Decision Making for Cryptorchid Castration; a Retrospective Analysis of 280 Cases

The location of an undescended testicle influences the choice of surgical technique for efficient cryptorchid castration. We review a standardized protocol for preoperative examination to dictate surgical approach to cryptorchidism. Cases are split into two periods: 2004–2006 and 2007–2014. In 2004–2006, conventional cryptorchidectomy and laparoscopic cryptorchid castration (standing) were both offered, but the choice of technique was based primarily on owners' preference for a recumbent or standing procedure. In 2007–2014, ultrasonography was used to locate the testes and dictate the preferred surgical approach; for abdominal testes, laparoscopic intraabdominal spermatic cord ligation without orchidectomy was preferred and for inguinal testes, conventional open orchidectomy. The numbers of animals requiring a second procedure to complete castration were compared between the two periods. In addition, failure rates for individual testes grouped by location were determined separately for the different techniques, and the value of preoperative ultrasonography to locate the retained testes was assessed. In 2004–2006, 15.3% (20/131) of the cryptorchids needed more than one surgery to complete castration, compared to 0.7% (1/144) in 2007–2014. Failure rates for laparoscopic castration were 0/168 (0%) for abdominal, 3/40 (7.5%) for inguinal, and 9/55 (16.4%) for scrotal testes; for conventional castration, failure was recorded for 3/12 (25%) abdominal and 0/92 (0%) inguinal testes. For 94% (156/166) of retained testes, ultrasound-based preoperative advice on surgical approach was correct. Using a standardized preoperative examination to determine choice of surgical technique significantly (P < .001) reduced the number of second surgeries needed to complete castration. Preoperative ultrasound is therefore a useful aid to determining the surgical approach to cryptorchid castration.     

The complex blood supply to the equine testis as a cause of failure in laparoscopic castration

REASONS FOR PERFORMING STUDY: Intra-abdominal ligation/ transection of the spermatic cord may result in necrosis of the testis; castration of abdominal cryptorchids via laparoscopy has therefore become common. Notwithstanding some adaptations of the technique, a small percentage of operations fail, prompting research into the anatomical background and clinical relevance of the procedure. HYPOTHESIS: That an alternate blood supply may prevent complete necrosis of the testis after spermatic cord transection. OBJECTIVE: To establish the prevalence of the problem in normal and cryptorchid stallions. METHODS: In a preliminary study, the spermatic cords of 8 normal stallions were ligated and transected at different sites and in various manners. Five weeks later the testes were removed and the vitality of both the testes and epididymes was evaluated. In a prospective clinical trial, intra-abdominal spermatic cord transection was performed in 241 cryptorchid and normal stallions. In cases of surgical failure, the testes were removed and histology performed. RESULTS: Examination of the specimen removed from the 8 animals of the preliminary study revealed that all epididymes were completely or largely spared. All except one testis were completely necrotic. In the patients that underwent surgery all abdominally retained testes (n = 123) were necrotic, while 5 out of 88 inguinally retained and 8 out of 236 normally descended testes had partially survived. The pattern of survival differed between inguinally retained and normally descended testes. The epididymes of these 13 horses were (largely) vital. The (partial) survival of the epididymes and inguinally retained testes was ascribed to an alternate blood supply via anastomosing vessels derived from the cremasteric artery. A tributary from the external pudendal artery was considered responsible for the partial survival of normally descended testes. CONCLUSIONS AND POTENTIAL RELEVANCE: After intra-abdominal transection of the entire spermatic cord, 5.6% of inguinally retained and 3.4% of normally descended testes failed to become completely necrotic, as a result of an alternate blood supply via the cremasteric and/or external pudendal artery. Therefore, laparoscopic castration without orchidectomy cannot be recommended as a trustworthy method for castration of inguinal cryptorchids and normal stallions.     

Cryptorchidism and monorchism in cats: 25 cases (1980-1989).

Of 1,345 cats admitted for orchiectomy during a 10-year period, 23 (1.7%) were cryptorchid and 2 (0.1%) were monorchid. Persian cats were over-represented in the cryptorchid population (P = 0.01). Cats were more likely to be unilaterally than bilaterally cryptorchid (P = 0.01). A predisposition for location of undescended testes (abdominal vs inguinal or right vs left side) was not identified in unilateral cryptorchids. All bilateral cryptorchids had abdominally located testes. The most common surgical approaches used for orchiectomy of cryptorchid cats were a caudal ventral midline incision for inguinal testes and a caudal ventral midline celiotomy for abdominal testes.     

