Testis Flashcards

Question

Whic is the most common equine testicular neoplasm Which cell type do these origonate from and which group(s) of horses are most commonly affected?

Answer 1

Seminomas Origonate from geminal cells of the seminiferous tubules Affect mainly older horses of those with cryptorchid testicles

Answer 2

Male pseudhermaphrodite (male gonadal tissue and more female like external genitalia) Typically have hypoplastic testes within the abdomen, and a penis like structure resembling a clitoris, emerging from a rudimentary ‘prepuce’ which may be positioned on midline anywhere between the perimeun or scrotal location. Phenotypic appearance resembles female but sexual behaviour is that of a male

Answer 3

Overall 88% Inability to palpate the ring(s) indcates abdominal crypt If the ring is palpable, either the epididymus or testis (or both) has traversed the ring, so either not an abdominal crypt, or a partial abdominal crypt (testis retained, epididymus descended)

Answer 4

Transient scrotal oedema, intratesticular hemorrhage ( may cause pressure necrosis), immune reaction to spermatozoa caused by disruption of the blood-testis barrier; dissemination of neoplastic cells if a neoplasm is biopsied, formation of a haematoma (negative effect on spermatogenesis)

Answer 5

1) Aspiration biopsy: + low risk. + Less damaging than needle biopsy - Usually no useful info re spermatogenesis. Main use is to determine the cause of testicular enlargement 2) Needle biopsy (or Trucut): + Most useful info on spermatogenesis. + Unlikely to have deleterious long term effects on the testes - More damaging than aspiration biopsy - More complications

Answer 6

Craniolateral quarter. Less vascular and remote from head of epididymus

Answer 7

Testosterone hCG stim test Oestrone sulphate Anti-mullarian hormone; this is the most reliable in animals \>2yrs

Answer 8

Testosterone is\<40pg/ml in geldings, \>100pg/ml in stallions (often 1000-2000) Crypts have testosterone between the 2 but significant overlap so **not suitable as a definitve dx test** Upto 14% error using basal testosterone alone although false positives are rare

Answer 9

Take baseline plasma T then inject w/ 6000-12000IU hCG IV Take 2nd sample at 1hr/3hrs/24hrs/even ideally 3days Stallions, T ↑ 4-30 fold, 0-120mins after IV hCG Geldings, T ↑ 0-2 fold Cryptorchids ↑ 3 fold 94.6% accurate in predicting the presence of testicular tissue, but response poor in horses less than 18months & in the Winter. Also abdo testes much less rx to hCG stim than scrotal testes

Answer 10

86% diagnostic accuracy NOT useful in donkeys (absence of conjugated E) or horses \<3 years Geldings had estrone sulphate \<0.12ng/ml (\<50pg/ml) Animals w/ testic tissue had estrone suphate \>1.0ng/ml (\>400pg/ml)

Answer 11

Cryptorchids have a significantly higher AMH concentration (32.4 +/- 5.0 ng/ml) than intact stallions (14.7 +/- 2.4ng/ml) and geldings (0.07 +/- 0.01ng/ml) High diagnostic accuracy and single sample required

Answer 12

Absence of testis indicates abdo testicle - Predicted with 98% accuracy for visualising inguinal testis, and 97% accuracy for ID abdo testes with absence of testicle inguinally

Answer 13

Abnormally distended/tortuous pampiniform plexus ## Footnote Treatment is removal of the cord and testis, but often tx NOT REQUIRED esp if semen quality is fine

Answer 14

ID and remove underlying cause where present (remember to check for peritoneal effusion) If occurring as a complication of open castration, remove the remaining tunic Castration of the affected testicle will lessen the negative effect on spermatogenesis of the contralateral unaffected testicle Px for fertility with bilateral hydrocoeles is guarded although some do retain normal spermatogenesis

