Clinical practice

Companion animal practice

Surgical diseases of the genital tract in male dogs 1. Scrotum, testes and epididymides

1. 2.
Abstract

Benito de la Puerta and Stephen Baines

While castration is the most common surgery carried out on the genitals of male dogs in first-opinion practice, there are several other, less common, surgical procedures that are performed to treat various conditions affecting the male reproductive tract. This article discusses the surgical diseases and treatment of the scrotum, testes and epididymides of dogs. A second article, to be published in the March issue of In Practice, will cover the surgical techniques used to manage disorders of the penis and prepuce.

Benito de la Puerta graduated from the University Complutense in Madrid in 1997, and obtained a clinical scholarship at the same university in 1998. In 2002, he undertook an internship in small animal medicine and surgery at the Royal Veterinary College (RVC). After a period in general practice, he completed a three-year residency in small animal surgery at the RVC. He now works at North Downs Specialist Referrals. He is a diplomate of the European College of Veterinary Surgeons and a European and RCVS specialist in small animal surgery.

Stephen Baines qualified from Cambridge in 1990. He currently works at Willows Veterinary Centre and Referral Service in Solihull, and was previously a senior lecturer in small animal surgery and head of surgery at the RVC. He holds certificates in veterinary radiology and small animal surgery, is a diplomate of the European College of Veterinary Surgeons, and is a European and RCVS specialist in small animal surgery.

Anatomy and physiology

The male genital organs in the dog comprise the:

Scrotum; Testes; Epididymides; Deferent ducts; Prostate gland; Urethra;

Penis; Prepuce.

The anatomy and physiology of the scrotum, testes and epididymides are described in Box 1.

Box 1: Anatomy and physiology of the canine scrotum, testes and epididymides
Scrotum The scrotum is a membranous pouch of skin located between the thighs. It is spherical in shape and is divided by a median septum into two cavities, each of which contains a testis, epididymis and spermatic cord.

The testes, epididymides, deferent ducts and associated vessels and nerves are covered by the visceral and parietal vaginal tunic and the spermatic fascia. The scrotal wall consists of two layers, the skin and the dartos. The skin is thin, pigmented and sparsely haired, and contains sebaceous and sudoriparous glands. The dartos is formed of a layer of smooth muscle with mixed collagenous and elastic fibres.

The scrotum functions as a temperature regulator for the cauda epididymides. Contraction of the dartos and the cremaster muscle causes the integument of the scrotum to retract and draw the testes closer to the body.

The principal blood vessels to the scrotum are the external pudendal artery and vein, which are branches of the external iliac artery and vein. The scrotum is innervated by the superficial perineal nerve, which is a branch of the pudendal nerve. Testes The testes (the male gonads) are located within the scrotum with their long axis in the dorsocaudal direction. The surface of each testis is formed by the tough tunica albuginea, and the testis is divided into lobules by connective tissue (septula testis). The seminiferous tubules containing the spermatogenic cells and the sustentacular (Sertoli) cells, as well as the glandular (Leydig) cells, are found inside these lobules.

The testicular artery and the artery of the ductus deferens supply blood to the testes and epididymides. The testicular artery (the homologue of the ovarian artery in female animals) arises from the ventral surface of the aorta at the level of the fourth lumbar vertebra. The ductus deferens artery is a branch of the prostatic artery from the internal iliac artery. The testicular vein follows the testicular artery but forms an extensive pampiniform plexus in the spermatic cord. The right testicular vein drains into the caudal vena cava and the left testicular vein drains into the left renal vein in a similar fashion to the ovarian veins.

Spermatogenesis takes place in the seminiferous tubules of the testes. This is a continuous process that is controlled by gonadotropins from the pituitary gland. The Leydig cells produce androgens, which are involved with spermatogenesis, maintenance of the accessory glands and secondary sexual characteristics, as well as changes associated with sexual maturity. The Sertoli cells are a probable source of oestrogens in normal dogs. Epididymides The epididymides lie along the dorsolateral border of the testes. Each epididymis is composed of a head, body and tail. The head lies on the medial aspect of the testis, communicating with the testis, and then twists around the cranial and lateral aspects of the testis to become the body. The body of the epididymis runs along the dorsolateral surface of the testis to become the tail, which attaches to the caudal aspect of the testis through the proper ligament, and continues with the ductus deferens. The spermatozoa complete their maturation process and are stored in the tail of the epididymis before ejaculation.