Diagnostic ultrasonography for evaluation of cryptorchidism in horses

The location and size of 11 retained testes were accurately determined ultrasonographically. There was 100% correlation between the location of the testis determined by ultrasound vs that determined by surgery. Testicular size determined presurgically in all cases closely approximated the actual size obtained by gross measurement of the excised testis. The cryptorchid testicular echotexture was less dense than that of the normal descended testicles, but was easily identified. Ultrasonographic evaluations were completed by use of an ultrasound base unit with attached 5-MHz transrectal transducer. Rectal scans were started at the pelvic brim and continued in a to-and-fro pattern between the midline and the lateral abdominal wall. When the testis was located, the image was froze to allow measurement. All testicular locations were ascertained ultrasonographically either by rectal or external inguinal scans.     

Retrospective study of 350 cases of equine cryptorchidism.

Equine cryptorchidism was examined by a review of the literature and a retrospective study of 350 horses over a 14-year period. The incidence of left vs right testis retention was nearly equal. On the left side, 75.2% of the retained testes were retained abdominally and 24.8% inguinally; on the right side, 41.8% of the retained testes were retained abdominally and 58.2% inguinally. Preoperative diagnosis by rectal palpation of the vaginal rings was considered a valuable technique, with 87.9% accuracy in 190 horses. Invasive and nonivasive surgical techniques for abdominal cryptorchidectomy and associated complications were compared. The results supported the technique of traction on gonadal structures outside the abdominal cavity (noninvasive) as superior to techniques requiring intraabdominal manipulation (invasive).     

Use of transabdominal ultrasonography to determine the location of cryptorchid testes in the horse

REASONS FOR PERFORMING STUDY: Transrectal ultrasonography is a reliable technique to identify intra-abdominal testes, but can be hazardous or impractical in fractious, juvenile or small equids. The transabdominal approach therefore requires validation. OBJECTIVES: To evaluate the sensitivity and specificity of transabdominal ultrasonography to localise cryptorchid testes. METHODS: Thirty-eight horses admitted for cryptorchidism underwent transabdominal ultrasonography to locate errant testes. Location of the testes was confirmed during surgery (n = 37) or necropsy (n = 1). RESULTS: Horses weighed 175-760 kg. Twenty-two testes were located within the abdomen, 19 in the inguinal space and 3 in a subcutaneous location. In 2 horses, a thick winter coat prevented adequate contact between the probe and the skin, and visualisation of their inguinal testis and one abdominal testis was missed during transabdominal ultrasonography. Excluding the 2 horses with excessive hair, the sensitivity of transabdominal ultrasonography to locate errant testes was 97.6% (93.2% when all horses were included), and its specificity 100%. CONCLUSIONS: Transabdominal ultrasonography is a reliable, safe and immediate technique to diagnose cryptorchidism precisely in horses of all ages, sizes and temperaments. POTENTIAL RELEVANCE: Transabdominal ultrasonography provides an immediate definitive diagnosis of adominal cryptorchidism and should enhance selection of an appropriate surgical approach for their removal.     

Use of an inguinal approach adapted from equine surgery for cryptorchidectomy in dogs and cats: 26 cases (1999-2010)

OBJECTIVE-To determine whether a surgical technique used in cryptorchid horses can be used successfully to remove testicles retained in the inguinal region or abdominal cavity in dogs and cats. DESIGN-Retrospective case series. ANIMALS-22 dogs and 4 cats with cryptorchidism. PROCEDURES-In 1999 through 2010, 26 cryptorchid patients underwent surgery during which an incision was made over the inguinal ring and the undescended testicle was located for removal via identification of the vaginal process and the embryonic gubernaculum. Castration was performed once a testicle was located in the inguinal region or via removal of an intra-abdominally located testicle through the inguinal canal. RESULTS-4 dogs and 1 cat were bilaterally cryptorchid. Testicles were retained in the abdominal cavity in 18 dogs and in the inguinal region in 4 dogs; in all 4 cats, undescended testicles were located in the inguinal region. Twenty-one dogs and 4 cats were castrated without breaching the abdominal cavity; in one of those dogs, the inguinal ring was enlarged to permit extraction of a tumorous testicle. In 1 dog, the inguinal ring was enlarged into a paramedian laparotomy and viscera were manipulated to exteriorize an intra-abdominally located testicle because the gubernaculum had ruptured. Major intraoperative or long-term complications did not occur. CONCLUSIONS AND CLINICAL RELEVANCE-Results suggested that as in horses, the surgical approach over the inguinal ring, wherein the vaginal process and the remnant of the gubernaculum are identified and used to locate an undescended testicle for removal, can be used successfully in dogs and cats.     

