the clinical signs of patients with prostatic diseases that would indicate neuter?

A
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18
Q

What are potential neoplasias that would indicate neuter?

A
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19
Q

What are clinical signs of neoplasia that would indicate neuter?

A
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20
Q

What is orchitis? Epididymitis?

A
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21
Q

What clinical signs can be seen with orchitis/epididymitis? Is it an indication to neuter?

A

It is an indication to neuter.

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22
Q

What is a perineal hernia? What are the clinical signs? Is it an indication to neuter?

A

It is an indication to neuter

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23
Q

Recap: What are the reasons you would neuter a patient other than routine neuters?

A
  • Cryptorchidism
  • Testicular Hypoplasia/Atrophy
  • Scrotal or testicular trauma
  • Testicular torsion
  • Prostatic Diseases
  • Neoplasia
  • Orchitis
  • Epididymitis
  • Perineal Hernia
    POTENT TCP
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24
Q

What are the steps to a pre scrotal approach for a neuter?

A

1.) Isolate testicle with non dominant hand, and push up away from scrotum and towards prepuce.
2.) Make incision on median raphe, directly over testicle ( 10-15 blade)
3.)Incise SQ tissue to expose testicles. ( use mosquitos to control SQ bleeders)
4.) Incise up to internal spermatic fascia/ parietal vaginal tunic.
5.) Dissect scrotal ligament ( using gause or blunt dissection with a blade) to release testicle. (Grab spermatic cord at caudal end of incision and pull cranially)
6.) Once released, strip fat and SQ tissue until spermatic cord is isolated.
7.) Use 3 clamp technique applied proximal to the testicle on the spermatic cord. Apply 2 ligatures (circumfrential and transfixing ligature)
8.) Check for bleeders after both testicles removed.
9.) SQ tissue closure. (prevents scrotal hematomas) Be careful not to include retractor penis muscle (Use simple continuous)
10.) Skin closure ( intradermal, simple interrupted