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Anatomical structures of the (a) testis, (b) epididymis and (c) scrotum of the dog. Reproduced, with permission, from Evans and Christensen (1993)

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Surgical diseases
Scrotum
Scrotal trauma Injury to the scrotum with involvement of the vaginal tunic or testes can cause infection and orchitis. Minor abrasions and laceration of the skin can be treated by gentle cleaning of the wound, followed by analgesia and the administration of appropriate antibiotics. It is also important to prevent self-trauma of the area, which can lead to dermatitis (Fig 1). More extensive wounds may need to be sutured after local wound management. Severe tissue damage or infection may require scrotal ablation and orchiectomy.

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Fig 1
Scrotal dermatitis may develop as a sequela of minor injury to the scrotum if self-trauma to the area is not prevented Scrotal tumours

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Neoplasia of the scrotum is rare. The most common tumours are mast cell tumours (Fig 2) and squamous cell carcinoma, although any cutaneous tumour may occur in this location. Local or wide local excision of the tumour, which may necessitate scrotal ablation and orchiectomy, is the treatment of choice.

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Fig 2
Scrotal mast cell tumour in a dog

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Testes
Anorchism and monorchism The congenital absence of one or both testes is rare in dogs. Monorchism has been reported in the literature, in which absence of the left testis was more common.

A diagnosis of anorchism or monorchism is made once it has been determined that there are no testes, or only one testis, in the scrotum, inguinal region and abdomen. This can be assessed by:

Careful palpation; Ultrasonography;

Exploratory celiotomy; Blood tests for the levels of testosterone and pituitary gonadotropins.

Testicular hypoplasia Testicular hypoplasia is a congenital, possibly hereditary, disorder that results from a marked reduction in the number of spermatogonia in the gonads. It may also be a component of intersex states. The hypoplasia may be unilateral or bilateral. This condition results in small testes, usually with a normal to soft consistency, although sometimes they can contain excessive connective tissue, which makes them firmer and more difficult to palpate. Hypoplastic testes are incapable of spermatogenesis but the Leydig cells may be functional; in such cases, the dog's libido will be maintained.

Histological evaluation of hypoplastic testicular tissue will reveal underdeveloped seminiferous tubules, a lack of germinal epithelium, and a variable number of Leydig cells. A diagnosis of hypoplasia should not be made until the dog is mature. There is no treatment for the condition. The prognosis for fertility will depend on the severity of the hypoplasia. Cryptorchidism Cryptorchidism is a congenital defect in which one or both testes has not descended completely into the scrotum by the time the dog is eight weeks of age. Testicular descent is the process by which the testes move from their developmental position at the caudal aspect of the kidneys into the scrotal sac. Cryptorchidism results from underdevelopment or aberrant outgrowth of the gubernaculum (an embryonic structure attached to the caudal end of the testis) and failure of the gubernaculum to regress and pull the testis into the scrotum. This process is mediated by the testicular hormone testosterone. In most normal dogs, the testes will have descended into the scrotum by 35 to 40 days of age, but the process can occasionally take until the dog is up to six months of age.

Small-breed dogs are 27 times as likely to develop cryptorchidism as other breeds (Pendergrass and Hayes 1975). The condition is more common in the chihuahua, miniature schnauzer, Pomeranian, poodle, Shetland sheepdog, Siberian husky and Yorkshire terrier. Cryptorchidism may be unilateral or bilateral, and the testes may be in an abdominal (Fig 3), inguinal (Fig 4) or prescrotal position. Unilateral cryptorchid-ism is more common than bilateral cryptorchidism and the right testis is more commonly undescended than the left (Yates and others 2003).

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Fig 3
Unilateral right abdominal cryptorchid testis. The urinary bladder has been flexed caudoventrally to help localise the testis in the abdomen

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Fig 4
Left inguinal cryptorchid testis. A surgical incision has been made directly over the testis

The ectopic testis is exposed to the normal body temperature, which causes degeneration of the germinal epithelium, but the Sertoli and Leydig cells continue to function, so that the normal endocrine function of the testis is retained. Unilaterally cryptorchid dogs can be fertile.