Comparison of the diagnosis and management of unilaterally castrated and cryptorchid horses at a referral hospital: 60 cases (2002-2006)

OBJECTIVE: To determine the incidence of unilaterally castrated horses among horses admitted to the hospital for castration and to compare horses that underwent previous unilateral castration with horses that had cryptorchism. DESIGN: Retrospective case series. ANIMALS: 16 unilaterally castrated horses and 44 cryptorchid horses. PROCEDURES: Medical records of horses that were admitted to the veterinary medical teaching hospital for castration, including cryptorchid and unilaterally castrated horses, between January 2002 and December 2006 were reviewed. Medical records of unilaterally castrated horses and cryptorchid horses were examined for age, breed, history, diagnostic procedures, surgical technique of cryptorchidectomy, location of the retained testicle, and cost of surgery. RESULTS: Of 160 horses admitted for castration, 16 (10%) had undergone previous unilateral castration and 44 (27.5%) had cryptorchidism. Unilaterally castrated horses were significantly older than cryptorchid horses. No significant difference was found in left versus right distribution of testicles. No significant difference was found in abdominal versus inguinal distribution of left-sided testicles. Unilaterally castrated horses had a significantly lower proportion of right inguinal testicles, compared with cryptorchid horses. The cost of diagnosis and management of unilaterally castrated horses was significantly greater than in cryptorchid horses. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that the distribution of retained testicles is significantly different in unilaterally castrated horses, compared with cryptorchid horses, which may affect the selection of diagnostic and surgical approaches to unilaterally castrated horses.     

Castration of the Vietnamese pot-bellied boar: 8 cases

Surgical techniques for castration of the Vietnamese pot-bellied boar and outcome are described. Vietnamese pot-bellied pig (VPBP) boars (n = 8) were admitted for castration. Data retrieved from medical records (2002–2011) for these pigs included signalment, history, reason for castration, perioperative management, surgical technique, and complications. Follow-up information was obtained from owners. A scrotal approach with closed technique was used for 6 boars with normally descended testes. A scrotal approach and open technique was used in 1 inguinal cryptorchid boar. In a hemicastrated abdominal cryptorchid boar an ipsilateral parainguinal approach was used. No complications occurred. Castration of the Vietnamese pot-bellied boar is associated with minimal complications and a satisfactory cosmetic outcome. We recommend the routine closure of the external inguinal rings, a simple and fast procedure that may prevent post-castration inguinal herniation.     

Morphological and immunohistochemical studies in testes of normal and cryptorchid boars

Scrotal (n = 66), inguinal (n = 7) and abdominal (n = 36) testes from pigs differing in age (from 1 day to 4 years) were collected after slaughtering or by castration, fixed in 4% formalin and examined by light microscopy. The expression of vimentin, desmin, alpha-actin and PCNA was detected by immunohistochemical technique. Histologically no differences between scrotal and cryptorchid testes are obvious during the prepubertal period, until the age of 10-12 weeks, but with the onset of puberty degenerative alterations (Sertoli-cell-only morphology, giant cells) in dystopic testes occur. Additionally the differentiation of the interstitial cells is disturbed in abdominal testes resulting in a deviating expression pattern of alpha-actin. The Sertoli cells show different distribution patterns (basal, perinuclear, apical) of vimentin depending on the position of the testis and the age of the animal.     

Noninvasive Inguinal Approach for Cryptorchidectomy in Thirty-eight Stallions

We describe the results of the noninvasive inguinal approach in 38 cases of cryptorchidism. Whether the retained testis was intra-abdominal or in the inguinal canal, this technique was found to be an easy, reliable method of locating abdominal and inguinal testes through a normal body opening. No postoperative complications were recorded in this series of cases and the postoperative rest period was minimal.     

Concentrations of oestradiol and testosterone in peripheral and spermatic venous blood of dogs with unilateral cryptorchidism

Plasma testosterone and oestradiol concentrations were measured in peripheral and spermatic venous blood of 13 dogs with unilateral inguinal cryptorchidism, 9 dogs with unilateral abdominal cryptorchidism, and in a control group of 36 mature normal dogs. The hormone concentrations were similar in the three groups, both in the peripheral and in the spermatic venous blood. The weight of the testes in the control group was correlated with the body weight and there was no significant difference between the weight of the right and the left testes. The weight of the abdominal testes was lower than that of the inguinal testes, and there was no compensatory enlargement of the contralateral scrotal testis. The cryptorchid testes showed little or no histological evidence of spermatogenesis, and spermatogenesis was usually normal in the scrotal testes.     

A polyorchid dog

The case of a polyorchid Irish Setter is presented here. Castration and intra-abdominal testis removal were performed one year of age when one scrotal and one cryptorchid testis near the right inguinal canal were removed. Later it became apparent that there was still testosterone production. A third testis, abdominal cryptorchid, was found on the right side cranially and right to the bladder. The third testis had a strong cranial suspensory ligament and the tail of the epididymis was elongated. The ductus deferens did not enter the prostate but followed the gubernaculum to the inguinal canal near the stump of the previous operation on the caudal right testis. This suggests that two right cryptorchid testes had common ductus deferens.     

