Male Reproductive Surgery

Canine male reproductive anatomy:

• Scrotum

• Prepuce

• Preputial muscle (preputialis)

• Midline

• Inguinal regions

Abdominal Male Reproductive Anatomy:

• Prostate gland

• Testicular vessels

• Vas deferens

What is the perineal prepcue ventral to, in feline males?

scrotum

What are found on feline male reproductive anatomy (not found on dogs)?

Androgen-dependent spines along penis (regress 5-6 weeks after castration)

What are the parts of the tunic and spermatic cord anatomy?

●Testis

●Spermatic fascia (green line)

●Parietal vaginal tunic

●Visceral vaginal tunic

●Epididymis

●Ligament of the tail of epididymis

●Cremaster

●Ductus deferens

●Testicular a. and
pampiniform plexus

What are some castration indications?

1) Population control

2) Preventive and therapeutic for androgen-dependent disease (generally geriatric illness)

3) Preventive and therapeutic for testicular tumors (common)

4) Odor, behavior (cats)

What are some common androgen-dependent diseases?

• Benign prostatic hyperplasia (common)

• Chronic prostatitis

• Perianal adenomas (common)

• Perianal hernias (breed-dependent)

What are some general castration risks?

reduced development of secondary sexual characteristics

What are some castration risk for cats?

• increased risk of obesity

• Diabetes mellitus

• Spontaneous capital physeal fracture/metaphyseal dysplasia

What are some castration risks for dogs?

• Prostate cancer (rare in dogs)

• Transitional cell carcinoma

• Cranial cruciate ligament rupture and other orthopedic diseases (common)

• Osteosarcoma and other noeplasms

What are some risk with castration due to timing/breed (dogs)

●Neutering <1 year of age à increased risk of hip dysplasia, CCL rupture, and elbow dysplasia in studies of golden retrievers, Labrador retrievers, and German shepherd dogs.^*

●Elevated cancer risk associated with neutering Dobermans at any age (same for female golden retrievers)^*

What are some concerns with castration timing in dogs?

• most risks associated with early castration

• most male reproductive diseases are adult-onset, not prevented by early castration

When do we castrate for population control/shelters?

castration is safe for dogs and cats at 8 weeks/1 kg of body mass

When is the best time to castrate for owned dogs/purebreds?

• consider later neuter (after 1 year) for owned dogs likely to be more than 20 kg

• Counsel owners of purebred dogs on disease risks associated with castration

Prescrotal approach

• adult dogs, larger puppies

• limits scrotal irritation

• single incision

Scrotal approach

• puppies, cats, adult dogs

• testicles in puppies can be difficult to isolate

• two incisions

• associated with scrotal ablation or perineal hernia repair (less common)

Open castration

spermatic fascia and parietal vaginal tunic are incised and the ligament of the tail of the epididymis is separated

Closed castration

spermatic fascia is incised and scrotal attachments broken down to exteriorize the testicle without incising the parietal vaginal tunic

What are the Pros of open castration?

• excellent ligature security

• can be easier in mature dogs

• reduced scrotal manipulation

What are some cons with Open Castration?

• Contraindicated if testicular abscess

• Slight risk of tunic bleeding if not ligated

What are the pros of Closed Casteration?

• Straightforward, easy in younger dogs

• Incision not exposed to testicular pathology (tumor, abscess)

What are the cons of Closed castration?

• Excessive scrotal manipulation can cause contamination

• Ligatures include more tissue

Cryptorchidism

●Is hereditary (mechanism unknown)

●Retained testes are small, with a comparatively large epididymis

●Retained testes are more likely to develop tumors, particularly Sertoli cell tumors and seminomas

●Retained, neoplastic testes more susceptible to torsion

What are some Cryptorchid castration considerations?

• right sided cryptorchidism more common

• can be difficult to distinguish in an awake patient. Anesthetize and palpate

What to tell is the cat is castrated or if it is a cryptorchi?

Extrude penis and look for spines, secondary sexual characteristics like prominent jowls may be present

How can you tell if the dog is castrated of has a cryptorchid?

prostate larger and cranial to pelvic brim, abdominal ultrasound, presence of secondary sexual characteristics

What to do with an abdominal cryptorchidectomy?

