Inguinal percutaneous ultrasound to locate cryptorchid testes

Standing laparoscopic removal of abdominally retained cryptorchid testes may reduce patient morbidity and speed recovery compared with traditional laparotomy because anaesthesia is avoided and skin incisions are smaller. Reliably locating the testis preoperatively is therefore optimal to avoid unnecessary surgical morbidity and expense. We describe and review the results of a simple method of location using ultrasound scanning of the inguinal region, with a negative result indicating abdominal retention. One hundred and twenty‐seven horses with 141 cryptorchid testes were identified. Eighty‐five testes were identified inguinally: 56 abdominal. Two inguinally retained testes were not observed on ultrasound (false negatives) and 2 testes were considered inguinal but subsequently had to be removed from the abdomen (false positives). Sensitivity of inguinal ultrasound to predict the location of cryptorchid testes was therefore 98% and specificity 97%. The technique described herein proved a reliable technique to locate cryptorchid testes prior to surgery, minimising morbidity and cost. Suspect cryptorchids with no external evidence of testes should undergo a screening blood test prior to this ultrasound method of diagnosis.     

Unsuccessful laparoscopic castration in a cryptorchid Frisian stallion

A 2-year-old unilateral inguinal cryptorchid Frisian stallion was castrated by bilateral laparoscopic intra-abdominal spermatic cord transection. Because blood testosterone levels were still high on postoperative day 7, both testicles were removed using an open approach. Pathology revealed the presence of vital Leydig-cells in both testes. Failure of the laparoscopic castration in this horse was attributed to an alternate blood supply to the testes by vessels derived from the cremaster and/or external pudendal artery.     

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.     

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.     

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.     

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.     

Laparoscopic sterilization of Sardinia donkeys using an endoscopic stapler

OBJECTIVE: To describe a laparoscopic technique for sterilization of the male donkey using an endoscopic linear stapler (ELS). STUDY DESIGN: Clinical report. ANIMALS: Male Sardinia donkeys (n=6), aged 24-36 months. METHODS: Laparoscopic sterilization was performed under standing sedation or recumbent under general anesthesia. An endoscopic linear stapler was used to transect, and control hemorrhage of, the spermatic cord. Serum testosterone concentrations were measured preoperatively and at 3, 6, and 12 months after sterilization. One testis from each of 2 donkeys was collected at 12 months for histologic examination. RESULTS: Sterilization was successfully achieved. The only minor intraoperative complication experienced was hemorrhage from 1 spermatic cord stump, which was re-stapled. No other major short- or long-term complications occurred. Serum testosterone concentrations were < 15 ng/dL at 3, 6, and 12 months after surgery in all donkeys. Testicular atrophy without evidence of revascularization was observed in the 2 testes examined histologically. CONCLUSIONS: Sterilization of descended testes by intraabdominal laparoscopic transection of the spermatic cord is a simple practical method, with minimal intraoperative or postoperative complications. Testicular revascularization did not occur. CLINICAL RELEVANCE: Laparoscopic sterilization in donkey can be performed using an endoscopic linear stapler as an alternative to scrotal castration.     

Monorchidism in three colts

Three monorchid colts were admitted for castration as cryptorchids. Two colts each had one normal descended testis, and the third colt had a small testis in the abdomen. Monorchidism was diagnosed at surgery by locating an incomplete epididymis without a testis. After the incomplete epididymis and other testis were removed, the absence of testicular tissue was confirmed by results of a human chorionic gonadotropin response test.     

