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.     

Testicular neoplasia in the retained testicles of an intersex male dog

This case describes the presentation and management of an 8 yr old phenotypically female intersex male dog presented for evaluation of a mass in the right inguinal region. The right inguinal space was surgically explored, and a large irregular mass resembling a fully developed testicle was identified in the right vaginal tunic. A second mass resembling an atrophied, but anatomically mature testicle, was identified in the left tunic. The larger mass was identified as a Sertoli cell tumor that had replaced all normal testicular tissue. The smaller mass was identified as a testicle that contained a small intratubular seminoma. The patient was diagnosed as having a phenotypic female sex, chromosomal male sex, and a gonadal male sex. Hormone assays completed before and after the gonadectomy and mass removal document an elevation of circulating progesterone presurgically that returned to baseline by 1 mo postsurgically. The source of the progesterone was identified to be the Leydig cells of the atrophied testicle.     

Identification of a Severely Atrophic Testicle During Castration of a Horse: A Case Report

Tissue considered to be testicle was removed from the scrotum of a horse considered previously to be cryptorchid. Close anatomical inspection after emasculation revealed the presence of the vas deferens, intact epididymis, pampiniform plexus, and a severely atrophic testicle. Histologic examination of the tissue confirmed the presence of an atrophic testicle. Accurate anatomic identification at the time of surgery prevented the need for exploration of the inguinal canal or abdomen.     

Bilateral intracorporeally sutured inguinal herniorrhaphy using 3-dimensional laparoscopy in a dog

A 7-month-old, intact male, mixed breed dog with bilateral inguinal hernias underwent general anesthesia for laparoscopic bilateral inguinal herniorrhaphy via a 3-port approach. A 3-dimensional laparoscopic system was used to perform the procedure immediately following prescrotal open castration. Intracorporeal suturing with polypropylene was performed, and 2 cruciate sutures were placed to close each inguinal ring. The caudal aspect of each inguinal ring was left slightly open so as not to disrupt the passage or patency of vessels and nerves. No intra- or post-operative complications occurred. One year after surgery, the dog has no evidence of recurrence of the inguinal hernias.Key clinical message:This case report demonstrates a novel minimally invasive approach to inguinal herniorrhaphy in a dog with no reported complications and a good long-term outcome. Intracorporeally sutured inguinal herniorrhaphy is feasible in dogs with good results, although additional cases are needed to gain experience with this technique in dogs with varying presentations of inguinal hernias.     

Clinical findings in 10 horses diagnosed with monorchidism following exploratory laparotomy or standing laparoscopic surgery

Monorchidism describes the complete absence of one testis and is rare in horses. This study reports the clinical findings in 10 horses diagnosed as monorchids by standing laparoscopy or exploratory laparotomy. Hospital records for all horses undergoing cryptorchidectomy (2000–2016) in four centres were reviewed from which horses diagnosed with monorchidism were identified. Surgery was by either standing flank laparoscopy or an inguinal exploration and subsequent exploratory laparotomy under general anaesthesia. Ten horses were diagnosed as monorchids, five by laparoscopy (one bilateral laparoscopy) and five by laparotomy. Nine horses had a normally descended scrotal testicle, which was also removed at surgery. The right testicle was absent in three horses, and the left testicle was absent in seven horses. Anatomical findings were recorded in each case; the vaginal process was present in all horses, ductus deferens and epididymis were present in 80% of horses and the ligament of the tail of the epididymis and testicular vessels were present in 50% of horses. Laparoscopy allowed easy identification of spermatic structures enabling a prompt diagnosis of monorchidism. In conclusion, when monorchidism occurs, most other associated spermatic structures are likely to be present. A diagnosis of true monorchidism is reliant on hormonal testing and absence of testicular tissue on histopathology and so some of these horses may strictly be somewhere on the spectrum of testicular degeneration. This information is particularly useful in the surgical situation when it is not clear whether the testicle is present or not.     

SCROTAL VESICLE SEMINAL HERNIA IN AN INTACT MALE DOMESTIC GUINEA PIG

A 9-month-old intact male guinea pig was presented with a 2-week history of progressive swelling involving the right scrotal sac. Physical examination revealed a soft mass involving the caudal aspect of the right scrotal sac. Subsequent radiographic evaluation of the affected area confirmed a soft tissue subcutaneous swelling. Ultrasonography revealed a hyperechogenic homogenous structure with normal hemodynamic pattern within the right scrotum, and an enlarged right inguinal ring measuring 8 to 9 mm. Exploratory laparotomy confirmed a right seminal vesicle herniation into the scrotum. The vesicle was reduced into the abdominal cavity, after which an abdominal castration and inguinal herniorrhaphy were performed. Five months postsurgery the patient was doing well without recurrence of herniation.     

Seminoma with cutaneous metastases in a dog

A 10-year-old Great Pyrenees was presented for anorexia and weight loss. On physical examination, the dog was emaciated and showed a large ulcerated lesion on the right lower lip in addition to an enlarged right testicle. Fine-needle aspiration biopsy of the testicle and surgical biopsy of the lip lesion were performed; the histopathological report was consistent with metastatic seminoma. The diagnostic and therapeutic approach in this unusual metastatic seminoma is presented and compared to the previous literature. A multimodality therapy consisting of surgery and chemotherapy is proposed for the clinical management of metastatic seminoma in dogs.     