Answer 15

Generally dt trauma (or haemoperitoneum). Differentiate form hydrocoeles with US and aseptic aspiration Can tx with aspiration of blood and lavage of vaginal cavity with LRS as long as tunica albuginea not ruptured. Minimises insulating effect of blood and risk of adhesion formation between visceral and parietal tunics If unsure if tunica albuginea is intact then should explore sx; allows evacuation of blood and suturing of the torn tunica albuginea or removal of the testicle Haematocoele may develop breech in the blood-testicle barrier - may trigger an immune response to the horse’s spermatozoa, and in turn, result in infertility

Answer 16

1. Serra cutting emasculator - crushes the cord and cuts distally simultaneously (have to be assembled correctly) 2. Henderson castration instrument - clamp applied proximal to the cord and and rotated slowly for slowly for about 5 turns and then the speed of the rotation is increased gradually while keeping tension on the cord. After approximately 20–25 rotations, the cord separates about 8–10 cm proximal to the instrument, 3. Improved Whites emasculator - cuts and crushes like the Serra. Serra has 2 curved arms and Whites one curved one straight

Answer 17

Left - Reimer. Crushes and cuts - separate handle operates cutting blade Right- Serra - cutting blade distal to crushing Bottom - Sands - crushing only

Answer 18

**Adv** + technically easy + Easy to perform standing + No foreign material left in situ - poss decr infection risk **Disadv** - potential for eventration higher (0.2-2.5%\_ - incr. bleeding risk? - incr. risk of hydrocoele and septic furniculitis PO as parietal tunic left in situ

Answer 19

+ decreased(/avoidance of) risk of evisceration PO (ligature closes parietal tunic, although not impossible) - (no advantage over open if a ligature is not applied proximal to the site of transection. Better for foals/standard breds which may be at increased risk of hernia) + decreased risk of haemorrage dt ligature (although some debate in literature) + Decreased incidence of septic furniculitis and hydrocele (parietal tunic removed) - technically more difficult to perform standing (esp if fractious) - foreign material (suture) left behind may incr infection risk

Answer 20

1. Haemorrhage 2. Swelling 3. Incisional infection 4. Hydrocoele (can occur a few months after OPEN castration) 5. Evisceration/eventration (esp open castration) 6. Schirrous cord/ septic furniculitis 7. Peritonitis 8. Colic 9. Lameness (with stump swelling/infection) 10. Pyrexia 11. Clostridial infection 12. Penile damage 13. Persistent masculine behaviour 14. Omental herniation

Answer 21

Closed but with 2-3cm incision in the parietal tunic at over the testis or distal cord to allow insertion of a finger into the vaginal cavity

Answer 22

1. Apply easculators perpendicular to the cord. An oblique transection results in a wider end of vessel remaining and incr. risk of haem 2. Avoid using a sharp cutting blade and make sure emasculators are assembled properly o that 'nut to nut' application rx in the crushing blade proximal and the cutting distal 3. Don't apply downward traction on the emasculators (ie leave them hanging); as when removed, elastic recoil causes stump to retract into the abdomen and more difficult to find in the event of haemorrhage or more likelt to experience haemoabdomen

Answer 23

Do anaesthetised via closed technique, more prone to haemorrhage vs horses. \<2 years; closed scrotal castration \>4years; inguinal castration 2-4; closed scrotal or inguinal depending on size of the Donkey Recommended ligature is the 'constrictor knot'

Answer 24

Cord is ligated +/- transected and the testicles left 'in situ' Can be performed within the abdomen laparoscopically (standing) or via an approach to the spermatic cord within the scrotum UGA

Answer 25

1. Standard scope portal (ventral TC, halfway between it and the last rib) OR ICS 17, with 2 instrument portals (cranioventral and caudoventral to scope portal) 2. Testicular vasculature identified and ligated as if courses toward the vaginal ring 3. Bipolar vessel ligation and ligating loop (post transection) 4. Bilateral approach or unilateral with elevation of the mesocolon 5. Testicles remain in the scrotum but are no longer palpable 5mo PO. 6. Testosterone undetectable within 7dPO. Head and body of epeididymis persist but no contribution to masculine behaviour Complications: 5.6% of inguinally retained and 3.4% of normally descended testes failed to become completely necrotic, as a result of an alternative blood supply from the cremasteric or external pudendal artery, or both, resulting in preservation of stallion-like behavior

