Small Animal Sx - Castration

drraythe's version from 2015-11-24 19:36

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, Aggression, Part of treatment of several other diseases (i.e. prostate), Cryptorchidism, Perineal hernia, Testicular torsion/abscess, Urethral obstruction (as part of scrotal urethrostomy), Scrotal/testicular trauma, Endocrine disorders, Scrotal and inguinal hernias, Neoplasia
what are some prostate problems which might be helped or solved by castration?prostatitis, prostatic cyst and 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 reoccuring if not castrated
how is Urethral obstruction related to castration?testes usually removed as part of scrotal urethrostomy (think: blocked cats) where they remove scrotrum and use portion of urethra and 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= first intention (stitch it up)
can you do a perineal approach to castration on a cat or a dog?dog-- not common nor reccomended. used in association with repairing pelvic diaphragm (bc theyre sternal)
when is a scrotal ablasion done in a dog? cat?DOG: remove testicles AND scrotum (like recurrent urinary obstruction in dalmations). CAT: done with 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 avoid repositioning when patient 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 unretained or the retained teste first?remove retained first, bc cleaner procedure
how does asepsis vary between cat and 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 and keep it under the drapes. if you ARE clipping prepuce, need to do preputial lavage and make wider margins up the abd
OPEN vs CLOSED castrationCLOSED: Parietal vaginal tunic is not incised (possibly less time and less risk of abd infection?). OPEN: Parietal vaginal tunic incised. More secure ligatures, but there is Communication with abdominal cavity (potential for ascending infecions)
you should always try to find the undescended testicle before you can you try to find it and 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 indescended testicle?an inguinal LN (LNS near dorsal penis, but smaller and softer )
careful not to clamp this with the towel clamp when drapingdont go to clsoe to scrotum-- you gotta push testes out, towel clamp cant get in the way
FIRST and SECOND thing you do after you're ready to start?(1) ASK ANESTHESIA IF PT IS READY (2) announce that you are going to cut before you start
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 without 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 with a gauze sponge to release testicle (ripping attachment of cord to scrotum)
once you disrupt the scrotal ligament and are able to pull the testicle out from the body, what must you do?Continue to strip fat and 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 and v and the ductus deferens are in the clamps/pedicle?the vaginal tunic and the cremaster mm
*know how to do the 3 clamp techniqe!know circumfrential before transfixing or pt can hge into abd
where do you cut to remove testicle?between mid and distal clamp
in an open castration, you are cutting...Incise parietal tunic with scalpel or scissors
in an Open Canine Castration, you open a window...where?Open window between parietal tunic/cremaster muscle and vas deferens/ testicular artery & vein (pierce through window with hemostat, clamp at attachment of tunic to the epididymis break attachment of the tunic try to clear up pampiniform plexus and 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 and you get a hematoma or seroma)
what do you need to break in the open castration to separate the parietal aka vaginal tunic and the cremaster from the vas and the aa and vv?tail of epi, and remnant of gubernaculum -- break this atachment (break and not cut or itll ooze)
how do you close your incision after castrating?Suture spermatic fascia and 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 one week
do you use abx after a castration?no, considered a clean procedure. only use abx is testicular trauma or infection
easy way to find where to make incision?cut along median raphae
after you pull the tunic and cremaster mm from the teste in the open technique, what do you do with it?just pull it down and leave it there with a clamp on it!!
once youve ligated your pedicle, removed the testicle, and checked for bleeders, what do you do with it?push pedicle back into scrotum, otherwise can cause a granuloma or will accidentally get included with 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 and softer and 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 between a retained testicle vs inguinal LN?lnn are often more dorsal and live closer to the base of the penis. the lnn are softer and more medial. testicles are harder/firmers and usually more in line with 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 and 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, and 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 cause testicular enlargement, are malignant but have a low rate of metastasis, and are often cured by castration (all are slow growing, bumpy, and hard)
why is it important to send the whole testicle in to the pathologist if you suspect neoplasia?Multiple tumors can occur in one testis
which testicular neoplasia can lead to feminization of the pt?Sertoli cell tumors may secrete estrogen
how much does cryptorchidism inc the chances of neoplasia?Cryptorchidism increases incidence by 14 times overall and 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 pts with sebborhea)
if you see a prostatic cyst during sx, you should...drain and remove!
Congenital Anomaly: Pseudohermaphrodite. What do they look like? how do you know what caused it?enlarged cliterus. inside theres a uterus, ovary, testicle. all should be removed and sent to the pathologist. pathologist will tell you what kind of pseudohermaphrodite the pt is
what IS the window you see between the parietal tunic+creamaster and the vas deferent+testicularaa/vv?mesorchium
when should you recheck pt 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

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 one each side), Place caudal traction on testicle until scrotal ligament breaks
what should you know if a client wants you to elim the male charateristics of their cat via castration?do before they get the characteristics because late castration wont fix it
why do perineal urethrostomy?give good quality of life to the cats that have been blocked repeatedly and cannot be unblocked anymore/strictures/urethral lesions remove scrotum and testes or widen the scrotum if they've been castrated before
what is the ligation technique for a feline castration?Separate ductus deferens and tie to vessels, 2 square knots. Can also use absorbable ligature or hemoclip. Can also use Overhand technique (separate vascular plexus from duct def and tie 2 throws and clamp remnant and remove). Then, Replace pedicle in scrotal sac, Repeat procedure on second testicle, Leave scrotal incisions open to drain and to heal by second intention
this is the technique you use on who?cat castration
two 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 and then grab the ductus deferens, slide the knot and 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 with L-arginine. injectied intratesticularly. 3-10 month old male dogs (off label for adult dogs and cats)- causes sclerosis of the testicular parynchyma.

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