• parapreputial skin incision

• Abdominal entry (paramedian if unilateral or along linea alba if bilaterl, and you will need to retract prepuce laterally is along linea alba)

• Testicular location: near inguinal rings, follow ductus deferens OR testicular artery and veins)

What are some infections related to castration complications?

●Breach of asepsis

●Hair and scrotal skin entering surgical field

●Prevent through: Open castration (less pulling) or, Transect scrotal attachment to epididymis, Prep widely, Drape sufficiently

What is important about castration complications?

●Poor hemostasis >> coagulopathy

●Insecure cord ligation, bleeding from tunics
or skin

How do we prevent hemorrhage in castrations?

○SECURE KNOTS

○Open castration or binding knots on cord

○Ligation of subcutaneous vessels

○Ligating tunics (if open)

○General health screening

What is important to remember about unplanned urethrotomy for castration complications?

When performing a prescrotal castration, ALWAYS push the testicle craniomedially so that the incision is created over the testicle and not the penis and urethra. 

Scrotal Albation

Resection of the scrotum at or following castration

What are indications of scrotal ablation?

• cosmetic for older dogs at the time of castration

• treatment for scrotal hematoma post-castration

What are some risks associated with Scrotal albation?

increased surgical time and complexity

Male reproductive disease:

●Cryptorchidism

●Prostatic abscess/prostatitis

●Testicular tumors

●Transmissible venereal tumors

●Perianal adenoma

●Perineal hernia

●Phimosis/paraphimosis

●Hypospadias

●Prostatic cyst

●Testicular torsion/hernia

Prostatic disease (dog)

●Relatively common in dogs (esp. intact) >6 years old

●Diseases: Benign prostatic hyperplasia (BPH), Prostatic cysts, Prostatitis (acute and chronic), Prostatic abscesses, Prostatic neoplasia—relatively uncommon, risk not affected by castration

Benign Prostatic Hyperplasia (BPH)

Normal glandular hyperplasia and hypertrophy, beginning at 3 yo and affecting >95% of dogs by 9 years of age

What are some causes of benign prostatic hyperplasia (BPH)

increased estrogen:androgen ratio secreted by testes → increased androgen receptors → glandular hyperplasia → cystic hyperplasia

What are some clinical signs of benign prostatic hyperplasia (BPH)?

• none-mostly asymptomatic

• tenesmus

• hematuria or urethral discharge

• hemospermia, stilted gait

What are treatments associated with BPH?

Castration or finasteride

Prostatic cyst

form from blockage and consolidation of canaliculi associated from BPH (prostatic cysts), commonly communicate with urethra

Paraprostatic cysts

○are associated with uterus masculinus remnants and are connected to the prostate by a stalk or adhesion

Prostatic cyst therapy:

Castration, ultrasound-guided aspirations, castration or finasteride

Acute Prostatitis

○Clinical signs: anorexia, fever, depression, vomiting, caudal abdominal pain, stiff/stilted gait, preputial discharge

○Dx:  History, PE , rectal exam, imaging, hematology, urinalysis/urine culture, prostatic fluid analysis

Chronic Prostatitis

vague signs—most commonly recurrent UTI and urethral discharge.  Evaluation of prostatic fluid is helpful

Treatment for Chronic prostatitis includes:

Prolonged treatment with appropriate abx., castration recommended

Prostatic Abscess

sequela to chronic prostatitis; abscesses can be large.  Tx includes U/S-guided or surgical drainage, antibiotics

Group 1 Testicular tumors:

• Germ cell tumors (seminoma, embryonal carcinoma, teratoma)

• Seminoma: generally solitary, associated with prostatic disease, perianal tumors, perianal hernia. 

Seminoma

generally solitary, associated with prostatic disease, perianal tumors, perianal hernia

Group 2 testicular tumors:

• Sertoli cell tumor, interstitial cell tumor, mixed tumors

• Interstitial cell tumor: functional, associated with prostatic disease, perianal tumors, perineal hernia; often bilateral

• Sertoli cell tumor: produce estrogen, cause feminization

Interstitial cell tumor:

functional, associated with prostatic disease, perianal tumors, perineal hernia; often bilateral

Sertoli cell tumor:

• produce estrogen, cause feminization