Laparoscopic‐assisted diagnosis of anomalous unilateral abdominal cryptorchidism

This report describes an unusual case of unilateral abdominal cryptorchidism in a Shetland pony. On the cryptorchid side, no testicular structures were present in the inguinal area but testicular/epididymal remnants at the distal end of a pedunculated structure could be discerned in the abdomen at laparoscopic examination. Furthermore, the deferent duct was disconnected from the epididymal remnants and the deferent duct was visible at the caudal aspect of the bladder, traversing over the lateral ligament of the bladder into the vaginal ring where it ended blindly in the vaginal process. After laparoscopic removal of the testicular/epididymal remnants and castration of the contralateral normally descended testicle, the hCG stimulation test was negative and the pony no longer exhibited masculine behaviour.     

Diagnosis and treatment of peritonitis caused by a larval cestode Mesocestoides spp., in a dog.

Infection of the peritoneal cavity with cestode larvae, presumptively diagnosed as tetrathyridia of the genus Mesocestoides, was found by exploratory celiotomy in a dog with clinical signs consisting of episodic anorexia, vomiting, and depression. Lymphopenia and hypoalbuminemia were associated clinicopathologic abnormalities. Dystrophic calcification and midline duodenal displacement were found on abdominal radiographs. Therapy with mebendazole was instituted after recurrence of the initial episodic clinical signs postoperatively. Daily use of mebendazole for intermittent periods of up to 3 months led to remission of gastrointestinal signs for 30 months. However, 17 months after the initial diagnosis, infection of the vaginal tunic of the testicle with similar cestode larvae necessitated castration and removal of the vaginal tunic to the inguinal ring. Mebendazole therapy was reinstituted and continued for 31/2 months postoperatively. The dog was free of clinical signs of infection during and for the 16 months since this period of treatment.     

Malignant Sertoli Cell Tumour in a Young Simmenthal Bull – Clinical and Pathological Observations

Tumours are rare in the bovine testicle. A case of malignant Sertoli cell tumour in a 29‐month‐old Simmenthal bull that was hospitalized with a history of severe unilateral scrotal swelling is reported. On inspection and palpation, the scrotal sac was found enlarged with fluctuant content in the right side. The right testicle was enlarged, hard and indolent. Also the right plexus pampiniformis and funiculus spermaticus were enlarged. Sonograms revealed severe changes in the right testicle with a loss of homogeneity and multiple hyperechogenic areas. After slaughter, the scrotum with testicles were removed and evaluated pathologically. On section, the right testicle contained areas of necrosis, haemorrhage, and mineralization. Histology showed Sertoli cells in tubular structures surrounded by dense fibrous stroma replacing normal testicular tissue. Both lymphatic and blood vessels were infiltrated by neoplastic cells. Immunohistochemically, the neoplastic cells stained positive for vimentin and negative for cytokeratin and S‐100. Based on the pathological observations a diagnosis of right‐sided malignant Sertoli cell tumour with vascular invasion and hydrocele was established.     

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.     

Inguinal-Scrotal Urinary Bladder Hernia in an Intact Male Domestic Rabbit (Oryctolagus cuniculus)

An 8-year-old intact male dwarf rabbit (Oryctolagus cuniculus) was presented with a 2-month history of unilateral scrotal swelling. The external physical examination of the rabbit patient confirmed the severe, unilateral, fluid-filled scrotal distention. Radiographic images of the effected scrotum revealed a soft tissue swelling in the area of the left testicle, and the absence of the urinary bladder in the caudal abdomen. Ultrasonography verified the presence of a fluid-filled mass in the scrotum, enveloping the left testicle. A fine-needle aspiration of the scrotal mass yielded urine, thus a diagnosis of a nonreducible herniation of the urinary bladder into the scrotum was made. An inguinal herniorrhaphy was performed, and the bladder was successfully reduced into the abdominal cavity. A bilateral routine castration and left scrotal ablation were also performed. Two months after surgery no recurrence was noted, and the patient had normal urinary function. Inguino-scrotal bladder herniation is rare in both humans and animals. Male rabbits are predisposed to inguinal and scrotal hernias because their inguinal rings remain open throughout life. Herniation of the urinary bladder should be considered as a differential diagnosis when intact male rabbits are presented with unilateral scrotal swelling.     

Castration of Horses with Primary Closure and Scrotal Ablation

Fourteen horses and one pony, 1 to 16 years of age, were castrated with a technique designed to promote primary healing and ablation of the scrotum following removal of descended testicles. Twenty-six testicles (10 nondescended, 15 normal descended testicles, and 1 neoplastic descended testicle) were removed. Nondescended testicles were removed through a skin incision over the external inguinal ring. Descended testicles were removed, and the scrotum was ablated by excision of the ventral scrotum. All testicles were removed by emasculation. The common vaginal tunic was not opened prior to emasculation of the descended testicles, and transfixation liqation sutures were used in only two horses. All incisions were closed with multiple layers of synthetic absorbable sutures in the subcutaneous and subcuticular tissues. All incisions healed by primary intention, and 14 recovered without complications. As a result of incomplete scrotal ablation, one horse had temporary lameness and swelling of the scrotal area that resembled the presurgical appearance.     