Compared with scrotal testes, intra-abdominal testes are more susceptible to torsion and neoplasia, particularly Sertoli cell tumours and seminomas. However, because temperature has no influence on the interstitial cells, the incidence of interstitial cell tumours is unchanged. The risk of testicular neoplasia is 10 times greater in a cryptorchid dog than in a normal dog (Hayes and others 1985). Testicular torsion may also be more likely to occur with neoplastic testes due to the increased size and weight of the neoplastic testis. Diagnosis It can be particularly difficult to diagnose cryptorchidism in young puppies because of the small size of the testes and their capacity to move freely between the scrotum and the inguinal region. In cases of inguinal cryptorchidism, the testes are smaller and softer than normal, with a prominent epididymis. Intra-abdominal testes are very difficult to palpate unless they are neoplastic or diseased. A thorough abdominal ultrasonographic examination and/or determination of plasma testosterone are required for diagnosis. In an animal with a single scrotal testis, cryptorchidism is a far more likely cause than monorchism. Treatment Medical and surgical attempts to move ectopic testes into the scrotum have been unsuccessful in dogs. In addition, since cryptorchidism is an inherited condition, such treatments would be unethical and so orchiopexy should not be considered. In unilaterally cryptorchid animals, a reported higher incidence of testicular neoplasia in the contralateral, descended testis justifies a recommendation of prophylactic bilateral orchiectomy. The surgical technique will vary depending on the location of the testis (see section on orchiectomy below). After removal, the testis should be evaluated histopathologically because of the increased incidence of neoplasia in cryptorchid testes. Testicular torsion Rotation of the testis about its horizontal axis will result in torsion of the spermatic cord, occlusion of venous drainage, and subsequent testicular engorgement and necrosis. Testicular torsion is rare, but is more common in cases of an enlarged, neoplastic, intra-abdominal testis. The cause of torsion of scrotal testes is unknown, but such cases could be related to rupture of the scrotal ligament following trauma or excessive activity. Scrotal testes that have suffered torsion normally have no histological evidence of disease. Diagnosis Dogs with a scrotal testicular torsion present with acute pain, scrotal swelling and reluctance to stand or walk. Physical examination will reveal an enlarged, firm testis and signs of pain will be apparent on manipulation. A thick spermatic cord may also be palpable. A patient with an intra-abdominal torsion will present with acute abdominal pain. Scrotal or abdominal ultrasonography may be used to confirm the diagnosis. Ultrasonographic findings include enlargement of the testis, with a uniform decrease in parenchymal echogenicity, enlargement of the epididymis and spermatic cord, and a lack of blood flow to the testis on colour-flow Doppler imaging. Treatment Testicular torsion is a surgical emergency. If the dog is presented in shock, it should be stabilised, followed by an orchiectomy and subsequent supportive care. The testis should not be de-rotated during the orchiectomy, to prevent the release of inflammatory mediators. The prognosis is good unless the torsion has been caused by a neoplastic process. The testis should be submitted for histopathology to rule out neoplasia. Orchitis/epididymitis As the testis and epididymis are in close proximity and connected via the duct system, any inflammatory or infectious process is likely to affect both structures.

Orchitis/epididymitis is normally caused by bacteria which gain access via direct trauma, the retrograde passage of infected urine or prostatic secretions, bacteraemia, or infected lymph. Bacteria commonly found in such cases include Escherichia coli, Staphylococcus species,Streptococcus species and Mycoplasma species. Orchitis/epididymitis can also be caused byBrucella canis (Taylor 1980). Orchitis has also been reported in cases of canine distemper virus infection, systemic mycoses and canine erlichiosis. Diagnosis Dogs with orchitis/epididymitis will present with acute pain, scrotal swelling (Fig 5) and be reluctant to stand or walk. The dog may need to be sedated to enable a proper examination, which will reveal swelling of the testis and/or epididymis, with local hyperthermia and pain on manipulation. Unilateral orchitis/epididymitis is more common than bilateral disease. A mucopurulent discharge may be present on the scrotum if a suppurative process with abscessation has occurred. Palpation per rectum may reveal an enlarged and painful prostate gland, which indicates acute prostatitis.

