Reproductive disorders

History and PE of the Female dog

• Overall health

  • Diabetes mellitus

  • Cushings

  • Hypothyroid

• Reproductive status

  • Are they intact

  • Are they pregnant

  • Have they ever had a litter of puppies

• Brucella canis statis

  • Zoonotic disease

• Vaginal cytology

  • Cheap and easy to do

• Progesterone

  • Run off of serum

  • Red top tube

Brucellosis (Brucella canis)

• Negative within the last 6 months

• Screening: rapid card or tube aggluntination test

  • 95-99% accurate for negative results

  • Negative - true negative OR early exposure (<8weeks)

  • Confirmation: AGID (Cornell)

• Diseases seen with this: Late term abortions (7-9 weeks), orchitis, diskospondylitis, uveitis

• Shed in urine, semen, saliva, mucous

• Ingestion or inhalation

• ZOONOTIC

• Treatment is usually unrewarding

  • Neuter

  • Tetracyclines +/- streptomycin

  • Relapse is common

• Isolate animal from the pregnant, young or old

  • Immunocompromised animals

• Becomes an outdoors only animal

Is brucellosis zoonotic

yes!

Screening for brucellosis

• rapid card or tube aggluntination test

  • 95-99% accurate for negative results

  • Negative - true negative OR early exposure (<8weeks)

  • Confirmation: AGID (Cornell)

Diseases seen with brucellosis

• Late term abortions (7-9 weeks)

• orchitis

• diskospondylitis

• uveitis

Herpesvirus

• Isolation is critical

• 3 weeks pre/post whelping

• Transmission: aerosol, venereal, in utero

• Diseases seen: abortion, premature birth, stillbirths, neonatal death

• Exposure of young females to older animals prior to breeding as precautionary measure

Average length of Proestrus and Estrus

9 days but can range from 3-21 days

Average length of Diestrus

65 days but can range from 50-80 days

Average length of Anestrus

135 days but can range from 60-180 days

Estrous Cycle stages

• Proestrus

• Estrus

• Diestrus

• Anestrus

Proestrus

• ~ 9 days

• Serosanguinous discharge

• Parabasal cells, intermediate cells, transitioned into a few anuclear cells, many RBCs, WBCs

• Starting to come into heat

Estrus

• ~ 9 days

• Vaginal cytology: 70-80% anuclear superficial cells

• Receptive to the male

Diestrus

• ~ 65 days

• Reappearance of parabasal, WBC

Anestrus

Image of cells

Vaginal Cytology

• Remember PISA

• % cornified vs. non-cornified

• Other cells - RBCs and PMN's

• Cytological estrus

• Cytological diestrus

• use a long cotton swab and insert it up and over the brim of the pelvis to that you do not go into the urethra

Tools to determine timing of ovulation

• Witness LH Test

• Progesterone

Progesterone testing

• Every 2-3 days

• ELISA

  • Target (Synbiotics)

  • Subjective (have to interpret color and gives range according to color

    • Faint blue

    • Light blue

    • Bright Blue

  • RIA

    • Local Lab or Antech

    • Precise Number

  • Magic Numbers

    • 2ng/mL = LH surge

    • 5 (4-10 ng/mL) = Ovulation

Simple Truths

• Ovulation occurs 2-3 days after LH surge

• Oocyte maturation and ability to fertilize occurs 4-6 days after LH surge

• Typically breed 2-4 days after ovulation

Pregnancy typically occurs

• 65 days from LH surge

• 63 days from ovulation

• 57 days from day one of diestrus

Ultrasound to determine pregnancy

Usually wait until day 30 so that you can hear heartbeat

Radiographs to determine prenancy

Day 45 is the first time you can do them but typically not until day 54

• typically with do a puppy count as well with this modality

Stage I Parturition

• Uterine contractions leading to cervical dilation

• 6-12 hours

• Restless, panting, shivering, +/- vomiting

Stage II Parturition

• Cervis dilated, puppies moving through birth canal

• Ferguson reflex --> oxytocin --> abdominal press

• May take 2-6 hours (up to 24 but highly variable)