Vaginal Ring and Round Ligament of the Uterus in the Female Cat

The peritoneum was examined for the existence of a vaginal ring and the round ligament of the uterus was dissected through the inguinal region in eleven embalmed adult female cats. In all cats, there was no evidence of a peritoneal evagination into the inguinal canal. There was no vaginal ring and no vaginal process. The round ligament of the uterus passed through the inguinal canal and disintegrated in the fascia a short distance beyond the superficial inguinal ring.     

Equine castration: review of anatomy, approaches, techniques and complications in normal, cryptorchid and monorchid horses

Complications associated with equine castration are the most common cause of malpractice claims against equine practitioners in North America. An understanding of the embryological development and surgical anatomy is essential to differentiate abnormal from normal structures and to minimise complications. Castration of the normal horse can be performed using sedation and regional anaesthesia while the horse is standing, or under general anaesthesia when it is recumbent. Castration of cryptorchid horses is best performed under general anaesthesia at a surgical facility. Techniques for castration include open, closed and half-closed techniques. Failure of left and right testicles to descend occurs with nearly equal frequency, however, the left testicle is found in the abdomen in 75% of cryptorchid horses compared to 42% of right testicles. Bilateral cryptorchid and monorchid horses are uncommon. Surgical approaches described for the castration of cryptorchid horses include an inguinal approach with or without retrieval of the scrotal ligament, a parainguinal approach, or less commonly a suprapubic paramedian or flank approach. Laparoscopic castration of cryptorchid horses has recently been described but the technique has limited application in practice at this time. A definitive diagnosis of monorchidism can only be made after surgical exploration of the abdomen, removal of the normal testis and hormonal testing. Hormonal assays reported to be useful include analysis of basal plasma or serum testosterone or oestrone sulphate concentrations, testosterone concentrations following hCG stimulation, and faecal oestrone sulphate concentrations. Reported complications of castration include postoperative swelling, excessive haemorrhage, eventration, funiculitis, peritonitis, hydrocele, penile damage and continued stallion-like behaviour.     

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.     

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.     

Laparoscopic Repair of Scrotal Hernia in Two Foals

Nonstrangulating indirect scrotal hernias were corrected in two 4-week-old Percheron foals by a laparoscopic technique. After laparoscopic reduction of herniated nonstrangulated small intestine each testes was retracted through the vaginal ring. The ligament of the tail of the epididymis was transected by electrocautery. The testicular vessels and nerves were isolated by cautery of the mesenteric portion of the mesorchium and then ligated. Staples were used to close the opening of the inguinal canal by apposing the peritoneal edges of the vaginal ring. Resection of umbilical stalk remnants via celiotomy performed in one foal after laparoscopic observation of enlargement of the right umbilical artery and urachus. No complications or recurrence of herniation had occurred 16 weeks after surgery.     

Cystic lymphangioma in a colt.

A 6-month-old Morgan colt was examined because of preputial edema and multiple nodular masses in the left inguinal region. A tentative diagnosis of lymphatic hamartoma was made on the basis of initial biopsy findings. The prognosis for surgical excision was poor due to the progressive expansile growth of the tumor. Secondary infectious complications developed, and the colt was euthanatized at the owner's request. An abdominal and retroperitoneal mass was seen at postmortem examination. The mass was adherent to the left lumbar musculature, the craniodorsal aspect of the pelvic inlet, the midjejunum, the left testicle, and the left kidney. The mass extended through the left inguinal and femoral canals into the deep intermuscular fascia of the hindlimb. Histologic examination of the mass indicated that it was a cystic lymphangioma.     

Intracorporeal suture closure of the internal inguinal and vaginal rings in foals and horses

Objective— To report a technique for repair or prevention of inguinal hernia in horses using intracorporeal suture closure of the internal inguinal and vaginal rings.
Study Design— Case series.
Animals— Foals (n=6) and geldings (n=2).
Methods— After selection of a peri-umbilical telescope portal, instrument portals were made unilaterally or bilaterally, as needed. Herniated viscera was reduced, castration (foals) or spermatic cord remnant transection at the internal inguinal ring (adults) performed, and then simple interrupted intracorporeal sutures of synthetic absorbable suture material were used to close the internal inguinal and vaginal rings.
Results— There was no recurrence of inguinal hernia. Postoperative morbidity was minimal and cosmetic outcome was comparable to that achieved with conventional, open techniques.
Conclusion— Laparoscopic, primary closure of the internal inguinal ring by use of intracorporeal sutures provides a secure barrier to herniation and costs considerably less than using endoscopic staples.
Clinical Relevance— Laparoscopic suture closure of the internal inguinal and vaginal rings provides safe and effective repair of inguinal hernia in horses.