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Fig 5
Staffordshire bull terrier that presented with acute pain, scrotal swelling and a reluctance to stand or walk. This dog was diagnosed with orchitis

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Ultrasonographic evaluation of the scrotum and testes will assist in diagnosis and identify any abscessation as well as aid in the collection of samples. Blood, urine and prostatic fluid, as well as a sample from any draining tract, should be sent for culture to isolate the aetiological agent and antimicrobial sensitivity testing. Treatment The treatment of orchitis/epididymitis will depend on whether the dog is intended for breeding purposes. If fertility is of no concern, the patient should be stabilised, treated with broadspectrum antibiotics and then castrated. Any primary disease should also be identified and treated appropriately. Initial antibiotics of choice would be amoxicillin/clavulanate, a trimethoprim-sulphonamide combination or enrofloxacin. If orchiectomy is not an option, the dog should receive supportive care with antimicrobial therapy and analgesia; local hypothermia therapy to minimise thermal damage to the germinal epithelium can also be used. The prognosis for preserving fertility is guarded.

Chronic orchitis/epididymitis may develop following an acute episode. In such cases, the prognosis for fertility is guarded to poor, and orchiectomy is the treatment of choice. Testicular trauma It is uncommon for the testes to suffer trauma even though they are in a relatively exposed location. Trauma to the testes may also involve the scrotum, epididymides or spermatic cord. Due to the expansile nature of the scrotum, large haematomas may form even after the rupture of small blood vessels. Damage to the testes may lead to leakage of sperm into the interstitial tissue, causing the formation of a spermatic granuloma or the development of immune-mediated orchitis due to the antigenic properties of the sperm. Inflammation and the resulting hyperthermia may reduce the dog's fertility temporarily or permanently. Trauma can also lead to orchitis/epididymitis. Diagnosis The clinical signs of testicular trauma may include local pain, swelling or bruising of the scrotum, or an open wound. The diagnosis is made on physical examination. Ultrasonography can be used to assess the integrity of the tunica albuginea and epididymides. Treatment Medical treatment is indicated in cases of minor trauma. Local hypothermia, analgesia and appropriate antimicrobial therapy should be provided. In addition, self-trauma should be prevented by fitting the dog with an Elizabethan collar. If there is continuous bleeding or persistent pain or swelling, or in cases of massive trauma to the scrotum or testes, surgical exploration with or without scrotal ablation and orchiectomy would be indicated. In dogs intended for breeding, surgical exploration through a cranial approach to the scrotum can be performed. The tunica albuginea or the vaginal tunic can be repaired using fine absorbable sutures (eg, poliglecaprone [Monocryl; Ethicon]) and bleeding vessels can be ligated or cauterised to achieve haemostasis. Testicular tumours The testes are the second most common location for tumours to develop in male dogs. The three most common types of testicular tumours are:

Sertoli cell tumours, which arise from the Sertoli cells of the seminiferous tubules. They are usually slow-growing and non-invasive. They can become very large when they involve an intra-abdominal testis. These tumours are firm and nodular on palpation. Approximately 10 to 20 per cent of Sertoli cell tumours are malignant; in such cases, metastasis can occur to the inguinal, iliac and sublumbar lymph nodes and to the lungs, liver, spleen, kidneys and pancreas.

The male feminising syndrome is most often seen with this type of tumour, although it can also be seen in cases of seminoma and, less commonly, with interstitial cell tumours. This syndrome results from the increased production of oestrogens by the tumour cells. The most common sign is bilateral, symmetrical, non-pruritic alopecia affecting the perineum, genital region, ventral and lateral abdomen, which may extend to the thorax (see Fig 6). In addition, hyperpigmentation, gynaecomastia, galactorrhea and a pendulous prepuce may be apparent. Bone marrow hypoplasia and pancytopenia can also occur in these cases.

Seminomas, which arise from the spermatogenic cells of the seminiferous tubules. They are usually benign, although they may metastasise to the same sites as Sertoli cell tumours in 5 to 10 per cent of cases. They range in size from less than 1 to 10 cm in diameter and are soft on palpation. Androgen secretion is more common in these tumours.

