Técnicas cirùrgicas de controlo reprodutivo en canídees e felídeos Surgery techniques for spaying, neutering and sterilise dogs and cats II Encontro de Formação OMV 8 e 9 de Outubro Josep Arus Marti, DVM ECAR diplomate Arvivet Veterinaris SL [email protected] ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com Introduction • Routine techniques and elective surgeries • Surgeries indicated in some pathologies • Some types of surgeries are not allowed in some countries – Every clinician must adapt at local legislation • Neutered or spayed is defined as no have reproductive organs • Sterilised is defined as unable to produce offspring by removing or blocking the sex organs • “we can do the same thing a lot of times in the incorrect way” ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com Spaying and neutering • DOG • CAT – FEMALE • Ovariohisterectomy – In Uterine Torsion – In Tumours – Others • Ovariectomy • Oviductomy • Colpossuspension – FEMALE • Ovariohisterectomy • Ovariectomy – MALE • Castration • Vasectomy • Cryptorchidism – MALE • Orchydectomy – Silicone implants • • • • Vasectomy Criptorchidism Orchiopexia Scrotal Ablation ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com Josep Arus Marti, DVM, ECAR diplomate. Arvivet Veterinaris SL. Terrassa. Spain. 1 Técnicas cirùrgicas de controlo reprodutivo en canídees e felídeos BITCH • Normal anatomy ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com BITCH • Ovariohisterectomy – Indications • Elective sterilisation – Prevent oestrus – Prevent undesirable pregnancies • Prevent mammary tumours • To prevent or as a treatment of uterine and ovarian pathologies – Ovarian cyst, pyometra, uterine torsion,uterine prolapse, uterine rupture • Others – Vaginal hyperplasia – Indicated in animals with diabetes or epilepsy ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com BITCH • Ovariohisterectomy – After first oestrus? • Complications of prepuberal castration like vaginal hypoplasia, perivulvar dermatitis, juvenile behavior, urinary incontinence • These complications have difficult therapies – – – – – – – Abdominal incission from umbilicus near pubis Localise uterine horn until every ovary Cut or broke suspensory ligament without any knot Clamp uterine horn to manipulate uterus The ovarian pedicle is tied and severed with one or two knots Cut or broke the broad ligament Knot the uterine body just before the cervix in every side of the uterus. Uterine arteries are individually ligated. – Some epiplon is tied to the body of the uterus – Clamp to review the knots just before abdomen closure – Correct closure of the abdominal cavity ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com Josep Arus Marti, DVM, ECAR diplomate. Arvivet Veterinaris SL. Terrassa. Spain. 2 Técnicas cirùrgicas de controlo reprodutivo en canídees e felídeos Localise uterine horn until every ovary Clamp uterine horn to manipulate uterus ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com Cut or broke suspensory ligament without any knot ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com –The ovarian pedicle is tied and severed with one or two knots ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com Josep Arus Marti, DVM, ECAR diplomate. Arvivet Veterinaris SL. Terrassa. Spain. 3 Técnicas cirùrgicas de controlo reprodutivo en canídees e felídeos Knot the uterine body just before the cervix in every side of the uterus. Uterine arteries are individually ligated ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com Correct closure of the abdominal cavity ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com Josep Arus Marti, DVM, ECAR diplomate. Arvivet Veterinaris SL. Terrassa. Spain. 