Answer 26

1) Incision-ligation technique: 5cm long, parallel incision is made through the skin over the spermatic cord, cord elevated through incision and parietal tunic incised. Vascular portion plus ductus isolated, and double clamped/double ligated, followed by clsoure of the tunic and skin. (no transection) 2) Section-ligation-release technique: similar to above but cord is triple- clamped, triple-ligated, and divided between the middle and distal ligatures 3) Pinhole technique: cord is retracted laterally and a needle with 2 sutures threaded is introduced medial to the spermatic cord through the caudal scrotal skin to exit cranially. Cord repositioned medially and the needle returned through the cranial suture hole to exit caudally, this time lateral to the cord. Tightened and repeated for the other side. NOT suitable for donkeys (incomplete necrosis)

Answer 27

1) Single incision: 2cm longitudinal incision of scrotum over medial aspect of one testis through dartos and parietal tunic. ID and isolate the ductus (2-3mm cord-like/firm tube). 2 ligatures placed proximall, and 1 2-3cm further distally and the section between the ligatures removed. Incision in the parietal tunic closed and then repeated for the other side via the same cutaneous incision. 2) Two-incision: procedure as above but each cord is accessed via its own scrotal incision.

Answer 28

Double ligation decreases the risk of sperm granuloma formation and re-anasotomosis Removal rather than transection alone decreases the risk of spontaneous re-anastomosis

Answer 29

Immunisation against GnRH rx in decreased circulating testosterone and oestrogen diminished sexual behaviour, and decreased testicular size, and it had a negative effect on semen quality Variable response, libido may not be completely surpressed Equity is the vaccine, licensed for control oestrus behaviour in mares, used off-license in stallions. Time required for recovery of libido and semen quality is unknown, therefore not recommended in horses which will definitely be required for breeding Sexual behaviour may not return Improvac (porcine GnRH vaccine) should **NOT** be used in horses, assoc. with adverse effects such as pyrexia and apathy

Answer 30

Inguinal Parainguinal Suprapubic paramedian Flank approach Laparoscopic - standing flank, GA ventral midline/paramedian

Answer 31

Complete - testicle and epididymus abdominally retained Partial - testicle abdominally retained, epididymus in inguinal canal

Answer 32

A - inguinal B - parainguinal C - suprapubic paramedian D - Scrotal

Answer 33

* Skin incision over the superficial inguinal ring (can use scrotal incision) * Bluntly expose sup ing ring (NB large pudendal vasculature) * Locate either the rudimentary vaginal process or the inguinal extension of the gubernaculum (elongated scrotal ligament); tension on the latter should rx in eversion of an inverted vaginal process (as with complete abdominal crypt) * Everted vaginal process is glistening white & finger sized. May have hypoplastic cremaster * Vaginal process is excised and epididymis exteriorised; traction on the proper ligament of the testicle should facillitate exteriorisation of the testicle * May need to strech the vaginal ring with a finger to facillitate passage of a abdo testicle * Ligate/emasculate as per other techniques * +/- external ring closure * Routine skin closure

Answer 34

Partial - locate the vaginal process as it passes through the superficial ring - incise vaginal process, exteriorise the epididymus and traction on it should exteriorise the yesticle via proper ligament Complete - location of the inguinal extension of the gubernaculum testis as it passes through the cranial-middle third of the external ring. Traction on this should evert the inverted vaginal process into the inguinal canal and steps then performed as above

Answer 35

1/ Suturing the external inguinal ring partially or completely, with primary closure of the skin incision 2/ Packing the inguinal canal with gauze for 24-36hrs. Evisceration can occur post removal and also prevents primary skin closure so surely less desirable

