Surgery of the Testes and Scrotum

Chapter 87 Surgery of the Testes and Scrotum



Harry W. Boothe


Orchidectomy is the most commonly performed surgical procedure of the testis. The technique depends, in part, on species and location of the testes (i.e., ectopic or scrotal). Indications for performing orchidectomy are listed in Table 87-1. Testicular biopsy may be part of a fertility examination. Scrotal ablation may be part of a routine orchidectomy or for neoplasia resection, especially in older dogs. It is also performed at the time of scrotal urethrostomy and feline perineal urethrostomy.



Table 87-1 INDICATIONS FOR PERFORMING ORCHIDECTOMY IN THE DOG AND CAT



Sterilization

Modification of behavior patterns

Testicular neoplasia

Severe testicular or scrotal trauma

Refractory orchitis-epididymitis

Benign prostatic hyperplasia

Suppurative prostatitis

Prostatic cyst

Perineal adenoma

Perineal hernia

Scrotal urethrostomy (canine)

Perineal urethrostomy (feline)



Key Point


Obtain owner consent before performing orchidectomy as a primary procedure or concurrent with another surgical procedure.



ANATOMY



• The testes are positioned obliquely within the scrotum, with their long axis directed dorsocaudally.

• The scrotal testis is covered by peritoneum (parietal and visceral vaginal tunics) and a dense, white, fibrous capsule (tunica albuginea).

• The testis and epididymis are connected to the parietal vaginal tunic by the caudal ligament of the epididymis.

• The arterial and venous patterns are similar, with the right testicular artery originating from the abdominal aorta cranial to the left and the veins forming an extensive pampiniform plexus in the spermatic cord.

• The right testicular vein empties into the caudal vena cava, whereas the left terminates in the left renal vein; testicular lymphatics drain to the median iliac lymph nodes.

• The canine scrotum is located more ventrally than the feline.

• The scrotal wall consists of the skin and dartos, a layer of smooth muscle and elastic fibers.

• The external spermatic fascia attaches to the caudal aspect of the scrotum as the scrotal ligament.

• Blood supply to the scrotum is principally via branches of the external pudendal artery; lymphatic drainage is to the inguinal lymph nodes.


TESTICULAR BIOPSY


See Chapters 86 and 94 for indications.



Preoperative Considerations



• Usually only one testis is sampled.

• Incisional techniques usually provide the best tissue samples for analysis.

• Fixation of specimens in Bouin’s, Zenker’s, or Stieve’s fixative is preferable to formalin fixation because of better preservation of architectural detail.


Surgical Procedure



Objectives



• Obtain a representative sample of the testis for histologic evaluation.

• Minimally disrupt the testicular architecture.


Equipment



• Standard general surgical pack and suture

• Sterile, thin razor blade

• Bouin’s, Zenker’s, or Stieve’s fixative


Technique



1. Place the animal in dorsal recumbency and aseptically prepare the prescrotal area.

2. Incise the skin just cranial to the scrotum and place the testis with the epididymis away from the incision.

3. Incise the tunics with a scalpel blade and the tunica albuginea with a sterile, thin razor blade, while avoiding blood vessels.

4. Excise the bulging testicular tissue using the razor blade or, if testicular tissue does not bulge, excise a wedge of testicular parenchyma. The razor blade’s sharp, flat blade makes it ideal for this procedure.

5. Close the tunica albuginea and the tunics separately (simple interrupted pattern, 4-0 absorbable suture).

6. Routinely close the skin (simple interrupted pattern, non-absorbable suture).


Postoperative Care and Complications



• Uncommon complications include hemorrhage, infection, scarring, adhesions, and atrophy.

• A temporary slight decrease in sperm count may occur.


Prognosis



• The prognosis depends on the disease process(es) present (see Chapters 86 and 94).

• Minimal patient morbidity is expected.


ORCHIDECTOMY IN THE DOG



Preoperative Considerations



• Determine the location of the testes before surgery.


Cryptorchidism



• If the animal is a unilateral cryptorchid, determine which testicle has descended and therefore which one is retained.
• Push the normal testicle dorsally and cranially to determine which inguinal canal (right or left) it slides into.

• Carefully palpate the inguinal canal(s) to determine if the retained testicle is located there or in the abdominal cavity.

• In a cryptorchid animal, approach an abdominal testis through a parapreputial skin incision and an extra-abdominal ectopic testis by incising directly over the testis (usually in the inguinal region).

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Aug 27, 2016 | Posted by in SMALL ANIMAL | Comments Off on Surgery of the Testes and Scrotum

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