4 Técnicas cirùrgicas de controlo reprodutivo en canídees e felídeos BITCH • Ovariohisterectomy in special cases – Gravid uterus • More easy visualize uterine and ovarian vessels • More easy to break uterus or vessels – Oestrus animals • Prone to haemorraghe – Uterine Torsion • Really difficult to localise the normal anatomic structures • Empty lumen before surgery – Cesarea • In block ovariohisterectomy • We have 45-60 seconds to extract puppies from uterus • We need experience and assistants ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com BITCH • Ovariectomy – Possible lateral flank approach – Indications: ovarian cysts and tumours • Oviductomy – Not recomended, because we don’t affect the normal phisiology of the bitch (estrus, behaviours, mammary problems, etc.) – Uterine tube is the correct name • Colpossuspension – Decrease incidence of urinary incontinence in the future – At the time of ovariohisterectomy ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com Oviductomy • From infundibulum to the uterine ostium • 6-10 mm long • Inside the bursa sheath • Oviduct = uterine tubes • Localise it (palpation) • Open the bursa and dissect • Knot the uterine tube Round ligament Uterine tube ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com Josep Arus Marti, DVM, ECAR diplomate. Arvivet Veterinaris SL. Terrassa. Spain. 5 Técnicas cirùrgicas de controlo reprodutivo en canídees e felídeos Colposuspension • Easy to perform • Don’t allow that bladder pass from abdominal situation to an intrapelvic situation • Pass the uterine stump between bladder and ureter through lateral bladder ligament • Suture the stump to the prepubic tendon ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com Common complications • Haemorrhage, ussually of the ovarian pedicles • Infection of the suture • Peritonitis • Evisceration • Vaginal bleeding from uterus vessels • Ovarian remnant syndrome • Fistulous tracts (non absorbable materials) • Ureter obstruction, ussually near uterine vessels • Urinary incontinence • Obesity • “suture reaction” to the abdominal closure • Bilaterally symmetrical nonpruritic alopecia ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com DOG Normal Anatomy ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com Josep Arus Marti, DVM, ECAR diplomate. Arvivet Veterinaris SL. Terrassa. Spain. 6 Técnicas cirùrgicas de controlo reprodutivo en canídees e felídeos DOG • Castration or Orchiectomy – Indications • Androgen dependent pathologies – PROSTATIC DISEASES – PERIANAL HORMONAL PROBLEMS » PERIANAL ADENOMAS » PERINEAL HERNIAS – UNCOMFORTABLE BEHAVIOURS » Mounting, roaming » urine marking, » Some types of agressiveness • Testicular pathologies – TUMOURS – ORCHITIS OR EPIDIDYMITIS – TESTICULAR TORSION ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com DOG • Castration open technique (closed one is more easy and recommended for some authors) – – – – – Incision cranial to scrotum Cut until parietal tunic Transaction of the tail of the epididymis Extraction of the testicle Tie in different knots pampiniform flexus and ductus deferens – Close the parietal tunic – Subcutaneous closure and skin ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com Displace the testicle to the preescrotal incisson Pampiniform plexus Ductus deferens Use two separate circumferential ligatures Incise: 1.-spermatic fascia 2.-parietal tunic 3.- Visceral tunic Transect the ligament of the tail ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com Josep Arus Marti, DVM, ECAR diplomate. Arvivet Veterinaris SL. Terrassa. Spain. 7 Técnicas cirùrgicas de controlo reprodutivo en canídees e felídeos DOG • COMPLICATIONS – Scrotal hernia – Scrotal bruising and swelling – Haemorraghe – Infection – Obesity ? – Arteriovenous fistula (rare) ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com DOG • Silicone implants – In special cases – May be not allowed in some countries or in some show dogs – Substitution of the testicles inside the vaginal tunic – www.neuticles.com – Possible in all species ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com DOG • Vasectomy – Bilateral removal or occlusion of a segment of the ductus deferens – Prevents fertility but not the androgendepending diseases and undesirable male sexual behaviours – Spermatozoa will continue be present 3 weeks after surgery. – Localisation the spermatic cord near testicles or near inguinal ring – Complications • Reanastomosis • Spermatocele and spermatic granulomas ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com Josep Arus Marti, DVM, ECAR diplomate. Arvivet Veterinaris SL. Terrassa. Spain. 