Answer 36

Parainguinal aproach * 4cm incision in the aponeurosis of EAO 1-2cm **craniomedial** and parallel to the ext ring * Bluntly separate EAO fibres and penetrate peritoneum w fingers * Palpate vaginal ring caudolaterally and locate epididymus, testis or gubernaculum and exteriorise with fingers * Traction on the tail of epididymus will exteriorise testicle. Enlarge incision to fit a hand if difficult * Emasculate/ligate as preferred. * Close EAO mm, can close or leave the skin/SQ open

Answer 37

+ Vaginal ring is not disrupted + Closure of the EAO mm may be easier than for the ext ing ring

Answer 38

* 8-10cm incision from the level of the preputial orifice caudally, 5-10cm lateral of ventral midline * Penetrate abdo bluntly after sharp incision of rectus sheath * Palpate/exteriorise testicular structures; if not easy to palpate, the ductus deferens can be found in the genital fold of the bladder and traced to the testis * Can ususally do both sides from one incision if bilateral crypt, although the contralateral testis is difficult to exteriorise and its cord usually must be transected with an écraseur * Multiple layer closure

Answer 39

Skin, SQ, EAO, IAO, transversus, peritoneum

Answer 40

+ Inguinal/parainguinal more *versatile* - allow removal of inguinal or abdominal testicles minimally invasively w min convalescence - Paramedian or flank approaches are only suitable for abdominal testicle (can't retract inguinal testes into the abdo) so not useful for inguinal or unknown testicle location - Longer convalescence for flank and paramedian approaches vs inguinal/parainguinal

Answer 41

Can be done standing (or GA) Faster convalescence Minimally invasive Observation of haemostasis clearly intra-op

Answer 42

1. Ventral aspect of TC, halfway between it and the last rib. Initial camera entry portal, 2. 8-10cm ventral to the scope portal above 3. 5-10cm ventral to the first instrument Alternatives exist, may to choose to swap the scope to a portal in ICS17

Answer 43

Std scope portal and single ventral instrument portal; allows the testis to be grasped and pulled through the flank without too much tension on the mesorchium and the vas deferens, with enlargement of the incision where necessary Emasculate/ligate as per preference and close lap and portals routinely

Answer 44

Standard scope portal and 2 instrument portals The claw grasping forceps are passed through a suture loop within the abdomen, then testis is grasped & pulled through the suture loop The suture loop is securely tightened using a knot push rod. Can place 2 if required Transect cord and remove testis via joining instrument portals Can use commercial retrieval bag to facillitate removal Portals closed skin only, larger incisions EAO and skin separately

Answer 45

Routine 3 portal approach Electrosurgical forceps are passed through the most dorsal instrument portal and the blades of the forceps are placed across the cranial aspect of the mesorchium 2-4cm dorsal to the testis Activate to coagulate until it shows signs of blanching and shrinkage, then repeated by repositioning the electrosurgical forceps 1–2 cm dorsal to each coagulation site in order to provide adequate hemostasis of the testicular artery. Vasculature located cranially. Then grap testis and transect cord w lap scissors

Answer 46

7mm or less

Answer 47

1. Retroperitoneal insufflation (use long canulas and visually confirm position within the abdomen prior to insufflation) 2. Injury to viscera on introduction of trochar/cannula (guarded are better for avoidance) 3. Haem from testicular aa (add more suture loops or use cautery/vessel sealer) 4. Dropping the testis in the abdomen. Aim to try remove as leaving behind may rx in revascularisation to peritoneum or bowel - incr androgen production and return of stallion like behaviour 5. Incisional pain/swelling - generally more of an issue with larger flank incisions

Answer 48

1. ***Open** inguinal approach with ipsilateral castration*. Can combine with ventral midline lap to perform R&A where required. Open vaginal process to inspect contents. Ligate cord proximal to this to prevent re-herniation +/- ext ring closure for additional security. Testicle sparing can be attempted by suturing the ext ring around the cord 2. ***Laparoscopic** approaches*: best suited for congenital **reducible** hernias, with or without testicle sparing methods. Closure of the internal ring/vaginal ring helps prevent re-herniation. Methods incl. peritoneal flaps sutured/tacked in place, partial ring closure w sutures, mesh insertion or cylindrical mesh plug. Can be done standing (adults) or GA trendellenburg (adults or foals)