Interstitial cell tumours, which are derived from the Leydig cells. They are usually small, less than 2 cm in diameter and non-palpable. If palpable they are soft and nodular. They are normally an incidental finding and almost always benign.

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Fig 6

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Dog with feminising syndrome secondary to an abdominal cryptorchid Sertoli cell tumour, showing ventral alopecia, hyperpigmentation and gynaecomastia (Picture, Zoe Halfacree)

Other tumours that have been reported, albeit rarely, are:

Embryonal carcinoma; Granulosa cell tumour; Haemangioma; Fibrosarcoma; Neurofibrosarcoma; Undifferentiated carcinoma; Sarcoma.

Tumours usually occur individually, although two or more tumours can be found in the same testis. As mentioned above, there is a greater incidence of testicular neoplasia in cryptorchid testes than in scrotal testes. Diagnosis The presence of a testicular tumour may be suspected if there is asymmetrical enlargement of the testes (Fig 7) or if male feminising syndrome is apparent (Fig 6). Abdominal radiographs or ultrasonography can be useful to identify an intra-abdominal neoplastic testis. Scrotal ultrasonography can be helpful in assessing scrotal testes for signs of neoplasia, and providing guidance for biopsy. If testicular neoplasia is diagnosed, radiography and ultrasonography should be performed to assess the presence of metastases before surgery.

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Fig 7
Dog with asymmetrical enlargement of the testes, which was diagnosed with a seminoma. (Picture, Sue Gregory)

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Treatment The treatment of choice for testicular tumours is scrotal ablation and castration. The prognosis is good to excellent, with most dogs being cured due to the low metastatic rate of these tumours.

Chemotherapy is indicated in dogs with metastases. Combination chemotherapy using vinblastine, cyclophosphamide and methotrexate has been reported to have some degree of efficacy, as has treatment with cisplatin, but chemotherapy will not cure these patients. The prognosis for metastatic disease is poor.

Surgical techniques
Orchiectomy
The indications for orchiectomy, other than to treat the conditions described above, are:

Behavioural problems, such as roaming, inter-male aggression, abnormal urination or unwanted sexual behaviour; Prevention of breeding for population control; Treatment of prostatic disease (eg, benign prostatic hyperplasia, prostatic abscess, prostatic or paraprostatic cysts).

The necessity and timing of orchiectomy are controversial, as there are possible adverse effects as well as benefits associated with orchiectomy. For example, prepubertal orchiectomy may influence skeletal growth, weight gain, food intake, the amount of body fat and the development of secondary sexual characteristics as well as behavioural development (Box 2).

Box 2: Side effects associated with orchiectomy

In one study of the effects of orchiectomy on the behaviour of dogs, objectionable sexual behaviour, inter-male aggression, roaming and abnormal urination were reduced after orchiectomy in approximately 60 per cent of the animals studied. Side effects such as increased bodyweight, increased appetite and decreased activity occurred in less than 50 per cent of the dogs (Maarschalkerweerd and others 1997). Another study (Salmeri and others 1991) involved three groups of dogs:

Dogs that were neutered at less than seven weeks of age (group I); Dogs that were neutered at seven months of age (group II); Sexually intact dogs (group III).

Growth plate closure was delayed in groups I and II compared with group III. The rate of bone growth was unaffected by orchiectomy, but in group I the final growth of the radius/ulna was greater. Orchiectomy did not influence the dogs' food intake, weight gain or back fat depth. Compared with group III, the development of the prepuce, penis and os penis was decreased in group I but not in group II. Dogs in group I were more active and excitable than the dogs in group III.

Neutered dogs have also been reported to have a higher risk of developing cancers of the urinary bladder and prostate, especially prostatic transitional cell carcinoma (Bryan and others
2007).

Orchiectomy can be performed via a prescrotal incision or by scrotal ablation, using either an open (Box 3) or closed (Box 4) technique. The advantage of an open approach is that vascular ligations are direct and more secure, and this technique may be preferable in dogs weighing over 20 kg. The disadvantage of open orchiectomy is that it involves the opening of an extension of the peritoneal cavity, which carries a possible risk of herniation of the intestine. This can be avoided by suturing the vaginal tunic together once the orchiectomy has been performed, although this is not a clinical concern in most dogs. A closed method should always be used when performing an orchiectomy in cases of testicular neoplasia, to prevent possible tumour contamination of the surrounding tissues.