Pinhole castration: a novel minimally invasive technique for in situ spermatic cord ligation

OBJECTIVE: To describe a minimally invasive technique for castration of bull calves by in situ ligation of the spermatic cord. STUDY DESIGN: Experimental study. ANIMALS: Male calves (n=6) aged, 48-56 days. METHODS: Calves were blocked by weight and then separated into 3 groups: (1) bilateral spermatic cord ligation; (2) unilateral-1 spermatic cord ligated; and (3) control-neither spermatic cord ligated. After local anesthesia, in situ spermatic cord ligation was achieved by restraining the cord laterally within the scrotal sac and passing suture through a hypodermic needle inserted caudal to cranial at the neck of the scrotum and adjacent the medial margin of the restrained spermatic cord. The needle was removed leaving the suture in place and the spermatic cord repositioned medially, then the needle was reinserted through the original holes and the suture passed back through the needle, which was withdrawn. The suture ends were tied ligating the spermatic cord, leaving the knot subcutaneously. Calves were monitored and testes removed after 30 days for gross and histologic examination. RESULTS: Castration was accomplished without postoperative complications. Spermatic cord ligation resulted in testis atrophy, and histologically, complete ischemic necrosis. CONCLUSIONS: This novel minimally invasive technique is a simple, alternative method for castration of bull calves. CLINICAL RELEVANCE: This method of castration is simply performed, without obvious skin wounds, and no postoperative care needed. The technique should be readily adaptable to other species.     

Comparison of intraoperative pain responses following intratesticular or mesorchial injection of lidocaine in standing horses undergoing laparoscopic cryptorchidectomy

OBJECTIVE: To compare pain responses in stallions undergoing standing laparoscopic cryptorchidectomy following intratesticular or mesorchial infiltration of lidocaine. DESIGN: Clinical trial. ANIMALS: 20 stallions with 1 or 2 undescended testes. PROCEDURES: Standing horses were administered a nonsteroidal anti-inflammatory drug and a caudal epidural injection of detomidine hydrochloride and underwent laparoscopic cryptorchidectomy. The undescended testis (1/horse) was grasped to determine the preoperative pain response (present vs absent) and assess severity of pain (by use of a visual analog scale [VAS]). The undescended testis or its mesorchium was injected with 2% lidocaine (10 mL); saline (0.9% NaCl) solution (10 mL) was injected in the untreated structure. Presence and severity of pain was determined by 2 individuals as the testis was grasped following infiltration and at the times of ligature placement and transection of the spermatic cord. Serum cortisol concentration was analyzed preoperatively, after ligation, and after transection. Presence or absence of signs of pain, severity of pain, and serum cortisol concentrations were compared within and between treatment groups. RESULTS: Detection of signs of pain and VAS pain scores did not differ between observers at any time point. Perceived pain responses associated with ligature placement differed significantly from preoperative responses. Pain responses and serum cortisol concentrations after intratesticular and mesorchial infiltration of lidocaine did not differ. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that intratesticular or mesorchial infiltration of lidocaine combined with administration of a nonsteroidal anti-inflammatory drug and caudal epidural injection of detomidine provides adequate analgesia in standing stallions undergoing laparoscopic cryptorchidectomy.     

Normal and cryptorchid castration

Surgical exploration of the horse that has presumably had a normal castration or a previously successful cryptorchid surgery remains a distinct challenge. No hard and fast rules dictate a proper course of action for each case. If a horse was anesthetized for routine castration, discovered to have only one scrotal testis, had a brief exploratory on the nondescended side and was recovered, trauma to the inguinal region would probably be sufficiently minimal that an inguinal approach could be used at subsequent exploratory surgery. If the inguinal canal was extensively manipulated and the tail of the epididymis was inadvertently removed, however, one of the alternate approaches would be advisable. Where previous history is unknown, external and rectal palpation, hormonal assays, and careful evaluation of the scrotal/inguinal scars under anesthesia are advisable prior to proceeding with a specific course of action. As previously cited, "one hopes for the best but prepares for the worst." Where inguinal canals are being explored in the supposedly previously castrated horse that still has aggressive male behavior, the surgeon is searching for vaginal process and contents or the stump of the spermatic cord. If the stump is identified to suggest complete previous castration, the stump should contain cremaster muscle, parietal vaginal tunic, testicular vessels, and ductus deferens. If a second nonvascular tubular structure is found but no testicular vessels are found, the tail of the epididymis was inadvertently removed and assumed to be hypoplastic testis. This determination can be difficult to make on gross observation of the stump. Again, a thorough case workup helps one plan in advance for what should be found at surgery.     

