Lecture 18: Male infertility

- testes should be in the scrotum by 10 days postpartum

- both testes should be descended by 16 weeks of age

What is the timeline of testicular descent like?

- testicle does not descend

- consider this after 6 months of age

- hereditary issue

What is cryptorchidism?

- administer human chorionic gonadotropin (hCG)

- get a baseline testosterone, 4 hours and 8 hours after

- should be more than double baseline testosterone if testes are present

How do you diagnose bilateral cryptorchidism?

- test testosterone

- anti-mullerian hormones test = single test (can be inconclusive sometimes)

- administer human chorionic gonadotropin (hCG) and test testosterone --> double baseline = bilaterally cryptorchid

How do you diagnose cryptorchidism?

- a rare extremely painful condition that can occur in any breed of dog

- need to pay attention to orientation of testicle

What is testicular torsion?

- bilateral orchidectomy

What is the treatment for testicular torsion?

- testicular tumors

What is the most common tumor after skin tumors in male dogs?

- Sertoli tumors = MOST COMMON

- seminoma tumor

- Leydig tumor

What are the types of testicular tumors in dogs?

- paraneoplastic syndrome (hormonal effect)

- enlargement of 1 testi and atrophy of the opposite testis

- bilateral in 45% of cases

- hyperestrogenism

How can sertoli tumors present?

- pancytopenia, anemia and bone marrow hypoplasia

- bilateral symmetrical alopecia

- comedones and hyperpigmentation of the inguinal area

- dry skin

- gynecomastia

- prostatic cysts

- pendulous prepuce and testicular atrophy

What can be seen with hyperestrogenism, caused by sertoli cell tumors?

- paraneoplastic syndrome (hormonal effect)

How can leydig tumors present?

- lack of pain on palpation

- ultrasound

- biopsy

How do you differentiate testicular tumors from Brucellosis?

- increases incidence by 13.6 times for all tumors

- increased by 23 times for Sertoli cell tumors

What are tumors in the retained testis/cryptorchidism like?

- a condition in which there are no sperm present in the ejaculate

What is azoospermia?

- retrograde ejactulation (into bladder)

- incomplete ejaculation

- bilateral cryptorchidism

- testicular injury (trauma, heat, orchitis)

- spermatogenic arrest

- testicular neoplasia

What are the 6 causes of azoospermia?

(not the entire list just come to remember if she asks)

- 200

There needs to be ______ million progressively motile spermatozoa to insure good conception rates

- transmissible venereal tumors

What is the most common penile tumor?

- penis, prepuce, vagina, mucous membranes

Where are transmissible venereal tumors seen?

- contact with mucous membranes (mouth, genitals, etc)

How are transmissible venereal tumor transmitted?

- squamous cell carcinoma

- Histiocytoma on cytology (round cells)

What is a common differential diagnosis for transmissible venereal tumor?

- round cells with more cytoplasms than lymphome

- can look like many round cell tumors --> histiocytoma

- LOCATION LOCATION LOCATION

Why is TVT hard to diagnose?

- Vincristine

How do you treat transmissible venereal tumors?

- idiopathic or sexual arousal induced

- genetic predilection in English Bulldogs

- pathognomonic "red pea" appearance at tip of penis

What is a urethral prolapse?

- urethral prolapse

What is wrong with this bulldog penis?

- surgical removal of prolapsed tissue --> urethropexy

How do you treat a urethral prolapse?

- unnatural penile tumescence that is rare

- looks like an erection that won't go away

- get neuro exam since could be neuro or back issue

What is a priapism? what should you do next?

- neurologic exam since can be neurologically caused

- look at back issues as well

What type of exam should you do on a dog with a priapism?

- benign prostatic hyperplasia (BPH)

What is the most common diagnosed prostatic disease in dogs?

- older, intact male dogs (8 years old)

- can occur in castrated males treated with androgens

What is the clinical presentation for benign prostatic hyperplasia (BPH)?

- may be asymptomatic

- serous to serosanguinous urethral discharge in primary complaint

- hematuria, dysuria

- rectal tenesmus (skinny ribbon poops)

- caudal abdominal pain

- infertility

What are the clinical signs seen with benign prostatic hyperplasia (BPH)?

assess by digital trans-rectal palpation

- uniform enlargement with no lumps or bumps

- often non-painful

- palpate the bony pelvis and pelvic urethra caudally

How do you diagnose benign prostatic hyperplasia (BPH)?

true

- in older dogs may need to elevate the prostate with one hand via the abdomen

- younger dogs = lies on pelvic floor

- 8-12 completely abdominal

True or false

with age the normal position of the prostate changes

- acute bacterial prostatitis

- chronic bacterial prostatitis

- prostatic adenocarcinoma

- prostatic and paraprostatic cysts

What are differential diagnoses for benign prostatic hyperplasia (BPH)?

- typically associated with fever, depression, pain on rectal palpation, neutrophilia, pyuria, bacteriuria

- it may occur concurrently with BPH

- often caused by E. coli

What is acute bacterial prostatitis like?

- typically associated with recurrent lower urinary tract infections

- it may occur concurrently with BPH

- often caused by E. coli

What is chronic bacterial prostatitis like?

- typically associated with poor appetite, weight loss, hind limb weakness, dysuria, hematuria, dyschezia

- carcinoma cells may be seen in urine sediment

- more common in castrated males

What is prostatic adenocarcinoma like?

- can cause palpable abdominal cystic mass filled with yellow to orange fluid

What are prostatic and paraprostatic cysts like?

- palpation

- prostatic wash

- CBC, cultures of seminal fluid and urine, U/S guided FNA, biopsy, rads

How do you diagnose prostate disease?

- BPH: uniform cells

- Neoplasia: variable cells

- Septic: inflammatory cells (neutrophils)

What does a prostatic wash differential and how?

- castration = tx of choice

- may use hormonal therapy also

How do you treat prostate disease?

- symmetrical, mild enlargement, slightly mottled, small cysts IN parenchyma

What does benign prostatic hyperplasia (BPH) look like on U/S?

- symmetrical, slightly mottled, often concurrent cystitis, hypoechoic areas with small cysts

What does acute prostatitis look like on U/S?

- symmetrical to asymmetrical, poorly marginated, multifocal mixed echogenicity, may have areas of mineralization

What does chronic prostatitis look like on U/S?

- asymmetrical and mottled parenchyma

What does a prostatic abscess look like on U/S?

- located next to prostate, not in it = looks like second bladder

- usually thin walled, but can have variable wall thickness and fluid echogenicity

What does a paraprostatic cysts look like on U/S?

- Finastreide (Proscar)

- definitive and preferred treatment is castration

How do you medically treat a dog with benign prostatic hyperplasia (BPH)?

- 5a-reductase inhibitors

- blocks the action of testosterone and/or dihydrotestosterone

What is the MOA for Finastreide (Proscar)?

- can take many months or even years to disappear

- often it lasts indefinitely because masculinization of the brain begins early in fetal life and is essentially innate in males; only modified by castration

Why can there be sexual behavior post castration?