Box 3: Open orchiectomy

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Step 1. Push the testis cranially and perform a ventral midline prescrotal skin incision

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Step 2. Incise the subcutaneous tissue and spermatic fascia over the testis while keeping traction on the testis to expose the parietal vaginal tunic. The parietal vaginal tunic is a distinct white, glistening layer

Step 3. Once the spermatic fascia has been divided, extrude the tunica-covered testis through the skin incision. To enable the complete exteriorisation of the testis, transect the scrotal ligament. Reflect the fat and fascia surrounding the parietal vaginal tunic with a gauze sponge to give better exposure of the spermatic cord and cremaster muscle

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Step 4 (left). Incise the vaginal tunic. Take care not to cut through the tunica albuginea as this would expose the testicular parenchyma. Separate the ligament of the tail of the epididymis from the tunic; ligation is needed only if a large blood vessel is present. Reflect the tunic proximally to expose the ductus deferens and pampiniform plexus

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 Step 5. Triple clamp the proximal portion of the spermatic cord

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Step 6. Remove the most proximal haemostat and place a transfixion suture (eg, polyglactin 910 [Vicryl; Ethicon]) through the ductus deferens and encircling the pampiniform plexus. Place a second encircling ligature next to the transfixion suture

Step 7 (left). Transect the spermatic cord distal to the ligatures, between the two haemostats, to prevent backflow haemorrhage from the testis

Step 8. Replace the remaining portion of the cord in its normal position and inspect it for bleeding. It is important to exert control during the release of the cord because the vessels will shorten and dilate, so slippage of the ligatures can occur at this time

Step 9. Remove the other testis in the same manner and through the same skin incision

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Step 10. Close the surgical incision routinely using 2 metric monofilament absorbable sutures (eg, poliglecaprone [Monocryl; Ethicon]) in a simple continuous pattern for the subcutaneous tissue. Ensure that connective tissue surrounding the retractor penis muscle is incorporated to obliterate dead space, and be careful not to invade the urethra

Step 11. Close the subdermal layer with 2 metric monofilament absorbable sutures (eg, poliglecaprone, as above) in a simple continuous pattern

Step 12. Close the skin using 2 metric monofilament non-absorbable sutures (eg, polyamide [Ethilon; Ethicon]) in a simple interrupted pattern

Box 4: Closed orchiectomy

The surgical approach for closed orchiectomy is the same as for the open approach. Once the testis is exteriorised, triple clamp the proximal portion of the spermatic cord, remove the most proximal haemostat and double ligate the spermatic cord with a transfixion ligature through the cremaster muscle to reduce the risk of the ligature slipping, and an encircling ligature placed next to the transfixion suture. Use 2 or 3 metric synthetic absorbable multifilament sutures (eg, polyglactin 910 [Vicryl; Ethicon]) for the ligatures.

There are a number of complications that may develop after surgery (Box 5).

Box 5: Complications of orchiectomy

The reported incidence of postoperative complications following orchiectomy in dogs is 61 per cent, most of them being minor (Pollari and others 1996). Complications can include:

Scrotal bruising and swelling; Haemorrhage; Scrotal haematoma; Infection; Self-trauma.

The likelihood of scrotal bruising and swelling can be reduced by manipulating the tissues gently and avoiding making an incision into the scrotum.

Haemorrhage can be a serious complication if the vessels are bleeding into the abdomen. In such cases, the patient may need a second surgical intervention to explore the wound, either through the original surgical site or via a laparotomy, and to ligate the bleeding pedicle.

Cases of postoperative infection may require drainage and flushing of the wound plus appropriate antimicrobial therapy following culture and sensitivity testing.

Scrotal haematoma can be treated with analgesia and local hypothermia. In addition, the dog should be fitted with an Elizabethan collar to prevent self-trauma.

