Equine Castration And Complications.

Front 1

When do the testicles of horses descend and via what?

Back 1

270-300 days of gestation via the gubernaculum into the inguinal canal from just caudal to kidneys.

Front 2

How is the open method of castrating a male horse carried out?

Back 2

Standing where external tunic is incised and left open.

Front 3

How is the closed method of castrating a male horse carried out?

Back 3

GA.

External tunic closed proximally by a ligature prior to testis removed.

Front 4

When do we not perform a standing castration?

Back 4

Mature stallion >4 years old as greater risk of hemorrhage and evisceration.

History of inguinal herniation.

Cryptorchid.

Donkey.

Fractious.

Front 5

What must we always check for before castration?

Back 5

2 testicles and absence of hernias.

Front 6

Advise to an owner with a foal with an inguinal hernia?

Back 6

Most are self resolving by 6 months.

Tell owner low risk of bowel incarceration.

Tell owner to manually reduce daily.

Advise of signs of rupture or bowel incarceration:

Cold clammy scrotum.

Colic/depressed.

Irreducible.

Front 7

Difference between inguinal hernias in foals and adults?Treat?

Back 7

In adults usually in stallions after breeding/exercise.

Usually non reducible with strangulating bowel.

Signs: severe colic, with severe swelling, cold clammy scrotum, ultrasound shows guts, rectal and feel guts in inguinal region.

Treat: colic surgery and castrate.

Front 8

How should we castrate a horse with a hernia?

Back 8

Closed under GA in dorsal recumbency so bowel falls back into abdomen.

Twist vaginal tunic so bowel goes into the abdomen.

Transfixing suture as low as possible to prevent recurrence.

Front 9

What are the preparation steps for a standing castration?

Back 9

1) History and clinical exam for any herniation.

2) I/V sedation and analgesia.

3) Local anaesthetic into the cord and scrotum and possibly testes.

4) Antibiotics.

5) Tetanus

6) Clean scrotal area thoroughly with disinfectant.

Front 10

Where do we cut on the anaesthetised testes and what are our next steps?

Back 10

Cranio-caudal direction on the midline deep.

Through: scrotal skin--> dartos-->parietal tunic.

Exteriorise testicle by pressure.

Front 11

After exteriorising our testicle what do we do?

Back 11

Section/split avascular ligament of the tail of the epidydymis

Front 12

After section/ spliting the avascular ligament of tail of the epidydymis what do we do? Risks of placing ligatures and pros?

Back 12

Transect and crush the spermatic cord with emasculators held in place for 2-4 minutes.

Remove testicle.

Risks of placing ligatures include: contaminated wound so can lead to infection but pro is better haemostasis.

Front 13

Pros and cons of open castration?

Back 13

Pros: cheaper and no risks of GA also quicker.

Cons: Increased risk of haemorrhage, eventration, infection compared to closed.

Front 14

What is normal wound haemorrhage from a standing open castration?

Back 14

Drips for an hour after.

Should be able to count drops.

SHOULDN'T BE A STREAM!!!!!!!!!!!!!

Front 15

Reasons for hemorrhage after an open castration?

Back 15

Emasculator on wrong way round- NUT TO NUT!

Emasculator inappropriate size.

Emasculator not held on long enough.

Emasculator worn out.

Unlucky/

Front 16

If we have haemorrhage after our open castration what do we do?

Back 16

Remain calm.

Resedate.

Sterile guaze to pack scrotum.

If doesn't stop hunt for the stump and grasp with artery forceps leave in place for 24 gours.

Unsuccessful GA and laparoscopy.

Front 17

Pros of closed castration?

Back 17

Minimal risk of evisceration, eventration, prolapse.

Sterile ligatures place- less risk of haemorrhage and infection.

Better surgical asepsis.

Front 18

Steps to perform a closed castrate?

Back 18

Incise both scrotums or one down through skin and dartos, shiny tunic intact.

Dissection aided by swabs.

2 transfixing ligatures applied with absorbable suture material.

Emasculate 2 cm distally to ligatures.

Allow cord to slowly retract down into canal and check there is no haemorrhage.

If any concern of contamination or sterility leaven partially open otherwise fully close with absorbable suture.

Front 19

Post operative care for a castrated horse?

Back 19

NSAIDS.

Antibiotics?

Walk out--> reduced oedema.

Observe scrotum frequently during 1st 24 hours.

Front 20

Signs of scrotal infection?

Back 20

Common complication esp in standing as done in dirty environment.

Febrile.

Swollen scrotum and prepuce.

Stiff hindquarters.

Exudation.

Front 21

Predisposing factors to scrotal infection post castration?

Back 21

Contamination during surgery.

Ligatures in non sterile site.

Dirty environment.

Small or lateral scrotal incisions.

Front 22

How do we treat scrotal infections?

Back 22

Ensure adequate drainage.

Clean out infected clots from scrotum.

Lavage scrotal interior-low pressure.

Systemic A/B.

Front 23

Chronic infections of the scrotum?

Back 23

Champignon- granulation tissue that protrudes out- open up and evacuate 3 day course of penicillin.

Funiculitis is a grossly infected spermatic cord that needs resecting.

Scirrhous cord- granulomatous tracts needs GA and removal! Staph infection.

Front 24

Signs of a scirrous cord?

Back 24

Swollen scrotum with draining sinus tract.

Small amounts of discharge.

Palpate hard swelling in scrotum or inguinal region.

Front 25

Other complications of castration? Which is a surgical emergency?

Back 25

Evisceration of omentum, dartos. SI.

Haematoa.

Intestinal evisceration is a surgical emergency!!!

Front 26

How do we emergency manage prolapsed intestine?

Back 26

Sedate horse.

Small amount intestine try suture scrotum closed.

Large amount support guts with damp pillow cover or sheet.

A/B and NSAID.

Refer to nearest centre who replace under GA, suture the vaginal tunic closed.

Front 27

Which horse is predisposed to cryptorchidism?

Back 27

Ponies esp. Welsh ponies.

Front 28

Where is the retained testicle usually?

Back 28

Inguinal canal between internal and external ring known as a high flanker.

Front 29

On clinical exam and history what do we focus on with a rig?

Back 29

Careful history to ensure its been from birth and not just castrated on one side.

Palpation for scars.

Ultrasound to find testicle.

If in doubt blood test.

Front 30

In horses >3 years old how do we diagnose a rig?

Back 30

Resting plasma oestrone sulphate assay to see if testicular tissue present.

<50 pg/ml in geldings.

>400 pg/ml rig.

Front 31

In horses <3 years old how do we diagnose a rig?

Back 31

Testosterone levels with HCG stim.

Front 32

Methods of surgically removing a retained testicle?

Back 32

GA, dorsal and open.

Standing/ GA laparoscopy.

Front 33

Steps to performing a retained testicle?

Back 33

Incision over external inguinal canal between the hindlimb and abdomen.

Avoid large pudendal veins once through deep fascia.

Bluntly dissect around external ring.

Bluntly dissect down inguinal canal.

Locate shiny vaginal process a blind pocket of external tunic.

Cut open external tubic and exteriorise structures.

Ligate and remove.

Front 34

How does the retained testicle look?

Back 34

Smaller and flaccid.