• 30 minutes - 1 hours between puppies

• 60% pups born cranial longitudinal, forelimbs extended

• 40% pups born caudal longitudinal, hind limbs extended

Stage III Parturition

• Fetal membranes expelled

• Usually pass quickly with puppy or between puppies

• Involution complete by 3 months post-partum

Lochia

This is normal in birth

• AKA uteroverdin

• Greenish-black in color, non-odorous

• Normally seen just prior to 1st puppy

  • ** if lochia is seen and no pup within 1 hour - potential dystocia

• Indication of placental separation

• Normally passed up to 3 weeks post-partum

Abnormalities of the female cycle

• Prolonged interestrous interval

• Shortened interestrous interval

• Prolonged Estrus

Prolonged inter-estrous interval causes

• Primary anestrus

  • Lack of estrous for 24 months

• Previous OHE

• Silent heat

  • Ovarian activity with no outward clinical signs

• Abnormalities of sexual differentiation

• Drug induced anestrus

  • Anabolic drugs, androgens, progesterone, or glucocorticoids

• Hypothyroidism

  • Lead to anestrus, prolonged proestrus or irregular inter-estrous intervals

• Progesterone-secreting ovarian cysts

• Ovarian aplasia

  • Rare congenital anomaly

  • Born without ovaries

• Immune-mediated oophoritis

  • Autoimmune destruction of ovary

• Hyperprolaktinameia

  • Prolonged pseudopregnancy

  • High prolactin level

Shortened inter-estrous interval

• Split estrus

  • Pubertal females

  • They come into heat and kind of go into proestrus and then all the sudden they regress

• Anovulatory cycle

  • Serum progesterone never rises above 3.5ng/mL

• Hypoluteoidism

• Short anestrus syndrome

  • Breed dependent (German Shepherd)

• Embryonal death/resorption

Prolonged estrus causes

• Ovarian cysts

  • Follicular cysts

    • Producing estrogen all the time

  • Can be treated with GnRH

• Ovarian Tumors

  • Granulosa cell tumors

• Pathological liver function

  • Metabolism of estrogens is reduced

• Exogenous estrogens

  • Hormone replacement in clients

Clinical signs associated with vulvar discharge

• Excessive licking

• Pruritis

• Stranguria

• Hematuria

• Dysuria

• Pollakiuria

• Incontinence

• Polyuria

• Polydipsia

Vulvar discharge

• Infection (bacterial or viral)

• Chemical irritation from urine or other instilled substance

• Foreign bodies

• Neoplasia (vaginal, cervical, or uterine)

• Pyometra or stump pyometra

• Ovarian remnant syndrome

• Congenital anomalies and trauma

Treatment and Diagnosis of vulvar discharge

• Vaginal cytology

• Vaginoscopy

• Antibiotics

Vaginal Neoplasia

• Vaginal leiomyomas are among the most common

• Canine transmissible venereal tumor

  • Tropical/developing countries

Vaginal prolapse

• Vaginal wall extends through the vulvar opening

• Occurs around parturition when estrogen rises

• Graded I-III

Grade I vaginal prolapse

•  Swelling and elevation of the vaginal folds may develop immediately cranial to the urethral orifice

  • May kind of look like a cherry tomato and go in and out

Grade II vaginal prolapse

Vaginal fold becomes large enough to protrude outside the vulva

Grade 3 vaginal prolapse

 Full protrusion of the vaginal circumference through the vulva "donut shaped"

Pseudopregnancy

• 1-3 months after estrus

• Development of signs and behaviors associated with end of luteal phase

• Mammary gland development and galactorrhea

• Mammary gland development and galactorrhea

• Nesting behaviors and adoption of stuffed animals

• No treatment necessary

• Can use dopamine agonists in severe cases

Pyometra

• One of the most common disease of the uterus

• PU/PD, Leukopenic, may be systemically ill

• Closed or Open

Closed pyometra treatment

• Antibiotics

• Fluid therapy

• Spay

Open pyometra treatment

• Estrumate/Lutalyse

• Antibiotics

• Fluid therapy

Reasons for abortions

• Bacterial

• Viral

• Hypoluteidoism

Abortions

• Green vaginal discharge or red mucopurulent

• If bacterial or viral cause

  • Unlikely to save puppies

  • Support dam as she continues to abort

  • Puppies to diagnostic lab --> do not FREEZE

• If hypoluteidoism or premature labor

  • Fetal heartbeat checks

    • Like them to be around 180bpm

  • Tocolytics

  • Progesterone therapy

Length of gestation for dogs

57-72 days

Tools to predict parturition

• Temperature drop

• Progesterone levels

• Radiographs

• Ultrasound

• Physical indications

Temp drop when prediction parturition

• Monitor 2-3x per day

• Delines 1 full degree (often <99 F)