Ventral Abdominal Approach for Laparoscopic Cryptorchidectomy in Horses

Objective —To report a ventral abdominal approach and a ligating loop technique for laparoscopic cryptorchidectomy in horses.
Study Design —Prospective.
Sample Population—Six horses, aged 1 to 5 years, with retained testes.
Methods —One laparoscopic portal and three to four instrument portals were used for ventral abdominal laparoscopic cryptorchidectomy. Laparoscopic instruments were used to maneuver and secure the testis through a ligating loop (modified Roeder knot) that was secured from outside the abdominal cavity. Only minimal enlargement of one instrument portal was used to remove the testicle.
Results —Three horses were bilateral cryptorchids, and three were unilateral (left side, two; right side, one) cryptorchids. Operative time, defined as the time from laparoscope insertion to removal, ranged from 20 to 25 minutes for unilateral cryptorchids and from 40 to 50 minutes for bilateral cryptorchids.
Conclusions —The reported technique allowed decreased tension on the tissues during ligation and removal of the testis from the peritoneal cavity. Improved observation of the abdominal cavity, ligation security, shortened patient confinement time, and minimally invasive technique are all considered to be benefits of laparoscopic cryptorchidectomy.
Clinical Relevance —Direct observation of retained testes and intraabdominal castration are distinct advantages of the use of laparoscopy in horses that have had previous unsuccessful surgical attempts, horses with unknown histories that have retained testicular tissue, or bilateral abdominal cryptorchids.     

Ultrasonographic and quantitative histologic assessment of sequelae to testicular biopsy in stallions.

A sample of testicular parenchymal tissue, approximately 2 x 7 x 7 mm, was aseptically removed from 1 testis in each of 9 stallions on day 0. Slight to moderate hemorrhage from the tunica albuginea was observed in 8 stallions, but bleeding from the parenchyma was detected in only 2 stallions. Stallions were castrated 27 days later. Normal development of granulation tissue was evident at the biopsy site, but hematomas were not observed. In situ measurement of the widths of the right and left testes, total scrotal width, and evaluation of testicular echogenicity during ultrasonography were variables used to monitor changes in the testicular parenchyma from 14 days before biopsy through 27 days after biopsy. The control testis was consistently larger than the biopsied testis, except for day 3. Ultrasonography revealed signs of a localized change in the parenchyma of the biopsied testis in 4 stallions, but each lesion decreased in size by day 27. Tissues removed during biopsy enabled an excellent appraisal of spermatogenesis at that time. Detailed examinations of seminiferous tubules in the testes were performed to assess for damage to testicular function. At castration, samples were taken from 6 sites in each testis. Quantitative histologic evaluations of testicular tissues revealed low numbers of spherical spermatids and pachytene spermatocytes in biopsied testes, compared with control testes. It was concluded that there was a transitory increase in degeneration of preleptotene spermatocytes and B spermatogonia at the time of biopsy. A mild inflammatory response at the biopsy site in some testes was evidenced by an increased number of leukocytes at the biopsy site and at a dorsal site.(ABSTRACT TRUNCATED AT 250 WORDS)     

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.     

Function of contralateral testis after artificial unilateral cryptorchidism in dogs

