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.     

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.     

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.     

Usefulness of computed tomography for cryptorchidism in bulls

Cryptorchidism is defined as the failure of the testis to descend into the scrotal position. Bulls with cryptorchidism have problems in both meat quality and husbandry management; thus, it is greatly important to accurately identify the retained testis and remove it during the early stage. Abdominal computed tomography (CT) was performed under general anesthesia in 34 bulls aged 3–9 months with cryptorchidism. All bulls underwent laparoscopic or incision approach for cryptorchidectomy, and 40 testes were dissected. The detection rates of retained testes were 64.5% in the abdominal cavity and 100% in the subcutaneous inguinal region, and the total detection rate was 72.5%. Furthermore, all cases in this study were suspected to have intra-abdominal cryptorchidism in primary care, but CT revealed that 22.5% of cases had cryptorchidism in the subcutaneous inguinal region. The CT value (mean ± standard deviation) of the retained testes was 20.96 ± 7.54 Hounsfield Unit, and the CT value and size of the retained testes showed a positive weak correlation with bovine age. Therefore, there is the demerit that general anesthesia and a huge device are necessary; nevertheless, CT is suggested to be useful in identifying the location of retained testes and selecting an appropriate surgical approach in bulls with cryptorchidism. Moreover, CT findings suggested that the maturation of the retained testes might depend not on the descending process but on age.     

Clinical, hormonal and ultrasonograph approaches to diagnosing cryptorchidism in horses

Cryptorchidism is a partial or total failure of testicular descent. For a proper diagnosis different methods are required. The main aim of this study was to compare different diagnostic methods. Sixty two horses (15 stallions, 32 cryptorchids and 15 geldings) were used in the experiment. They were clinically examined and ultrasonography was used to locate the testes. Blood samples were taken from the animals to measure the plasma level of testosterone and total estrogen (RIA method). In 22 horses suspected of cryptorchidism, the hCG stimulation test was performed. Blood samples were taken every 20 minutes for 8 hours and then 24 and 48 hours after injection. Clinical examination had a 60% success rate in detecting superficial and profound canal cryptorchids. Inguinal ultrasonography had a 100% rate of detection when the retained testes were in the area of the internal or external inguinal ring. The rate of detection with abdominal cryptorchids was 72.7%. The highest levels of testosterone were found in stallions' blood (2.3 ng/ml), they were lower in cryptorchids (0.68 ng/ml) and lowest in geldings (0.15 ng/ml). Total estrogen levels revealed a similar tendency (respectively: 395 pg/ml, 228 pg/ml and 26 pg/ml). Administration of hCG usually increased the level of testosterone from 0.68 ng/ml to 1.05 ng/ml 60 minutes after injection. We found that to successfully diagnose cryptorchids in veterinary practice a combination of clinical, ultrasonographic and hormonal examinations should be used.     

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).     

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.     

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.     

Laparoscopic cryptorchidectomy using electrosurgical instrumentation in standing horses

OBJECTIVE: To describe a technique for laparoscopic cryptorchidectomy in standing horses using electrosurgical instrumentation. STUDY DESIGN: Retrospective clinical study. ANIMALS OR SAMPLE POPULATION: Ten horses, 1 to 7 years of age, with unilaterally or bilaterally retained testes. METHODS: Food was withheld for a minimum of 12 to 24 hours. Horses were sedated using xylazine hydrochloride (0.5 to 1 mg/kg) and butorphanol tartrate (0.02 mg/kg) or detomidine hydrochloride (0.02 to 0.03 mg/kg) and restrained in standing stocks. Three portal sites in the paralumbar fossae were locally desensitized using 2% mepivacaine. After trocar and laparoscope insertion, the ipsilateral testicle, mesorchium, and ductus deferens were identified. The cranial mesorchium was coagulated with either monopolar (one horse) or bipolar (nine horses) electrosurgical forceps, and then the mesorchium, ductus deferens, and ligament of the tail of the epididymis were transected from cranial to caudal using laparoscopic scissors. Once the testis was freed, the transected mesorchium was inspected for hemorrhage and the testis was removed by connecting the two instrument portals (eight horses). In two horses, the testis was placed within a laparoscopic retrieval bag and then removed without enlarging the portal incision. If the testes were retained bilaterally, the retained contralateral testis was removed similarly through the opposite paralumbar fossa. If the contralateral testis was descended, it was removed by a standard, standing castration technique. RESULTS: Vessels of the mesorchium were adequately coagulated using bipolar and monopolar electrosurgical forceps. No immediate or short-term complications occurred in 10 horses at 3 to 11 months after surgery. CONCLUSION: Standing laparoscopic cryptorchidectomy can be performed easily and safely using electrosurgical instrumentation as the sole means of providing hemostasis of the equine mesorchium. CLINICAL RELEVANCE: Standing laparoscopic cryptorchidectomy using electrosurgical instrumentation provides a safe, reliable, and efficient alternative to achieve hemostasis of the equine mesorchium.     