8 Técnicas cirùrgicas de controlo reprodutivo en canídees e felídeos DOG • Cryptorchidism – Developmental defect in male dogs (1,2% to 5% in some studies) – Monorchidism has not been reported in dogs (Johnston, Shirley D. Canine and Feline theriogenology, 2001) – Wait until 6 months of age, and more in some specific breeds. – Unilateral (79,8%) more common than bilateral (20,2%), and left (65,7%) more common than right (34,3%) – At 6 months of age starts the functional closure of the inguinal rings – Is heritable – Medical treatment is of little value – Retained testes • Abdominal testes are smaller that the inguinal • Capable of steroid genesis but are not capable of normal spermatogenesis • Predisposed to neoplasia (x10 times more frequent) • Predisposed to torsion ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com DOG • Cryptorchidism – Abdominal testes • Lateral approach in the unilateral cases – Testicle located ussually lateral to the bladder • Abdominal midline incission in the bilateral cases – We can retroflex the urinary bladder to localise ductus deferens – Often located caudal to the kidneys • The same technique that for castration ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com DOG Scrotal testicle • Cryptorchidism – Orchiopexy • Is the surgical placement of the retained testis in the scrotal sac • Not recommended • Regain some spermatogenic function • Increase the dog’s value fraudulenty Cryptorquid testicle Ligament of the tail of the epidymis ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com Josep Arus Marti, DVM, ECAR diplomate. Arvivet Veterinaris SL. Terrassa. Spain. 9 Técnicas cirùrgicas de controlo reprodutivo en canídees e felídeos DOG • SCROTAL ABLATION – Specific pathologies • • • • • Trauma to the scrotum Scrotal neoplasia Scrotal hyperplasia Pendulous scrotum Perineal uretrostomy ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com 1.-Ellipticial incission around base of the scrotum 2.- Incision is carried throug underlying fascias until parietal tunic. Open or closed castration Profuse haemorrage in scrotal hyperplasia ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com CAT FEMALE • Ovariohisterectomy – Indications like in the bitch – Same procedure like in bitch – Important anatomical differences • Good visualisation of ovarian anatomy • Ectopic follicular fragments • Short uterus body – Complications • The same like in bitch • Special importance of the ovarian remnant syndrome ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com Josep Arus Marti, DVM, ECAR diplomate. Arvivet Veterinaris SL. Terrassa. Spain. 10 Técnicas cirùrgicas de controlo reprodutivo en canídees e felídeos ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com CAT FEMALE • Ovariectomy – More used in some countries – Same indications that ovariohisterectomy – We left inside abdomen a “non useful uterus” – Same complications like in ovariohisterectomy – Same indications like in ovariohisterectomy ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com CAT MALE • CASTRATION – A lot of different techniques and procedures – Normal Anatomy of the cat • Perineal position • Penile spiculas – Technique • • • • 2 scrotal incissions Incission of the parietal vaginal tunic Ligation of the components of the spermatic cord Scrotal incission left unsutured – Complications like in dog ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com Josep Arus Marti, DVM, ECAR diplomate. Arvivet Veterinaris SL. Terrassa. Spain. 11 Técnicas cirùrgicas de controlo reprodutivo en canídees e felídeos CAT MALE • VASECTOMY – Same technique like in dog except • for perineal testicular position • Incision near testicles – Indications • Prevents fertility • Dominant males in communities to copulate females to induce ovulation without pregnancies. • Sperm present in ejaculate until 7 weeks after the procedure ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com CAT MALE • Cryptorchidism – Suspected heritable nature • • • • Normal feline testis descends into srotum prior to birth Diagnosis until 5 months of age Incidence of 0,37 % to 1,7 % More common unilateral (90% of cases) – Presence of androgen dependent penile spines if testosterone is produced – Monorchydism is extremously rare !!! – Possible localisations • Abdominal (28%) • Inguinal ring (14%) • Subcutaneous fat or inguinal (58%) – Technique like in dog ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com ArViVet Veterinaris. TERRASSA. SPAIN. www.arvivet.com Josep Arus Marti, DVM, ECAR diplomate. Arvivet Veterinaris SL. Terrassa. Spain. 12
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