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25
What are the steps to the 3 clamp technique?
1.) 3 hemostats are applied proximal to the testicle. Make sure if they are curved that they are pointing up. 2.) 2 ligatures are applied, a circumfrential, and a transfixing which should be the most distal ligature. Testicular pedicle can then be transected.
26
Where is the first ligature placed in the 3 clamp technique?
◦ 1st Ligature (A) ◦ Placed on “crushed” tissue once proximal hemostat is removed. This will be the hemastat closest to body wall. ◦ Circumferential: Miller's knot, Modified miller’s knot, Surgeons knot, Square knot
27
Where is the 2nd ligature placed in the 3 clamp techique?
◦ 2nd Ligature (B) ◦ Placed between 1st ligature and middle hemostat ◦ Loosen the forceps while first 2 throws of ligature are being secured (aka “flash) and then re-clamp - Circumferential: Miller's knot, Modified miller’s knot, Square knot ◦ Transfixing: Only applied on most distal ligature: 2 knots ◦ Transect testicular pedicle between 2 clamps
28
How many ligatures should be placed on the spermatic cord for small dogs?
◦ 1 – 2 ligatures for small dog
29
How many ligatures should be placed on the spermatic cord for large dogs?
◦ Minimum 2 ligatures for large dogs
30
Where do you transec the testicular pedicle after placing your ligatures?
◦ Transect testicular pedicle between 2 clamps
31
What pattern should be used when closing the subcutaneous tissue in a pre scrotal approach?
Simple continuous pattern
32
What is the importance of closing the subcutaneous tissue in a canine neuter that is done with prescrotal approach?
Prevents scrotal hematomas
33
What must you avoid when closing the subcutaneous tissue in a canine neuter that is done with prescrotal approach?
Careful of including retractor penis muscle.
34
When would you preform a scrotal approach neuter? What is the benefits/ cons of it?
35
What is the steps to neutering with a scrotal approach in dogs?
1.) Scrotal incision slightly lateral to the median raphe. 2.) 1st testicle removed through scrotal incision 3.) Perform closed castration ( do not open the internal spermatic fascia) 4.) Place 1-2 ligatures for small dogs ( Circumferential ( most proximal) transfixing (most distal)) Minimum of 2 for large dogs) 5.) Close with one single buried SQ suture in scrotal incision ( smalll amount of oozing is normal.
36
An owner calls with concerns after her dog comes home from his scrotal neuter. The owner notices the site has a small amount of oozing. What would you tell the owner?
- Small amount of oozing is normal, nothing to be concerned with.
37
What is important post op care after neuter procedures.
- Exercise restrict (10-14 days is ideal but rare) Suture removal / recheck at 10-14 days. - E collar ( must wear 1 week) - NSAIDs to go home. (Carprofen/ rimadyl) or (meloxicam/metacam) Give these for 5-7 days.
38
How long should a patient be sent home on NSAIDs after a neuter?
5-7 days
39
How long should a patient be exercise restricted after a neuter?
10-14 days
40
How long should you wait before removing sutures/ rechecking incision after neuter?
If no complications 10-14 days
41
What are the NSAIDS that can be given to patients after a neuter?
Meloxicam/ Metacam Carprofen/ Rimadyl
42
How long should a patient wear a cone after a neuter?
At least 1 week
43
What are the types of cat neuters?
Scrotal approach Scrotal ablation with perineal urethrostomy
44
Is a cat neuter a sterile procedure?
Clean procedure
45
How do you prepare a cats testicles prior to neuter?
Pluck hair vs shave Chlorhexidine + alcohol skin prep.
46
What are the steps of a cat neuter?
1.) incision made directly over each testicle ( 10 or 15 blade) 2.) exteriorize testicle 3.) Strip spermatic cord of excess tissue/ fat ( closed vs. open technique) 4.) autoligation (cord tie) vs figure 8 tie the testicle on itself) 5.) Transect testicle 6.) Leave scrotal incisions open to drain and heal by second intention.
47
How does a feline scrotal neuter heal?
Second intention
48
How does a canine scrotal neuter heal?
1st closure
49
How to autoligate a feline testicle? Perform it?
50
How to figure 8 tie a feline testicle? Perform it?
51
What is the post op care recommended for a cat that has been neutered?
- Shredded/ paper litter or yesterdays news. - +/- NSAID ( Onsior 3 days SID) (Metacam (3 doses off label) - +/- e collar
52
How many doses of onsior should be sent home with a cat who had been neutered and did not receive an injection of it during the neuter? What about if a dose was given during the neuter? How many total doses?
3 dose sent home if no injection. 2 doses if injection given 3 total doses.
53
How many doses of metacam should be sent home with a cat who had been neutered and did not receive an injection of it during the neuter? What about if a dose was given during the neuter? How many total doses?
3 dose sent home if no injection. 2 doses if injection given 3 total doses.
54
What are the potential complications of a neuter procedure?
◦ Hemorrhage ◦ Scrotal irritation/bruising ◦ Scrotal hematoma ◦ Infection ◦ Dehiscence ◦ More common in dogs than cats
55
What animals have more potential for complications after a neuter procedure?
◦ More common in dogs than cats
56
What complication is seen in this image?
Scrotal hemotoma
57
What complication is seen in this image?
infection/ dehiscence
58
What complication is seen in this image?
Scrotal irritation/ bruising as well as overall bruising on the prepuce. Potential hemorrhage depending on how extensive the bleeding is.
59
An owner called after their cat was neutered and wants to know if they could do anything different in their normal routine to assist healing. What is a recommendation you can make?
If they are licking, cone. Use shredded paper litter or yesterdays news instead of regular litter.
60
What kind of ligation is seen in this image?
Figure 8 tie
61
When is an open neuter technique used?
Usually by accident
62
In cats, why is autoligation preferred?
cats more likely to have reaction so avoid foreign material at all costs.
63
What can cause scrotal hematoma in cat? What do you do to help the patient?
- patient too active after procedure - -very painful, icing, give pain control.
64
what can cause scrotal irritation/ bruising?
how aggressive tissue was manipulated during the procedure.
65
Testicular tumors are not very common in _______
CATS
66
Why do we neuter cryptochid dogs?
- Chance it can become cancer ( undecended testicle likely to become sertoli cell) - Dont allow them to breed, cryptorchidism has genetic component.
67
Are prostatic tumors usually primary or secondary
Mostly secondary due to tcc metted from bladder.
68
What is the driving force of urethral hyperplasia?
Testosterone.
69
Perineal hernia is more comon in _______ ________
intact dogs.
70
When you see a perineal hernia, what is the swelling seen adjacent to the rectum?
- failure of the pelvic diagphram allows organs to be displaced in between muscle.
71
New studies show there are benefits to _________ neuters
Scrotal
72
When should you not use a scrotal approach to neuter?
Bilateral cryptorchidism, trauma, pyoderma, ect
73
What is important to note about a testicular block?
- makes it less painful, use 2mg/ kg split between testicles. When testicle becomes firm stop injecting it.
74
When can you use an autoligation in a canine neuter?
If preforming a scrotal approach and scrotum is not pendulous and testicle is not larger than what you would see in an adult tom cat then you can autoligate. Any larger move to suture ligations.
75
One testicle may lie more cranial to the other, which should be removed first?
The more caudal testicle
76
Besides NSAIDs for pain, what else can you send home with canine patients post neuter to help with recovery?
Trazadone, exercise restriction/ calmness.

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