Answer 49

* GA dorsal in Trendellenburg ( 20-25°) with PPV * Std scope portal just cranial to umbilical scar following sharp incision of the skin, SQ and linea alba (latter in the modified Hasson approach), trochar used to penetrate parietal peritoneum * Visualisation of the retained testicle - usually adjacent to the bladder/ing ring, occasionally dorsal to some colon so req instrument to find **Two-portal Technique** (laparoscopic assisted) * Parainguinal incision craniomedial to the ext ring and lap grasping forceps used to grab testis * Incision enlarged to accomdate removal of testis & emasculation/ligation/transection is ectra-abdominal. _Adv is leaving the inguinal rings intact_ **Three-portal Technique** * Scope plus 2 instrument portals, roughly 15cm cranial to the ext ring and 15cm off midline * Alternatively can place both portals on the contralateral side of the retianed testis to optimise angle of approach * Intracorporeal haemostasis can be achieved with ligating loops or mono or bipolar cautery, or advanced bipolar vessel sealing (Ligasure) * Remove with enlargement of instrument portal

Answer 50

GA - + access to both inguinal regions from standard umbilical portal + immobilsed animal - useful esp if fractious - GA risk Standing - + avoids GA risk + useful for testicles in abnormal locations (eg perirrenal) - not suitable for esp fractious animals

Answer 51

**Congenital**: manual reduction, figure-8 truss application (approx 2 weeks) **Acquired**: manual replacement via external massage (ideally GA dorsal) or per rectum manipulaiton w caudal epidural (+/- uni or bilateral castration where correction was successful) Shouldn't attempt either if there is any doubt re: viability of intestine OR if ruptured ing hernia / ing rupture present

Answer 52

1. Following successful correction of an acquired inguinal hernia (external massage or surgical) where testicular preservation is the main priority. Closure of vaginal rings used to prevent recurrence 2. Can use prophylactically in at risk breeds (eg SBs, drafts) or larger WBs with enlarged vaginal rings palpable per rectum (GA if doing in foals)

Answer 53

1. Standard PLF entry followed by insufflation to 10-12mmHg 2. Scope portal changed ICS 17 and both instrument portals in PLF. Portals 2 and 3 made under direct visualisation. Third portal is made distal and **caudal** in the PLF for the Covidien EndoHernia 3. Sub-peritoneal administration of 2% lido at the proposed location of the peritoneal flap 4. Create the flap which is ventrally based and U-shaped w 10cm height and 6cm width with the caudal half of the flap extending 2-3cm cranial to the vaginal ring w lap scissors, carefully dissecting it free from underlying mm, leaving subperitoneal fat attached to the flap 5. Invert the flap caudally over the vaginal ring making sure that the flap contains both mesorchium and vas deferens and covers the entire vaginal ring 6. Use 12-mm 30cm Endo Hernia roticulator through the more ventral and caudal portal, and rotate the tip to its maximum 65° toward the flap. The caudal part of the flap is secured to the peritoneum caudal to the vaginal ring with two staples 7. Stretch the flap ventrally and attach it with the remaining 8 staples to the cranial, mid, and caudal portions of the vaginal ring as well as to the mesorchium 8. Peritoneal defect heals by 2nd intention

Answer 54

1. Accidental anesthesia of the femoral nerve when using more than 30mL of local anesthesia when performing subperitoneal anesthesia (inability to sustain stifle extension on the affected limb, inability to WB, limit to 30ml 2% local total 2. Creating too small or thin a peritoneal flap. 3. Incomplete closure of the vaginal ring - failing to completely close the caudal aspect of the vaginal ring is a risk factor for recurrence, since herniation occurrs **caudally** 4. Failure to restrict movement for 6wk PO can overcome strength of the staples and rx in recurrence