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.     

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.     

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.     

Abdominal cryptorchidectomy in the horse, using inguinal extension of the gubernaculum testis.

Removal of abdominal testes was accomplished in 32 horses ranging in age from 6 to 72 months. Twenty were unilateral and 12 were bilateral abdominal cryptorchids. An incision was made over the superficial inguinal ring, and the extension of the gubernaculum testis was identified and grasped with forceps. Traction was applied to this structure until the vaginal process was everted beyond the superficial inguinal ring. The vaginal process was incised and the protruding structure, usually the epididymis, was grasped. The testis was drawn out by gentle traction on the epididymis, and castration was performed in the routine manner.     

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.     

Transabdominal Ultrasonography for Pregnancy Diagnosis and Estimation of Gestational Age in Dromedary Camels

The objective of this study was to evaluate the use of transabdominal ultrasonography as a method for pregnancy diagnosis and establish some foetal biometrics guidelines of pregnancy staging. Transabdominal ultrasonography was performed weekly on six pregnant camels from the 4th to the 19th week and at 2‐week intervals from the 20th to the 52nd week of gestation. Six areas were selected for examination: caudal abdominal (CAA), inside the thigh, above the base of the udder; middle abdominal (MIA), from the base of the udder to the umbilicus; and cranial abdominal (CRA), from the umbilicus to the xiphoid cartilage. Several foetal parameters including orbital diameter (ORD), biparietal diameter (BPD), abdominal diameter (ABD), chest depth (CHD) and ruminal diameter (RUD) were measured using standardized scan plans. The relationships between the gestational age and the foetal parameters were evaluated. From the 6th to the 12th week, the conceptus was always observed through the left CAA approach. Between the 13th and 27th week, the foetus was entirely visualized by the MIA examination. From the 28th to the 52nd week, the conceptus was mainly detected through the left CRA approach. The foetal parameters were measured frequently during mid‐ and late gestation. All regression and correlation coefficients were highly significant (p < 0.0001). In conclusion, transabdominal ultrasonography was shown to be a reliable technique for pregnancy diagnosis and estimation of gestational age in dromedary camels.     

Laparoscopic cryptorchidectomy in horses.

Laparoscopic cryptorchidectomy was successfully performed in 15 standing or recumbent horses. In 3 horses, owners believed that castrations had been performed, but the horses had retained stallion-like behavior. Successful removal of undescended testes in these horses stopped this behavior. Laparoscopy offered excellent visualization of the structures of the vaginal ring and facilitated removal of the abdominally located testis. The internal and external inguinal rings were not invaded, thus the chance of serious complications that may result during open cryptorchidectomy procedures was minimized.     

Sertoli cell tumors associated with feminizing syndrome and spermatic cord torsion in two cryptorchid dogs

The association of cryptorchidism, functional Sertoli cell tumors, and spermatic cord torsion has been rarely reported in the literature. Two dogs were admitted for bilateral skin alopecia and weight loss. Both animals were cryptorchid and displayed a pendulous preputial sheath, prostate hypertrophy, and increased levels of circulating oestrogen. Transabdominal palpation and ultrasonography revealed the presence of neoplastic retained gonads. During surgery, spermatic cord torsion was also detected in the enlarged neoplastic testes of both dogs. Histologic examination confirmed the presence of Sertoli cell tumors that were primarily responsible for the feminizing syndrome. Complete remission of all symptoms occurred within 3 months after orchiectomy.     

Transrectal ultrasonography of the cranial mesenteric artery of the horse

Transrectal ultrasonography was performed on the cranial mesenteric artery and its major branches in 23 conscious adult horses. Ultrasonographically, 25 arterial segments were classified as either normal or abnormal. These ultrasonographic classifications were later compared with the gross and histologic evaluations of each artery following necropsy of each horse. In this study, transrectal ultrasonography as a diagnostic test for verminous arteritis had a 90% sensitivity for detecting normal arteries and an 86% specificity for detecting abnormal arteries, suggesting that ultrasonography may be useful in the antemortem diagnosis of verminous arteritis.