CASTRATION

VetSuite Veterinarians
Surgery (General & Soft Tissue)

DEFINITION AND INDICATIONS

Castration (orchiectomy, neuter) is a surgical procedure in which the testicles are removed from the body. It is performed most commonly to render pets unable to breed, thus helping to control pet overpopulation. Other benefits include, reducing the risk of certain prostate diseases and preventing or treating certain neoplasms or metabolic disorders. Castration is also indicated in the cryptorchid animal.

PREOPERATIVE CONCERNS

• Clinical signs and history - Most animals are healthy with no signs of illness.
• Physical examination - Often normal. If cryptorchid, only one or no testicles are palpable. To determine which testicle is retained, move the descended testicle into the inguinal canal to see which side it enters. If a testicular tumor is present, the testicles will not be symmetrical and the affected testicle may be painful.
• Diagnostic tests - Extensive preoperative work-up is usually unnecessary for healthy young dogs and cats. PCV and a pre-anesthetic screen may be all that is indicated. If testicular neoplasia is suspected, thoracic radiographs are indicated to examine for metastasis.

ANESTHETIC CONSIDERATIONS

• Induction agents - There are no known contraindications to any induction agents other than barbiturates in sight hounds.
• Special anesthesia concerns - None

PREOPERATIVE PREPARATION

• Antibiotics - Not necessary
• Patient preparation - In dogs, the area just cranial to the scrotum is shaved and scrubbed. Be careful not to shave and scrub the scrotum, since superficial dermatitis will result. In cats, the hair on the scrotum is plucked and the scrotum is scrubbed.
• Positioning - The patient is placed in dorsal recumbency with legs securely fastened to the surgical table to prevent rotation during surgery.

SURGICAL TREATMENT

• Approach, suture and special instruments, procedure and technique - In dogs, an incision is made along the ventral midline just cranial to the scrotum. One testicle is pushed forward and the vaginal tunic is exposed by carefully incising through the subcutaneous tissues and deep fascia. The testicle can then be exteriorized through the incision. In a closed castration, the testicle remains within the tunic and the vessels and vas deferens are ligated together. Place hemostatic clamps on the vessels and vas deferens and remove the testicle by incising between the clamps. A full circumferential, followed by a transfixing ligature (distal to the circumferential ligature) are placed using absorbable suture material. In an open castration, the vaginal tunic is incised, exposing the testicle, vessels, cremaster muscle and vas deferens. After clamping the vessels and vas deferens, the testicle is removed. The vessels and vas deferens are then individually ligated as described for the closed castration. The procedure is then repeated on the other testicle. The subcutis is closed with absorbable suture and the skin is closed with surgical glue, intradermal closure with absorbable suture, non-absorbable suture or staples.
  
  In cats, an incision is made in the scrotum immediately over the testicle. Careful incisions through the subcutaneous tissue and deep fascia allow the testicle to be exposed through the incision. The vessels are ligated either with absorbable suture or by tying the vessels on themselves using a hemostat. The testicle must be removed from the spermatic cord before tying the cord on itself. The cord is severed and the testicle is removed. The procedure is repeated on the other testicle. The incisions are left open to heal by second intention.
  
  If the animal is cryptorchid, attempt to determine if the retained testicle is located in the inguinal canal or the abdominal cavity. If it is in the inguinal canal, and it cannot be pushed far enough caudally to be removed by the same incision as the normal testicle, make a separate incision over the retained testicle and remove it as described previously. If the testicle is in the abdominal cavity, either a paramedian or ventral midline incision is required. If the retained testicle is not immediately obvious, find the vas deferens by retracting the urinary bladder caudally to expose the prostate gland. The vas deferens are seen associated with the prostate. Follow the vas to the retained testicle. Ligate the vessels and vas deferens with absorbable suture, and then excise the testicle. The abdominal incision is routinely closed.

PAIN MANAGEMENT

Analgesics are recommended to speed recovery. Buprenorphine, butorphanol, morphine and ketoprofen are commonly used.

POSTOPERATIVE CARE

• During hospitalization - A warm, dark, quiet area is recommended during recovery immediately following surgery. Analgesics are recommended during the hospital stay.
• Home care - Activity and exercise should be restricted to reduce the risk of dehiscence or scrotal hematoma or seroma. Some animals may benefit from continued analgesics. An Elizabethan collar may be necessary for those animals that persistently lick or chew at the incision.
• Long-term care/convalescence - Not necessary. Most animals return to normal activity and behavior in three to five days following surgery.

POTENTIAL COMPLICATIONS

Possible complications include dehiscence, peritonitis, incisional infection and hemorrhage causing either a scrotal hematoma or seroma.

PROGNOSIS

The prognosis following castration is excellent. Complications are rare.

FOLLOW-UP

If skin sutures were used, suture removal is necessary 10 to 14 days following surgery. At this time, the animal is examined. Further follow-up is usually not necessary. If the castration was performed for non-reproductive reasons, further treatment and/or monitoring may be necessary.