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Cryptorchidism in the horse PowerPoint PPT Presentation


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Cryptorchidism in the horse. Dr JE Cox Division of Equine Studies. Cryptorchidism in horses. I apologise for the poor quality of some slides (scanned in a hurry) some pictures being missing (my set has got depleted over the years)

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Cryptorchidism in the horse

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Cryptorchidism in the horse l.jpg

Cryptorchidism in the horse

Dr JE Cox

Division of Equine Studies


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Cryptorchidism in horses

I apologise for

the poor quality of some slides (scanned in a hurry)

some pictures being missing (my set has got depleted over the years)

the possibility that this may be of absolutely no help to you in the forthcoming exam

BUT

Good luck


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The phenomenon of cryptorchidism in horses

Temporary inguinal retention

Permanent inguinal retention

Incomplete abdominal retention

Complete abdominal retention


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Inguinal retention

Temporary and permanent forms have same anatomy – the testis has passed through the inguinal canal but has not descended to scrotum

Temporary form very common in ponies


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Incomplete retention

Epididymal tail descended but testis still in abdomen


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Complete retention

Testis and epididymal tail both in abdomen

Note that there is a small vaginal process and the remains of the gubernaculum (inguinal extension…) through the inguinal canal


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Abdominal retention

Note that complete retention is more common on the left whilst complete and incomplete retention are equally represented on the right side – all to do with timing of descent of left and right testes


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Positioning for cryptorchidectomy

Penis pulled forwards; inguinal and paramedian areas prepped

Dorsal recumbency;

good anaesthesia


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Inguinal exploration

ALWAYS explore inguinal region surgically, even though you cannot feel anything

LOOK for scars – though they only tell you someone has made a hole


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Inguinal exploration

Cut through skin where the scrotum should be – then DISCARD SCALPEL – there are large veins down there (one shown here) so continue by blunt dissection


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Inguinal exploration

You may find a stump with a muscle (the cremaster) on the outside – open it carefully.

If you find, as here, blood vessels and the deferent duct, then it has been castrated (on that side at least)


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Inguinal exploration

You may find a testis inside its vaginal tunic (as here)

Remove it and the animal has then been castrated on that side


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Inguinal exploration

You may find a vaginal tunic which when you cut into it, you find epididymal tail (e), deferent duct (v) and body of epididymis (b) as here.

See next slide


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Inguinal exploration

You may be able to deliver the testis by traction on the epididymal body

Anatomy slide shows why

this works – they are attached

to each other


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Inguinal exploration

You may find “inguinal extension of gubernaculum” – difficult to recognise as you may guess from this picture

This is a case of complete retention

See next slide


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Inguinal exploration

You then be able to identify a small vaginal process and inside it a ligament – traction on this may deliver the epididymal tail and then the testis

Anatomy slide shows why

this works – they are attached

to each other


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Where now ?

The chart shows the options:-

“Invasive via inguinal canal” are no longer recommended – they have a high rate of post-operative prolapse of gut !!!


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Where now ?

The chart shows the options

“Non-invasive via inguinal canal (Adams)” is also no longer used – it was, in any case, based on a misunderstanding of the anatomy !!!!!


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Where now ?

The chart shows the options

“Non-invasive via inguinal canal (Inguinal extension…)” is the one described on slide 16


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Where now ?

The chart shows the options

“Invasive via body wall (flank) “ is no longer used – it has no advantage over paramedian and is more difficult if both testes are in the abdomen.


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Where now ?

The chart shows the options

“Invasive via body wall (paramedian)” was originally devised in the early 1800s (pre Lister, pre chloroform !) and then lost favour until “re-discovered” at Leahurst by Prof JG Wright in the late 1950s


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Where now ?

The chart shows the options

Not shown is laparoscopic removal which is gaining favour


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Paramedian

Paramedian incision parallel to opening of sheath and at that level – too far back may be easier to get testis, but there is cod-fat to cut through; too far forwards and it is difficult to exteriorise testis


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Paramedian

Below fat lies tendon of external and internal oblique combined – incise along length of incision


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Paramedian

Below tendons of external and internal oblique combined lies straight abdominal muscle (also called rectus abdominis) – split along fibres along length of incision


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Paramedian

Below straight abdominal muscle lies tendon of transverse muscle, fibres at right angles to incision – split along fibres at right angles to incision and puncture peritoneum below and enter peritoneal cavity.


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Paramedian

Put your hand in –

How are you going to find the testis working completely blind ?

It all follows from the anatomy shown at the beginning of this presentation

See next slides


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Paramedian

Dissection of rig pig – head to right and tail to left;

Gut removed;

Caudal abdomen exposed;

Bladder (b) reflected caudally to expose cut end of rectum (r) at entrance to pelvic canal

See next slide


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Paramedian

Dissection of rig pig – head to right and tail to left;

Note testis (t) and epididymal tail (e)

Note ligament (= proper ligament of testis) joining testis (t) to epididymal tail (e)


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Paramedian

Note ligament going from epid tail into vaginal process

AND

Deferent duct going from epid tail to dorsal surface of bladder


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Paramedian

If testis does not fall into your hand (most are soft and floppy), then find the deferent duct on dorsal surface of bladder, follow to epid tail and thence to testis

(By now you should know that these are connected to one another)


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Paramedian

And pull out a plum !

Use emasculator for haemostasis (ligatures rarely required)


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Paramedian

Repair transverse tendon and straight abdominal muscle in one layer as shown.

(there were some cracks in the glass of the slide – hope you can work out what is crack and what is not)


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Paramedian

Then, matress sutures in combined tendon of internal and external oblique.

Close dead space in fat.

Suture skin (all absorbable)


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Don’t forget !

Laparoscopic removal has been developed since I gave up doing any surgery

However, failure rate of paramedian, even in inexperienced hands, is probably less than for inguinal non-invasive and laparoscopic removal.


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