SA surgery- abnormal urogenital/repro surgery

what age does normal testicular descent occur?

2 months

at what age can you diagnose an undescended testicle as cryptorchid?

6 months (after 6 months it is unlikely for the testicle to descend)

when doing a cryptorchid castration, should you remove the crypt testicle or normal testicle first?

always remove the cryptorchid testicle first

what is the surgical approach for an inguinal cryptorchid castration?

linear skin incision, very similar to prescrotal castration

the testicular pedicles are similar to normal, but shorter than in routine castrations, and have more tension

what is the surgical approach for an abdominal cryptorchid?

midline abdominal approach, identify prostate and vas deferens and follow to testicle

what structures do you need to be cautious of when doing an abdominal cryptorchid castration?

be cautious of the prostate and ureters (need to differentiate ureters from vas deferens)

for abdominal cryptorchid castrations, how/where is the retained teste usually found?

1. reflect bladder caudally- the retained teste is usually right next to the bladder

2. ID vas deferens on dorsal aspect of bladder as they exit prostate and cross over ureters

3. follow vas deferens to ID testicle

4. ligate vessels and vas deferens separately

what should you do with the cryptorchid testicle after removing it?

always submit cryptorchid testicle for histopathology

how is an ovariectomy (OVE) performed?

technique similar to OVH, except ligation and division caudal to the ovary at the level of the proper ligament

is there any difference in long term urogenital problems (neoplasia, pyometra, etc.) when doing an OVE vs an OVH?

no

what is the difference between an OVE and OVH?

OVH:

-technically more complicated

-more time consuming

-associated with greater morbidity (larger incision, more intra-op trauma, increased discomfort)

how are ovarian remnants prevented when performing OVEs?

palpation

and once the ovary is out, open the ovarian bursa to ensure you have all of the ovary

how do pregnant dog OVHs differ from non-pregnant dogs?

the tissues of pregnant animals are more friable

dont overclamp tissues, only click once when clamping or you'll probably tear thru

the broad ligament also has more vessels, and you may need to ligate

what are 2 methods for performing a caesarean section (c-section)?

1. en bloc OVH

2. hysterotomy

is en block OVH or hysterotomy the preferred c-section method?

hysterotomy is the preferred method

for en bloc OVH, you have to resuscitate the puppies once out

what is the method for a hysterotomy c-section?

only using 1 incision in the uterus to get the puppies out

-use gentle traction on fetus/placenta

-clamp each umbilicus and pass off to non-sterile assistant

-either close uterus or OVH

what are 2 ways of closing the uterus for c-sections?

1. 2 layer closure

-appositional (simple continuous) 1st layer

-inverting (cushing) 2nd layer

2. perform OVH

what is the potential risk for future pregnancy if the uterus is left after a c-section?

increased risk of dystocia

what is the biggest concern with pyometra procedures?

tissues are much more friable

what is the approach for a pyometra surgery?

1. use longer incision (go cranial to umbilicus)

2. careful with hemostats, consider not clamping (may tear tissue)

3. use lap sponges to pack off abdomen

what should you not make a stab incision for pyometra surgeries when entering the abdominal cavity?

to prevent accidentally puncturing the purulent-filled uterus and contaminating the abdomen

what is the main organism isolated from pyometra cases?

e. coli

what peri-operative antibiotics are used for pyometra? what should your final antibiotic choice post-sx be based on?

ampicillin is usually an okay empirical choice peri-op

but submit a culture and sensitivity! final decision on abx choice is based off C&S results

how is ovarian remnant syndrome diagnosed?

-clinical signs of estrus

-vaginal cytology

-ultrasound

-anti-mullerian hormone

how long should the incision for ovarian remnant surgery be?

make a longer abdominal incision, at least umbilicus to pubis (due to prior scar tissue from spay)

what is the procedure for identifying ovarian remnants?

1. examine both pedicles (can be bilateral) just caudal to kidney

2. elevate ovarian tissue and ligate vessels (beware of ureters)

3. submit to histopathology

what structure should you elevate to visualize the right ovarian pedicle?

elevate intestines and viscera with mesoduodenum

what structure should you elevate to visualize the left ovarian pedicle?

elevate intestine and viscera with mesocolon

if unilateral, are ovarian remnants more likely to be left or right-sided?

more likely to be right-sided if unilateral

bc right side is more cranial and harder to get to