Evaluation of success rate of laparoscopic castration without orchidectomy in 32 mature horses

The surgical success of laparoscopic castration without orchidectomy results from avascular necrosis of the testes. However, failures and subsequent production of testosterone and stallion‐like behaviour have been previously identified. Laparoscopic castration without removal of the testes was performed in 32 horses with 2 normal descended scrotal testes between July 2006 and October 2012. The objectives of our study were to evaluate the success rate of laparoscopic castration without orchidectomy on descended testes in our population and assess complications and recovery time. Endocrine tests were performed after surgery and owners also asked to report on their horse's behaviour and ability to resume exercise. Castration was deemed successful if endocrine test results were in accordance with gelding values. Failed horses were castrated using a conventional technique and histology performed when possible. Basal testosterone levels decreased below 3 nmol/l after surgery in 30/32 cases. However, in 2 horses, stallion behaviour persisted and histological evaluation after inguinal castration showed residual viable tissue. Two horses maintained high testosterone levels after surgery associated with stallion‐like behaviour. Based on these results, 12.5% of horses (4/32 horses) failed to be considered a gelding based on either endocrine tests and/or histology. All horses, with one exception, were able to resume exercise less than a week after the procedure. Laparoscopic castration without orchidectomy appears to be a safe procedure. When assessing the success of laparoscopic castration, our total failure rate was 12.5% (4/32 horses) which is significantly higher than previously reported.     

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.     

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.     

Laparoscopic intra-abdominal ligation of the testicular artery following castration in a horse

A 364-kg (800-lb) 1-year-old mixed-breed horse was admitted for treatment of uncontrolled bleeding after castration. Multiple attempts to ligate the testicular artery through the scrotal incisions prior to referral had been unsuccessful. Because of the owner's concerns about cost, an attempt was made to control the bleeding by applying pressure to the inguinal region and administering formalin IV. However, hemorrhage continued. A decision was made to use laparoscopy to ligate the testicular artery. The horse was anesthetized and positioned in dorsal recumbency, and a routine ventral laparoscopic approach was used. The horse recovered without further complications. Laparoscopy should be considered for ligation of the testicular artery in horses with uncontrolled bleeding after castration.     

The clinical features and short-term treatment outcomes of scirrhous cord: A retrospective study of 32 cases

Scirrhous cord (SC) is an uncommon complication of castration, characterised by chronic infection of the spermatic cord remnant. It is reported that surgical excision of the infected tissue is the most effective means of treatment, but there are few published studies assessing the outcomes of horses treated for SC. The aims of this retrospective study were to describe the clinical features and short-term outcomes in horses treated for SC at two equine hospitals in the UK. The clinical records of horses diagnosed with SC over a 10-year period were reviewed. A diagnosis of SC was made if the gelding presented with typical clinical signs with confirmation at surgery. Thirty-two cases of SC were identified at the two equine hospitals. The mean age at presentation was 6 years (range 2–14 years, n = 22), and the median time from castration to presentation was 29.5 days (range 20–2500 days). Mean age at castration was 4.3 years (range 6 months to 10 years, n = 10). Clinical signs included scrotal swelling, discharging wounds, hindlimb lameness and pyrexia. Five horses demonstrated hyperfibrinogenaemia (n = 8). Microbial culture isolated various bacterial species. All 32 cases were treated with surgical excision of the infected tissue and discharged from the hospitals between 1 and 10 days post-operatively. A limitation of this study is that it was a retrospective study with no long-term follow-up available. It was concluded that the results of this study confirm that SC can present at variable time points following castration, even many years later, and that a variety of bacterial species may be involved. Surgical excision of infected tissue is a successful treatment with a good short-term prognosis for survival.     

Costs and complications of equine castration: a UK practice-based study comparing 'standing nonsutured' and 'recumbent sutured' techniques