• Begin to whelp within 24 hours

Progestrone levels for prediciting parturition

Declines to <1ng/ml 24-48 hours prior to whelping

Radiographs for prediciting parturition

• 45 days after LH surge (first mineralization)

• Puppy count best done later rather than earlier (55-60 days post LH surge)

• Teeth visible 3-8 days prior to whelping

  • Technique

  • Digital radiography

  • Not sufficient for time elective c-section

Ultrasound for prediciting parturition

• Never use for puppy count

• Primary use is assessment of fetal viability

  • Fetal HR should be 2-2.5x HR of dam

  • ~170bmp or greater

  • Fetal HR consistently <170 = Fetal distress

  • Fetal HR consistent < 150 = CUT

Physical signs for prediciting parturition

Lactation, lochia, nesting, etc.

Dystocia

• Recognize and intervene

• Assess dam first

  • Stabilize/supportive care

• Rule out obstructive dystocia by digital exam per vagina +/- rads

  • Cleanliness, gentleness, and lubrication

  • If see strong visible that do not produce a pup in 30 minutes --> INTERVENE

• Fetal causes

Fetal causes of dystocia

• Anasarca

  • Have a lot of water in them

• Multiple limbs

• Hydrocephalus

Gestation length in cats

65-66days

Parturition in felines

• Gestation = 65-66 days

• Usually timed from breeding … why?

• Dystocia's are uncommon

  • Maternal and fetal causes similar to canine

  • Partial expulsion of fetus more common in queens

    • Cleanliness, gentleness, and lubrication usually successful

  • Uterine torsions can happen

Hemorrhage postpartum

• Excessive blood loss

• Uterine rupture

• Female may appear pale, lethargic, painful

Subinvolution of placental sites

• Occurs when involution process is delayed

• Trophoblastic cells do not degenerate and continue to invade

• Hemorrhagic discharge not odiferous

• Uterine swellings may be palpated

• Spontaneous remission may occur

Retention of pup or placenta

• Greenish-black discharge

• Systemically ill --> toxic

• Ultrasound/Radiographs

• Caesarian section

Postpartum metritis

• Usually due to whelping in un-hygenic conditions

• Dirty obstetrical procedures

• Fever, depression, foul-smelling vaginal discharge from purulent to sanguine-purulent

• CBC/Chem

• Fluid therapy, antibiotics based on sensitivity

Hypocalcemia

• Clinical signs:

  • Anxiety

  • Apprehension

  • Disorientation

  • Hypersalivation

  • Shivering

  • Muscle tremors

  • Clonic-tonic seizures

• Calcium administration: calcium glunconate

• Supplement calcium after

• Supplement puppies may have to early wean puppies

Mammary disorders

• Agalactia

• Mastitis

Agalactia

• Failure to provide mild to neonates

• Premature parturition, severe stress, malnutrition, debility, metritis, or mastitis

• Continue to allow neonates to suck but supplement

• Oxytocin +/- metoclopramide (dopamine antagonist)

Mastitis

• Septic inflammation of the mammary gland, may be acute or chronic

• Coliforms, staph and strep are most commonly isolated

• Milk is commonly discolored

• Cephalosporins and beta lactamase resistant penicillin are recommended as safe in neonates

• Opioids for analgesics

• Warm compresses

Uterine Neoplasia

• Rarely reported in the female

  • 0.3-0.4% of all tumors

• Most commonly Leiomyomas

Ovarian Remnant syndrome

• Retention of active ovarian tissue

• Most commonly due to improper clamping ovarian pedicle in OVH

• Iatrogenic condition

Clinical signs of Ovarian Remnant syndrome

• Vaginal bleeding

• Swelling of vulva

• Attraction of males

Diagnosis of Ovarian Remnant syndrome

• Clinical history

• Clinical symptoms

• Routine vaginal cytologic examinations

• Ultrasound

Treatment of Ovarian Remnant syndrome

surgical excision of the remnant of tissue

Stump pyometra

• Result of incomplete OHE

• Clinical Signs similar to pyometra

  • Depression, anorexia, fever, inappetence, vomiting, abdominal pain or distention