Answer 55

**Indications**: following acquired inguinal hernia development when the testis has been spared during the first surgery or when herniation has been reduced manually or spontaneously. NOT suitable for management/preventrion of rare direct hernias * **Technique**: std PLF approach; instrument portals caudoventral to the scope * ID vaginal ring and pull spermatic cord caudally. * Polyethylene extension tubing positioned at the cranial aspect of the vaginal ring and 2mL of methyl-cyanoacrylate or n-butyl- 2-cyano-acrylate are injected into the inguinal canal, including its margins, taking care to avoid the viscera, especially the bladder and the bowel. * Compress for 30sec wth Babcocks * Can reinforce adhesive with sutures if concerned Main advantages are speed of procedure (25min) and lack of requirement for specialised equipment (on top of laparoscopy)

Answer 56

Can be performed a few days after inguinal herniation when manual reduction or reduction using an inguinal approach has been attempted, or 6 weeks after a laparotomy

Answer 57

* Umbilical scope portal, instrument portals 12cm craniolaterally to each ing ring * The peritoneum ventrolateral to the internal inguinal ring is elevated and cut on three sides, then separated from the underlying muscle using laparoscopic scissors * The flap is inverted and drawn dorsomedially to cover the vaginal ring. It is then fixed laterally and, if necessary, medially to the parietal wall, 2cm dorsal to the ring, fixed with suture or stapling/tacking device * Good outcome expected - no recurrence in 14 horses and 5/5 used for breeding were fertile

Answer 58

1. Indicated if conservative management of congenital inguinal hernias is unsuccessful by 3-6mo, or immediately for ruptured inguinal hernias 2. Although testicle sparing approaches are available, not recmmended given the likely heritable nature of the condition 3. Trendelleberg position is req so facillities need to be available and foal well enough for anaesthesia

Answer 59

1. Conventional approaches with bilateral inguinal castration, proximal tunic ligation +/- ext ring closure where concerned 2. Laparoscopic inguinal herniorrhaphy approaches (+/- teticle sparing)

Answer 60

* GA dorsal; initial portal 2-3cm 2–3cm lateral to the umbilicus to avoid the urachal remnants. * 4 instrument portals: 1 on the left side, 5cm lateral to the scope portal and 1 8–10 cm lateral and 4 cm caudal to the first instrument portal, plus same on right side * In foals with a ruptured scrotal hernia, the herniated small intestine is reduced by grasping and applying traction with atraumatic forceps * Transect the gubernaculum at the level of the internal ing ring bilaterally w scissors, cautery or vessel sealing device * Testicles retracted into the abdomen * Int ring/vaginal ring closed with either intra-corporeal suturing, stapling devices * Testicles are then ligated/transected/removed

Answer 61

Apply emasculators at right angles to the cord Ligature may reduce risk of haem although debate in the literature - emasculators alone probable sufficient for open castration, ligature likely useful in closed (although ? incr. infection risk - again conflicting evidence in the literature) Intervention indicated when bleeding is unabated for 15-30 mins (\>1 drop/sec or steady stream) Options incl. packing scrotum 24-48hrs, applying clamps or re-emasculating bleeding vessel and leaving clamps on 24+ hrs, or ligation of the vessel, usually UGA Aminocaproic ar tranexamic acid can be useful

Answer 62

0.2-3% incidence. Incr risk in SBs, drafts, European WBs Closed castration WITH a ligature rx in much reduced occurrence (has been reported but likely a direct hernia); no decr risk if no ligature is applied. Ideally leave cremaster out of ligature as can cause it to loosen. Usually occurrs within 4-6he post castrate but reported as much as 12d after Larger amount of protruding intestine and requirement for resection/anastomosis are neg px factors. Management - support eviscerated viscera in clean moist towel or replace for transport. Ventral midline lap preferable to inguinal approach -\> better outcomes. Overall 44% long term survival Omental prolapse can be managed w proximal emasculation and 48hrs box rest