REASONS FOR PERFORMING STUDY: Clinicians are often asked to guide owners and trainers over the relative advantages and disadvantages of equine castration performed in either the standing horse with an open unsutured scrotal wound with healing by second intention, or a recumbent horse under general anaesthesia in aseptic conditions, with sutured scrotal skin allowing primary wound closure. OBJECTIVES: To identify types and frequency of complications following the 2 differing approaches, and to compare the financial cost associated with each procedure, based on practice charges. METHODS: Veterinary expenses of 217 horses castrated by a Newmarket equine veterinary practice over an 18-month period were analysed. Of these, Group 1 (n = 121) were castrated standing and nonsutured by one of 2 ambulatory clinicians and Group 2 (n = 96) castrated in recumbency, in aseptic equine hospital conditions. RESULTS: Group 1 had a complication prevalence of 22% with no mortalities, and Group 2 a significantly lower complication prevalence of 6% (P = 0.001) with a mortality rate of 1%. The financial cost of Group 1, without complications, was approximately one-third of the cost of uncomplicated Group 2. However, the cost of Group 1 with complications increased to approximately two-thirds of the cost of an uncomplicated Group 2 castration. CONCLUSIONS: Even though the complication prevalence for Group 1 castrations leaving an open scrotal wound was significantly higher than for a recumbent horse with a sutured scrotal wound in a hospital, the average cost of Group 1 was still less, even taking into account the additional follow-up costs associated with treating such complications. POTENTIAL RELEVANCE: This report provides a benchmark for the outcome of 2 methods of castration based on a database obtained from particular circumstances within the practice involved. Further studies are required to corroborate and take into account future development in surgical and anaesthetic techniques.     

Evaluation of ‘Section‐Ligation‐Release (SLR)’ Technique Devised for Castration in the Stallion

A novel technique [Section‐Ligation‐Release (SLR)] was evaluated for castration in the horse. Clinical traits, serum testosterone concentrations after challenge with human chorionic gonadotrophin (hCG), and histopathological changes of the testicular tissue were assessed. Five stallions, aged 24–48 months, were castrated using SLR technique under general anaesthesia. Both spermatic cords in each stallion were exposed at the scrotal neck by two 5‐cm long incisions, followed by sharp dissection through the parietal vaginal tunic. Both vascular and non‐vascular structures in the cords were triple clamped, transected and ligated. Both testes were left in situ. Serum testosterone concentrations were measured pre‐operatively and at 2 months after castration following IV administration of 1 × 10⁴ IU of hCG. Both testes from each castrate were collected at 2 months for histopathologic examination. SLR castration was successfully achieved. Moderated scrotal and preputial swelling was the only experienced short‐term complication. Serum testosterone concentrations were significantly lower than basal pre‐operative levels at 2 months after castration, and did not respond to hCG. On histopathology, hyalinization of the seminiferous tubules and loss of testicular interstitial tissue were indicative of complete avascular necrosis. This novel primary closure castration technique of stallion is a simple practical method, with minimal post‐operative complications; and could be safely advocated as an alternative to the traditional castration techniques allowing for second intention healing of scrotal wounds.     

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.     

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.     

Comparison of post-operative inflammatory response in horses undergoing elective castration treated preoperatively with ceftiofur crystalline free acid or procaine penicillin G

Castration is among the most common surgical procedures performed in the horse (Equus Caballus) and a variety of post-operative complications can occur. This study aims to determine if a single dose of long-acting ceftiofur crystalline free acid (CCFA) used as a preoperative antimicrobial in equine field castrations offers any reduction in post-operative inflammatory markers when compared to procaine penicillin G (PPG). Sixty-five horses aged 8 months to 2 years were randomly assigned to the CCFA (n = 33) or PPG (n = 32) treatment groups. Horses were castrated under general anaesthesia using a closed castration technique with removal of the median raphe. Quantitative and qualitative inflammatory markers were measured and short-term complications were recorded post-operatively on Days 3, 8 and 14. No clinically significant difference in any post-operative inflammatory markers between the CCFA and PPG group was detected. In the CCFA group, 48% of horses experienced short-term post-operative complications compared to 31% in the PPG group. Regardless of the preoperative treatment, castration induced significant elevation in serum amyloid A (P<0.0001), preputial oedema (P<0.0001) and scrotal oedema (P<0.0001) at Day 3. These values returned to baseline levels by Day 8. Horses with grade 3 or above preputial oedema had elevated serum amyloid A values (P<0.001). The data from this study indicate CCFA used as a preoperative antibiotic for routine castration offers no advantages over PPG. The difference in complication rate between groups is likely of minimal clinical importance, as all complications were mild and self-limiting.     