  • Leukocytosis, monocytosis, azotemia

  • May present with urinary signs

• Surgical removal of stump

Male dog history and physical exam

• History

  • Vaccinations, sired litters, last seam evaluation

• Complete PE

• Evaluation of reproductive system

  • Scrotum

  • Testes

  • Epididymis

  • Spermatic cord

  • Penis

  • Prepuce

  • Prostate gland

• Brucella status

Semen evaluation

• Manual collection

• Separate 3 fractions

  • Sperm free fraction

  • Sperm-rich fraction

  • Prostate fraction

Semen motility

 70% progressively motile

Semen morphology

70% normal sperm

Total sperm

500 million to 1 billion

Primary infertility

• Never been fertile

• Ex. Testicular hypoplasia

Acquired infertility

• Secondary to inciting cause

• Trauma, fever, age, orchitis, Brucellosi, epididymitis, hormonal disturbance

Conditions of the penis

• Posthitis

• Canine transmissible venereal tumor

• Paraphimosis

• Priapism

• Phimosis

• Preputial foreign body

• Penile and preputial trauma and ulceration

• Fracture of the os penis

Posthitis

• Non-specific balanoposthitis

• Small lesions or mild hyperemia

• Small amount of purulent discharge from the orifice of the prepuce

Canine transmissible venereal tumor

• Neoplastic round cells

• Transferred from one host to the next

• Size can vary considerably from small to large fungating masses that cause preputial swelling

• Friable, ulcerated and bleed

• Diagnosis

  • Histological evaluation and differentiation from other round tumor

Paraphimosis

• Protrusion of the nonerect penis with an inability to retract the penis back into the prepuce

• Idiopathic

• Becomes dry, traumatized and may swell with edema, eventually become necrotic

Priapism

• Persistent erection of the penis without sexual stimulation

• Become dry, traumatized, and may become necrotic

• Trauma, neoplasia, inflammation, or vascular anomaly, or idiopathic

Phimosis

• Inability to extrude the penis

• Stenosis of the orifice is most common

• Congenital or acquired

Preputial foreign body

• Hemorrhage from the prepuce or voluminous purulent discharge

• Foreign material lacerates the penile mucosa and causes inflammation

• Foreign body is removed

• Healing occurs

Penile and preputial trauma and ulceration

• Ulceration or laceration of the penis and prepuce have similar origins

• Erect penis is subsequently traumatized

  • Foreign body in prepuce

  • Breeding through wire fence

  • Forced separation of tie during breeding

• Healing with granulation tissue

• Adhesions may occur between penis and prepuce

Fractured os penis

• Well recognized condition that occurs with local trauma

• Pathologic fracture secondary to neoplasia is rare

Conditions of the Prostate

• Benign prostatic hyperplasia

• Prostatitis and prostatic abscess

• Prostatic neoplasia

• Prostatic and paraprostatic cysts

Benign prostatic hyperplasia

• Disease of intact male dogs, usually older but not always

• Disorder consists of both cellular hyperplasia and hypertrophy

• Some with disease may show no clinical signs

• Others will

  • Sanguineous prostatic fluid

  • Hemospermia

  • Hematuria

  • Dysuria

  • Constipation and tenesmus

• Treatment: Castration of finasteride

Prostatitis and prostatic abscess

• Occurs secondary to ascending infection

  • Organism travel from the penis and prepuce up the urethra to prostate

  • Can occur secondary to hematogenous spread with Brucella canis

• Acute

  • Painful condition

  • Systemic illness

• Chronic

  • Subclinical

• Diagnosis

  • Prostatic wash, collection of prostate fluid during manual collection

• Antibiotics

• BPH treatment

Prostatic neoplasia

• Adenocarcinomas or transitional cell carcinomas are the most common

• Higher incidence in castrated males vs. intact

• Highly aggressive and metastatic

• Clinical signs

  • Mimic those of others

  • Dyschezia, dysuria

  • Pain associated with gait, back, or abdomen

• Prostate is irregular on palpation and heterogenous on ultrasound

• Treatment is palliative care

Prostatic and paraprostatic cysts

• My be located with in the prostatic parenchyma on in paraprostatic position

• Predispose to the development of abscessation

• Removal is recommended

Conditions of the testis and epididymis

• Testicular hypoplasia

• Testicular degeneration

• Orchitis

• Epididymitis

• Cryptorchidism

• Interstitial cell tumor

• Sertoli cell tumor

• Seminoma

Testicular hypoplasia

Born with really small testicles

Orchitis

• First thought should be Brucella

• Very large and painful testicles

Interstitial cell tumor

• Higher incidence in descended testicle

• Increase in testosterone

• Castration

Sertoli cell tumor

• Excess secretion of estrogen --> feminization

• Alopecia - flanks and over the back

• Treatment: Castration

Seminoma

• Rarely metastasize

• Confined to affected testicle