The effects of a cryptorchid testis on the contralateral testis were investigated after artificially producing unilateral cryptorchidism in 8 beagle dogs. Bilateral testicular biopsy and collection of spermatic vein blood and peripheral vein blood were performed at the time of the operation to produce the cryptorchidism and 52 weeks later. The testicular tissue was used for histological examination by light microscopy and measurement of the testicular transferrin (Tf) concentration by enzyme immunoassay. Plasma testosterone (T), estradiol-17 beta (E2), and luteinizing hormone (LH) levels were measured by radioimmunoassay. Semen was collected weekly and its quality was examined. No spermatogenesis was observed in the cryptorchid testes at 52 weeks after the operation, and the number of germ cells in the contralateral testes had decreased but the number of Sertoli cells did not change. The Tf concentration in both testes had also decreased. The mean total number of sperm between 48 and 52 weeks after the operation (194 x 10(6)) was less than half the number before the operation (510 x 10(6)). Mean spermatic vein plasma T levels (51 ng/ml) in the cryptorchid testes 52 weeks after the cryptorchid operation were significantly lower than before the operation (91 ng/ml; P < 0.05). By contrast, spermatic vein plasma E2 levels (80 pg/ml) were significantly higher than the values before the operation (51 pg/ml P < 0.05). The peripheral plasma LH levels decreased. These findings indicate that a large quantity of E2 secreted by the cryptorchid testis inhibits the endocrine and spermatogenic functions of the contralateral testis in the dog. In particular, it is assumed that dysfunction of the contralateral testis is associated with Sertoli cell dysfunction suggested by the low Tf concentration.     

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.     

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.     

Expression of connexin 43 protein in testes, epididymides and prostates of stallions

REASONS FOR PERFORMING STUDY: Connexin 43 (Cx43) is a ubiquitously distributed gap junction protein in testes and other reproductive tissues. Adjacent cells share ions and small metabolites through intercellular channels, which are present in gap junctions. Previously, Cx43 has not been reported in testes, epididymides and prostates either in healthy stallions or cryptorchid horses. OBJECTIVES: To demonstrate the expression pattern of Cx43 in the reproductive tissues of stallions and examine whether naturally occurring bilateral cryptorchidism has any influence on distribution and expression of Cx43. METHODS: The expression and the presence of Cx43 protein were detected by means of immunohistochemistry and Western blot analysis using a polyclonal rabbit anti-Cx43 antibody. RESULTS: In stallions, gap junctions appeared as structures localised to cell-cell contacts between adjacent cells. In testes, Cx43 expression was detected in the interstitial tissue and seminiferous tubules, between Leydig and Sertoli, as well as Sertoli and germ cells. In epididymides, Cx43 was localised between epithelial cells, whereas in prostates, between secretory cells of the glandular epithelium. In the cryptorchid, a clear reduction of Cx43 signal was observed in all reproductive tissues. CONCLUSIONS: Coupling of Leydig cells via gap junctions may suggest that steroidogenic function of the testis is under the influence of these intercellular channels. Within seminiferous tubules, the expression was found to be stage-specific, pointing to its role in coordinating spermatogenesis. Differential distribution of Cx43 protein in the reproductive tract of normal and cryptorchid stallions indicates that expression is clearly dependent on the physiological status of the horse. POTENTIAL RELEVANCE: Detection of Cx43 expression in equine testicular, epididymal, and prostatic cells is important for a better understanding of the role of intercellular membrane channels in direct cell communication within the reproductive tract of stallions.     

Results and complications of a novel technique for primary castration with an inguinal approach in horses

Reasons for performing study: Complications associated with equine castration can have medical and financial consequences. This retrospective study investigated a novel method of castration via an inguinal approach in mature stallions and compared the incidence of complications with other methods. Hypothesis: Castration via an inguinal approach has a low complication rate at the site of surgery compared with other castration techniques. Methods: Mature stallions (n = 238) were castrated under general anaesthesia in dorsal recumbency using an inguinal approach. The vaginal process was incised, the spermatic cord ligated twice and the testis removed. After suturing, the vaginal process and one or 2 layers of fascia, the subcutis and cutis were closed in a simple continuous pattern. Results: Five of 238 (2.1%) horses had post operative haemorrhage and a haematoma in the scrotal region, which required additional treatment. All horses made a full recovery. Five of 238 (2.1%) of the horses had a post operative respiratory infection, which resolved with antibiotic therapy. Sixteen of 238 (8.8%) had transient signs of colic shortly after surgery. Conclusion: This technique of castration with an inguinal approach had a low incidence of complications at the site of surgery compared with other methods. An inguinal approach and leaving the vaginal tunic in situ may cause less soft tissue trauma than a scrotal approach.