Acute cortisol responses of lambs to ring castration and docking after the injection of lignocaine into the scrotal neck or testes at the time of ring application

OBJECTIVE: To test whether injecting lignocaine into the scrotal neck 5 to 10 s before or into both testes immediately after ring castration and docking wound significantly reduce the plasma cortisol response to castration and docking. DESIGN: A physiological study with controls. PROCEDURE: Lambs were given one of six treatments: control handling, injection of lignocaine into scrotal neck, injection of lignocaine into both testes, ring castration and docking, ring castration and docking after lignocaine was injected into the scrotal neck, and ring castration and docking before lignocaine was injected into both testes. Blood samples were taken before and regularly after treatment and analysed for plasma cortisol concentrations. RESULTS: The plasma cortisol concentrations of lambs castrated and docked after lignocaine had been injected into the scrotal neck were significantly lower between 20 and 60 min after treatment than in lambs castrated and docked without local anaesthesia. Injecting lignocaine into the testes after ring application did not significantly reduce the cortisol response to ring castration and docking. CONCLUSIONS: Lignocaine injected into the scrotal neck 5 to 10 s before ring castration will reduce the cortisol response and by inference the pain associated with ring castration.     

Midline scrotal ablation technique for unilateral cryptorchid castration in horses

Thirty-nine unilateral cryptorchid horses were castrated, using a midline scrotal ablation technique. This approach was satisfactory to access both inguinal rings, to eliminate the need for 2 incisions, and to allow for completion of the surgery by primary closure. These horses recovered from surgery with few complications, returned to work promptly, and had excellent cosmetic results.     

Acute cortisol responses of lambs to castration using a rubber ring and/or a castration clamp with or without local anaesthetic

Changes in plasma cortisol concentrations during the first 4 hours after castration of 6-week-old lambs by one of four methods were measured. The methods were application of a rubber ring above the testes, application of a ring to shorten the scrotum below the testes, use of a castration clamp plus a ring, and use of a castration clamp alone. The efficacy of local anaesthetic in reducing or abolishing the cortisol responses to castration by all these methods except short scrotum was assessed. Local anaesthetic was injected into the neck of the scrotum, both spermatic cords, the scrotal neck plus spermatic cords, or into both testes. The combined clamp plus ring method was used to test whether or not clamp damage to afferent nerves from the testes would reduce the cortisol response to ring castration. The short scrotum method elicited a significantly lower cortisol response than that caused by ring castration. Injection of local anaesthetic into both spermatic cords marginally reduced the cortisol response to ring castration, but the response was virtually abolished by prior scrotal neck, or scrotal neck plus spermatic cords, or intra-testicular local anaesthetic injections. The clamp plus ring method, where each spermatic cord and the associated scrotal tissue were crushed separately for 1, 5 or 10 seconds with no overlap between the two crush lines, did not elicit lower cortisol responses than the ring-only method. Local anaesthetic injected into the scrotal neck virtually abolished, and spermatic cord injections markedly reduced, the cortisol responses to combined clamp plus ring castration. The IO-second clamp application caused a more protracted cortisol response than did ring-only castration, whereas the cortisol responses to 1-second clamp application and to ring-only castration were similar. Local anaesthetic injected into the scrotal neck or spermatic cords did not affect significantly the cortisol response to the IO-second clamp application. The following conclusions were drawn from this work: the testes as well as the scrotum were sources of noxious sensory input after ring application; the clamp plus ring method used here was ineffective in reducing the pain-induced distress (as indicated by cortisol concentrations) caused by ring-only castration; injection of local anaesthetic into the scrotal neck or into the testes prior to ring application blocked most noxious sensory input from both the scrotum and the testes; and on the basis of the present cortisol responses the 10-second clamp applications method could not be recommended in reference to the ring-only method, but the l-second clamp application method might be equally acceptable for castrating 6-week-old-lambs. Of the methods examined, injections of local anaesthetic into the scrotal neck or both testes were the most effective in reducing the pain-induced distress caused by ring-only castration.     

Comparative study of 2 surgical techniques for castration of guinea pigs (Cavia porcellus)

The objective of this study was to compare 2 surgical approaches (scrotal or abdominal) for castration of guinea pigs and to investigate post-operative infection rates with either technique. Forty-eight guinea pigs were castrated by scrotal or abdominal technique after being randomly assigned to 1 of 2 groups (n = 24). Individuals were either castrated by an experienced exotic animal surgeon (n = 12) or by an experienced small animal surgeon (n = 12). Surgical wounds were evaluated daily before euthanasia for histological evaluation 2 wks after surgery. Post-operative infection rate was significantly higher in the scrotal group than in the abdominal group, with a higher rate for the experienced small animal surgeon. Castration of guinea pigs with the abdominal technique is significantly faster and has a significantly lower post-operative infection rate than the scrotal technique.     

