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SA Sx - Castration

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drraythe's version from 2017-09-13 18:49

Intro + Canine Castration

Question Answer
Other words for castration?Orchiectomy/Orchidectomy
What IS castration?Castration is the surgical removal of both testes
Some indications for castration?Sterilization
Elimination of male characteristics
Reduce Aggression
Part of Tx of several other Dzs (i.e. prostate)
Cryptorchidism
Perineal hernia
Testicular torsion/abscess
Urethral obstruction (as part of scrotal urethrostomy)
Scrotal/testicular trauma
Endocrine disorders
Scrotal & inguinal hernias
Neoplasia
What are some prostate problems which might be helped or solved by castration?Prostatitis
Prostatic cyst & abscess
Prostatic hypertrophy
Why do you wanna remove cryptorchid testicles?High chance of developing neoplasia
How is a Perineal hernia related to castration?Over 2x inc in chance of hernia reoccurring if not castrated
How is Urethral obstruction related to castration?Testes usually removed as part of scrotal urethrostomy (think: blocked cats) where they remove scrotum & use portion of urethra & make a new opening
*CAT VS DOG: most common approach for neuter for each?DOG: PRESCROTAL
CAT: SCROTAL
Why don't we do a prescrotal on a cat?Cats penis goes backwards so no room for a prescrotal area, so use scrotal
What is the diff in how we let scrotal vs prescrotal heal?Scrotal = Heal by 2nd intention (just leave it)
Prescrotal = 1st intention (stitch it up)
Can you do a perineal approach to castration on a cat or a dog?Dog - not common nor recommended. Used in association w/ repairing pelvic diaphragm (bc theyre sternal)
When is a scrotal ablation done in a dog? Cat?DOG: Remove testicles & scrotum (like recurrent urinary obstruction in Dalmatians)
CAT: Done w/ perineal urethrostomy (salvage procedure for blocked male cats)
Usually use Pre-scrotal approach for...Routine elective castrations
Usually use scrotal ablation approach for...Scrotal/testicular neoplasia or trauma, scrotal urethrostomy, pendulous scrotum
Inguinal or abdominal approach forCryptorchidism
Perineal / scrotal approach for..To avoid repositioning when PTx is in perineal position
How do you determine which side the undescended teste belongs to?Figure out which testicle by pushing it out through the inguinal canal
Do you remove the un-retained or the retained teste 1st?Remove retained 1st, bc cleaner procedure
How does asepsis vary btwn cat & dog neuter?Dog is aseptic technique
Cat is considered a "clean" procedure
How does hair removal for castration vary from dog to cat?Dogs you CAREFULLY clip the scrotum. Cats you PLUCK the hairs
What do you do about the prepuce when prepping sterile field for dog procedure?Usually leave it unclipped & keep it under the drapes. If you ARE clipping prepuce, need to do preputial lavage & make wider margins up the abd
OPEN vs CLOSED castrationCLOSED: Parietal vaginal tunic is not incised (possibly less time & less risk of abd Infnxn?)
OPEN: Parietal vaginal tunic incised. More secure ligatures, but there is Communication w/ abdominal cavity (potential for ascending infxns)
You should always try to find the undescended testicle before you start...how can you try to find it & where should you look?Use ultrasound, can be anywhere from caudal pole of kidney up to the entrance of the inguinal canal
What should you NOT confuse for an undescended testicle?An inguinal LN (LNS near dorsal penis, but smaller & softer)
Careful not to clamp this w/ the towel clamp when drapingDont go to close to scrotum - you gotta push testes out, towel clamp cant get in the way
1st & 2nd thing you do after you're ready to start?(1) ASK ANX IF PTx IS READY
(2) Announce that you are going to cut before you start (Anesthesiologist will need to write down when you started the procedure)
Should you be cautious of making a long incision?No - incisions heal side to side
How long should you make the incision?Incision long enough where testicle can be popped out w/o squeezing (if tumor, squeezing puts tumor cells somewhere else)
In order to pull the testicle away from the body, what must you do?Bluntly disrupt scrotal ligament w/ a gauze sponge to release testicle (ripping attachment of cord to scrotum)
Once you disrupt the scrotal ligament & are able to pull the testicle out from the body, what must you do?Continue to strip fat & subcutaneous tissue until spermatic cord is completely isolated (make sure pedicle is long enough for 3 clamp technique)
In a closed castration, what structures aside from testicular a & v & the ductus deferens are in the clamps/pedicle?The vaginal tunic & the cremaster mm
*Know how to do the 3-clamp technique!Know circumferential before transfixing or PTx can HGE into abd
Where do you cut to remove testicle?Btwn mid & distal clamp
In an open castration, you are cutting...Incise parietal tunic w/ scalpel or scissors
In an Open Canine Castration, you open a window...where?Open window btwn parietal tunic/cremaster muscle & vas deferens/ testicular artery & vein (pierce through window w/ hemostat, clamp at attachment of tunic to the epididymis break attachment of the tunic try to clear up pampiniform plexus & separate all the attachment so you have enough room to make the placement of the 3 clamps clamp a vessel around there or else it'll tend to leave immediately post op & you get a hematoma or seroma)
What do you need to break in the open castration to separate the parietal aka vaginal tunic & the cremaster from the vas & the aa & vv?Tail of epididymis & remnant of gubernaculum - break this attachment (break & not cut or itll ooze)
How do you close your incision after castrating?Suture spermatic fascia & SQ (dont accidentally incorporate retractor penis mm or penis wont work), Intradermal skin closure or skin sutures
How long should you restrict exercise?Restrict exercise for 1 week
Do you use ABx after a castration?No, considered a clean procedure. Only use ABx is testicular trauma or Infnxn
Easy way to find where to make incision?Cut along median raphae
After you pull the tunic & cremaster mm from the teste in the open technique, what do you do w/ it?Just pull it down & leave it there w/ a clamp on it!!
Once youve ligated your pedicle, removed the testicle & checked for bleeders, what do you do w/ it?Push pedicle back into scrotum, otherwise can cz a granuloma or will accidentally get incldd w/ the suture
Who more commonly gets complications from castration?DOGS (in cats it's rare)
How does a retained testicle usually compare to a regular one?Smaller & softer & color is a little more intense.
What can you do to help scrotal swelling/ hematoma?Hot pack to vasodilate to favor return/ resolution of hematoma (monitor closely so doesnt turn into an abscess)
Differences btwn a retained testicle vs inguinal LN?Lnn are often more dorsal & live closer to the base of the penis. The lnn are softer & more medial. Testicles are harder/firmer & usually more in line w/ the inguinal canal
How do you incise for a retained testicle?Open w oblique incision that follows the trajectory of the testicle through the SQ & skin (usually oblique incision following the trajectory of the testicle, usually use metzenbaum scissors)
Who gets testicular neoplasia most commonly?DOGS
3 types of testicular neoplasias?Sertoli cell tumor
Seminoma
Interstitial (Leydig) Cell Tumor
How do the 3 testicular neoplasias affect the testicle? Are they benign or malig? How do they behave? Are they often curable?All cz testicular enlargement, are malignant but have a low rate of metastasis & are often cured by castration (all are slow growing, bumpy & hard)
Why is it important to send the whole testicle in to the pathologist if you suspect neoplasia?Multiple tumors can occur in 1 testis
Which testicular neoplasia can lead to feminization of the PTx?Sertoli cell tumors may secrete estrogen
How much does cryptorchidism inc the chances of neoplasia?Cryptorchidism increases incidence by 14 times overall & by 23 times for Sertoli Cell tumors
Signs of hyperestrogenism? (Which tumor does this?)(Sertoli cell tumor) [this is PARANEOPLASTIC SYNDROME]
Alopecia
Gynecomastia
Testicular atrophy
Penile atrophy
Pendulous prepuce
Prostatic atrophy
Prostatic cysts Reduced male behavior, may attract males (look like cushing PTxs w/ seborrhea)
If you see a prostatic cyst during Sx, you should...Drain & remove!
Congenital Anomaly: Pseudohermaphrodite. What do they look like? How do you know what czd it?Enlarged clitoris. Inside theres a uterus, ovary, testicle
All should be removed & sent to the pathologist. Pathologist will tell you what kind of pseudohermaphrodite the PTx is
What IS the window you see btwn the parietal tunic+creamaster & the vas deferent+testicularaa/vv?Mesorchium
When should you recheck PTx postop?3d
***True or False - Prescrotal castration is performed in catsFalse
Scrotal for Cats
Prescrotal for Dogs
***What type of testicular neoplasia may secrete estrogen, causing feminization?Sertoli
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Feline Castration