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Fig 8
Marked scrotal haemorrhage secondary to castration in a dog

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Cryptorchid castration
An extra-abdominal testis is removed using a similar method to a prescrotal castration. If the testis is in the inguinal region, a skin incision is made over the testis (see Fig 4) and the testis is then removed using a standard open or closed method. If the testis is not located in the inguinal region, the approach should be via a caudal ventral midline laparotomy incision. The testis may be present anywhere along the line of its descent from the caudal pole of the kidney to the inguinal canal. The ductus deferens can be located by reflecting the bladder caudoventrally and tracing the ductus from its prostatic termination to the testis (see Fig 3). The testis may be very small, and so whatever tissue is found at the termination of the ductus deferens should be excised. Once the ductus deferens and vessels have been located, they should be clamped, ligated and divided. The vessels should be checked for bleeding before the abdominal cavity is closed in a routine manner. Intraabdominal ectopic testes can also be removed laparoscopically. Irrespective of the approach used, the excised tissue should be examined histopathologically to ensure that a testis has been removed and to rule out neoplasia.

Scrotal ablation
The indications for scrotal ablation include:

Neoplasia;

Trauma; Abscesses; Ischaemia.

Scrotal ablation may also be performed in conjunction with scrotal urethrostomy.

In this procedure, the scrotum and testes are elevated from the body wall and an elliptical incision is made around the base of the scrotum, making sure that enough skin is left to close the incision without tension (Fig 8). The skin of the ventral scrotum is often pigmented, and, in such cases, the incision can be made at the junction of the pigmented and non-pigmented skin. Haemorrhage should be controlled by electrocautery or ligation. During scrotal ablation, orchiectomy can be performed using either a closed or open method.

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Fig 8(a), 8(b) and 8(c)

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Scrotal ablation in a dog. (a) The scrotum and testes are elevated from the body wall and (b) an elliptical incision is made at the base of the scrotum, making sure that enough skin is left to close the incision without tension. (c) Closed castration is then performed

Vasectomy
When performing vasectomy, the ductus deferens can be interrupted anywhere along its course from the epididymis to the prostatic urethra. A 1 to 3 cm long incision is made in the inguinal region over the spermatic cord as it transverses from the scrotum to the inguinal canal. Applying caudal traction to the scrotum will put tension on the spermatic cord, allowing it to be identified more easily. The cord is then gently dissected from the surrounding fascia and fat. Once localised, a small incision is made through the vaginal tunic. The testicular vessels lie in one fold of the visceral vaginal tunic, while the ductus deferens and its vessels lie in the other fold. The ductus is isolated and the artery and vein are dissected from the surface of the duct. The duct is clamped, ligated and divided. Ligation should be routinely performed, as recanalisation has been reported after the duct has only been severed. The vaginal tunic is sutured with fine absorbable sutures and the rest of the layers are closed in a routine manner. The surgery is then repeated on the other side.

Summary
This article provides an overview of the different diseases that affect the testes, scrotum and epididymides of the dog, and describes the surgical techniques that may be employed to manage these conditions. A second article, to be published in the March issue of In Practice, will discuss the most common conditions affecting the penis and prepuce of the dog, and their treatment.

Acknowledgments
The authors would like to thank Sue Gregory and Zoe Halfacree for their support during the preparation of this article.

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[Abstract]

1. Taylor D. J. (1980) Serological evidence for the presence of Brucella canis infection in dogs in Britain. Veterinary Record 106, 102104

9.

1. 2. 3.
[Abstract/FREE Full text]

Yates D., Hayes G., Heffernan M.,

4. Beynon R. (2003) Incidence of cryptorchidism in dogs and cats. Veterinary Record 152, 502504

Further reading
1. 1. Boothe H. W. (2003) Testes and epididymides. In Textbook of Small Animal Surgery, 3rd edn. Ed Slatter D. H.. W. B. Saunders. pp 15311542 2.

1.

Feldman E. C.,

2. Nelson R. W. (2004) Disorders of the testes and epididymides. In Canine and Feline Endocrinology and Reproduction, 3rd edn. Saunders. pp 961962 3. 1. Romagnoli S. E. (1991) Canine cryptorchidism. Veterinary Clinics of North America: Small Animal Practice 21, 533544 [Web of Science]

4. 1. Hardie E. M. (1984) Selected surgeries of the male and female reproductive tract.Veterinary Clinics of North America: Small Animal Practice 14, 109122 [Web of Science]