Influence of local anaesthesia on short- and long-term pain induced in calves by three bloodless castration methods

Behavioural and cortisol responses of calves were used as indicators of pain to assess short- and long-term effects of three bloodless castration methods with and without local anaesthesia. Eighty calves, aged 21 to 28 days, were control handled (20) or castrated by Burdizzo (25), rubber ring (25), or crushing technique (10). Either a total volume of 10 ml of Lidocaine or NaCl was distributed in both spermatic cords and the scrotal neck. The plasma cortisol response was monitored for 72 hours, and behavioural and clinical traits over a three-month period. Castration success was assessed by degree of atrophy and histological tissue examination. The crushing technique cannot be recommended due to incomplete castration success, and the evaluation was stopped after 10 animals. Local anaesthesia reduced the level of indicators of acute pain after Burdizzo and rubber ring technique. It did, however, not result in a totally painless castration. When castration is performed at the age of 3 to 4 weeks, the rubber ring but not the Burdizzo method showed evidence of chronic pain lasting for several weeks.     

Effect of local anaesthesia on short- and long-term pain induced by two bloodless castration methods in calves

Behavioural and cortisol responses of calves were used as indicators of pain to assess short- and long-term effects of bloodless castration methods with and without local anaesthesia. Seventy calves, aged 21-28 days, were control handled (20) or castrated using the Burdizzo (25) or rubber ring technique (25). Either 10 mL lidocaine or NaCl were distributed in both spermatic cords and the scrotal neck. The plasma cortisol response was recorded for 72 h, and behavioural and clinical traits monitored over a three month period. Local anaesthesia reduced the level of indicators of acute pain after both the Burdizzo and rubber ring techniques. It did not, however, result in a totally painless castration. As there was evidence of chronic pain lasting for several weeks after rubber ring castration, the Burdizzo method is judged to be preferable to the rubber ring technique.     

Afferent activity in the superior spermatic nerve of lambs — The effects of application of rubber castration rings

Electrophysiological techniques were used to record afferent activity in the superior spermatic nerves of young lambs under general anaesthesia. Receptive fields were identified in the pampiniform plexus and the deep tissue of the testis in response to mechanical stimulation. Application of a standard rubber castration ring to the scrotal neck evoked vigorous afferent activity, including some from formerly silent units with receptive fields particularly in the pampiniform plexus. Some of this multi-unit discharge adapted rapidly within 10 s of the application of the ring and was followed by a discharge pattern which decayed exponentially over 90 min. The rate of decay of this discharge showed more than one exponent (time constant) with inflections at approximately 90 s and 16 min. After the application of the castration ring, quantitatively controlled scrotal compression continued to excite receptors, though a declining frequency was recorded over the period of observation. It was concluded that: (a) rubber castration rings initiated afferent activity which persisted for periods in excess of 90 min, a time course which is similar to the behavioural and humoral changes in the conscious animal; (b) both standard and small rubber castration rings were ineffective in rapidly producing neuronal pressure block of the slowly conducting afferent fibres in the superior spermatic nerve; (c) intra-testicular injection of local anaesthetic rapidly blocked afferent fibres running in the superior spermatic nerve.Abbreviations TTL transistor transistor logic     

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.     

Intra-abdominal hypertension in two adult horses

Objective – To describe the clinical and pathological findings in 2 adult horses with documented increases in intra-abdominal pressure (IAP), and to describe the direct puncture technique used to measure this pressure.
Series Summary – Two adult horses developed increases in IAP secondary to large-volume abdominal effusion. A 9-year-old Quarter Horse cross gelding was presented for evaluation of urinary and neurologic signs. Abdominal ultrasonographic examination showed a hepatic abscess along with abdominal effusion. A 4-year-old Quarter Horse gelding was presented for evaluation of castration complications. A castration site infection extended into surrounding tissues, resulting in peritonitis, abdominal effusion, and severe cellulitis of the limbs. IAP measured in both horses was increased relative to reported equine reference values. Changes in hemodynamic parameters in both horses, notably increased central venous pressure, were consistent with those seen in other species in which intra-abdominal hypertension (IAH) and its sequellae have been documented.
New or Unique Information Provided – Extensive research and clinical literature guides management of humans with IAH and abdominal compartment syndrome. Knowledge of these conditions in companion animal and large domestic species is less well developed. Recent research has established reference values for standing, sedated and recumbent, anesthetized horses. Detailed reports of equine clinical cases of IAH have not been reported in the literature. This report provides information on the clinical, hemodynamic, and pathologic characteristics of 2 horses with measured increases in IAP, and describes the direct puncture technique used to perform these measurements.     

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.