Answer 63

Ideally long scrotal incisions **Exercise** is key Cold therapy (hosing) may be beneficial although some thought of incr contamination Establish ventral **drainage** ABs ideal based on C/S where indicated

Answer 64

May be more prevalent in open castrations but can occur with either technique May be dt extension of scrotal infection or contamination of emasculator or ligature Ventral drainage and AB worth a try Removal of the stump often required, esp if ligature placed at castration Can approach via the scrotal scar or inguinally. Ventral drainage required

Answer 65

Subclinical nonseptic peritonitis occurs in many horses after castration because of communication of peritoneal and vaginal cavities TNC \>10000cells/ul indicates inflamm - routinely this high for 5d post castrate - may be greater than 100,000 (100x10’9/L) Septic peritonitis - colic, pyrexia, tachycardia, diarrhea, weight loss, and reluctance to move Dx - degenerate neuts of intra-cellular bacteria Tx - ABs, NSAID, supportive tx +/- peritoneal lavage, establish scrotal drainage

Answer 66

Rare and idiopathic; occurs with open castration since the tunic is left in place Can occur months-years post castrate, more common in mules Fluid in the scrotum - can often be reduced into the abdomen If it is not excessively large or aesthetically displeasing then no tx is necessary. Otherwise sx resection - incise the skin over the fluid filled sack - the sac is bluntly separated from adherent fascia, and the scrotal ligament, which attaches the vaginal sac to the scrotum, is severed. Transect the sac w scissors or emasculator. Close or second intention healing

Answer 67

1. Overall complication rate of 10.7%; similar vs conventional castration complications (6.9-37.7%) 2. Most were mild complications - 77.8% seroma 3. **Increasing age** was a risk factor for complications. Horses ≥4 yrs had ↑ odds of complication; for each additional year of age, risk of developing complication ↑ by 13% 4. 1 horse eviscerated (0.4%) - low rate may be dt twisting and sealing of vaginal tunic, although clearly still possible 5. Mortality rate 0.8% (1 evisceration, 1 botulism); suggests that the Henderson tool offers a safe alternative to traditional castration 6. No reported PO bleeding in any horse, and low PO SSI rate

Answer 68

* 6cm scrotal skin incision to the parietal tunic * 1cm window made into the tunic w scalpel, enlarged to length of the skin incision w Mayos * Backhaus towel clamps affixed at 12,3,6,9 o'clock positions to hold tunic to scrotal skin before exteriorising the testicle * W Mayos, small opening was bluntly created through the mesorchium immediately adjacent to the vaginal tunic before continuing with the scissors through the mesorchium until ligament of the tail of epididymis cut * Vaginal tunic gently torn away from the mesorchium for a distance of approximately 8cm * Double ligate cord w USP 2 lactomer (polysorb) w simple encircling ligatures \*\* the ligature has to include the created fold of tissue where the torn mesorchium met the reflected s to ensure haemostasis distally. * Emasculator for 2 minutes on the cord structures surrounded by visceral vaginal tunic * Parietal vaginal tunic then was gently raised over the stump of the cord, and a purse-string suture of 2-0 poliglecaprone placed within the lumen of the vaginal tunic. This first layer of closure was used to occlude the proximal aspect of the tunic from the distal aspect surrounding the testes * Towel clamps removed as the invaginated edges of the vaginal tunic were sutured together with the scrotal fascia w USP-2 absorbable lactomer in a continuous Cushing * Then SQ tissue immediately beneath the dermis was performed with 2-0 poliglecaprone in a modified continuous horizontal mattress pattern. The remaining testicle was removed similarly

Answer 69

2/38 (5%) complication rate - both swelling tx with diuretic/dex cold and walking 95% excellent cosmesis at 24hr PO

Answer 70

1. The testicular vessels from the aorta 2. The vas deferens leading to the bladder 3. The ligament of the tail of the epididymis running to the apex of the vaginal process