Testicular seminoma associated with torsion of the spermatic cord in two cryptorchid stallions

Two adult horses had colic attributable to spermatic cord torsion and strangulation of abdominally retained neoplastic testes. Both horses had caudal abdominal soft tissue masses palpable per rectum. One horse was treated successfully by surgical removal of the testis, and the other was euthanatized without treatment. Histopathologic diagnosis of the involved testes was testicular seminoma. Spermatic cord torsion of an abdominally retained testis should be considered in the differential diagnosis of signs of abdominal pain in cryptorchid stallions, especially those with a palpable caudal abdominal mass.     

A Review of Laparoscopic Cryptorchidectomy

Laparoscopic cryptorchidectomy has provided the surgeon with an easy, efficient means of locating and castrating abdominally retained testes without the complications associated with routine open approaches. It is especially useful when the horse's castration history is unknown, or if previous attempts at cryptorchid castration have been made. With the direct visualization that laparoscopy provides, surgeons are able to visualize both vaginal rings for presence of intra abdominal and inguinal testis in addition to testicular remnants and adhesion formation from previous surgical manipulations. Furthermore, because it is minimally invasive, laparoscopy shortens patient confinement time and reduces postoperative complications such as eventration. With experience, it is a technically easy procedure and can safely be performed on anesthetized or standing sedated horses.     

Uncommon castration complication: Penile amputation and sheath ablation following an iatrogenic phallectomy

This report describes the repair of an iatrogenic phallectomy that occurred during an attempted castration of a horse that was discovered to be a unilateral cryptorchid (inguinal testis). Use of a modification of a described phallectomy and sheath ablation technique allowed penile retroversion to be avoided, decreasing excessive dissection and post‐operative morbidity, despite the urethral orifice being positioned more caudally than previously reported.     

Laparoscopic Cryptorchid Castration in Standing Horses

Objective — This article describes a new technique for laparoscopic cryptorchid castration in standing horses. Study Design — Prospective study. Animals or Sample Population — Eight horses aged 11 months to 3 years and weighing between 300 and 643 kg. Methods — Food was withheld for 24 to 36 hours, and then horses were sedated with detomidine HC1 (0.02 to 0.03 mg/kg) and butorphanol tartrate (0.02 mg/kg). The paralumbar fossa region was desensitized with 2% mepivacaine in an inverted “L” pattern and caudal epidural anesthesia was administered with either xylazine (0.18 mg/kg diluted to 10 to 15 mL with 0.9% sodium chloride) or a combination of 2% mepivacaine and xylazine (0.18 mg/kg). Initial laparoscopic exploration was performed from the left flank; in three horses, right flank laparoscopy was needed to complete the procedure. The spermatic cord was ligated within the abdomen with one or two sutures of 0 polydioxanone suture, and the testis or testes removed through a flank incision. Results — In five horses with no palpably descended testes, standing laparoscopy was the only procedure performed, whereas in two horses, the abdominal testis was removed laparoscopically, and the descended testis was removed under short acting anesthesia. In one horse, with nonpalpable testes, it was determined by laparoscopic observation that the testes were in the inguinal canal, and castration was performed under general anesthesia. No surgical or postoperative complications were noted. The right side of the abdomen, and especially the right vaginal ring, could be easily observed from the left side by passing the laparoscope through a small perforation in the mesocolon of the descending colon or by elevating the descending colon with an instrument or by use of an arm in the rectum. Conclusions — The standing laparoscopic approach combined with or without short-acting anesthesia to remove the descended testis is easily performed. Clinical Relevance — This approach will provide surgeons with another option to castrate cryptorchid stallions.     

Incidence of cryptorchidism in dogs and cats

Over a period of 54 months, 3518 dogs and 3806 cats were castrated; 240 of the dogs and 50 of the cats were cryptorchid. Pedigree dogs, in particular the German shepherd dog, boxer and chihuahua were over-represented. Among the dogs, right-sided inguinal cryptorchidism was the most common form, followed by right-sided abdominal cryptorchidism. The location of the affected testicle(s) was most variable in the boxer. Among the cats, left- or right-sided inguinal cryptorchidism were the most common forms of the condition.     

Laparoscopic cryptorchidectomy in a cat

Several techniques for castration of cryptorchid cats have been described. In this case report, the use of laparoscopy for castration of a bilateral cryptorchid cat (with testes located in the abdomen) is described. Three trocars were inserted into the abdominal cavity, the testicles were easily identified adjacent to the urinary bladder. Haemostasis of the gubernaculum testis and spermatic cord was achieved with bipolar cauterisation. The testicles were easily removed in approximately 20 min. To the authors' knowledge this is the first report of the use of laparoscopy for the treatment of cryptorchidism in cats.