Question Answer
Indications for feline castration?Sterilization, Urethral obstruction (as part of perineal urethrostomy), Testicular or scrotal trauma, Elimination of male characteristics (odor of urine, fighting)
Surgical technique for feline castration?Pluck hair from scrotum, Scrub area, Scrotal incision/s (on 1 each side), Place caudal traction on testicle until scrotal ligament breaks
What should you know if a client wants you to elim the male characteristics of their cat via castration?Do before they get the characteristics bc late castration wont fix it
Why do perineal urethrostomy?Give good quality of life to the cats that have been blocked repeatedly & cannot be unblocked anymore/strictures/urethral lesions remove scrotum & testes or widen the scrotum if they've been castrated before
What is the ligation technique for a feline castration?Separate ductus deferens & tie to vessels, 2 square knots. Can also use absorbable ligature or hemoclip. Can also use Overhand technique (separate vascular plexus from duct def & tie 2 throws & clamp remnant & remove). Then, Replace pedicle in scrotal sac, Repeat procedure on 2nd testicle, Leave scrotal incisions open to drain & to heal by 2nd intention
This is the technique you use for? Cat castration
2 options for ligation for cat castration?Absorbable Ligature or Hemoclip (2 ligature minimum!!!!)
Describe the "overhand" technique for ligation of cat castrationsFigure 8 around the hemostat & then grab the ductus deferens, slide the knot & tug gently to have a tight closure.
What should you tell owners about their kitty litter after the castration?Instruct owner to use shredded paper or un-popped corn instead of kitty litter for a few days
What is Chemical Sterilization using? How does it work? How do you do it? Who is it approved for?Zinc gluconate neutralized w/ L-arginine. Injected intratesticularly. 3-10 mo old male dogs (off label for adult dogs & cats) - czs sclerosis of the testicular parenchyma.
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