Pinellas County Animal Services News
Detailing the Scrotal Approach to Canine Orchiectomy
With the growing popularity of implementing the scrotal approach to orchiectomy, I thought it was fitting to review and educate those unfamiliar with this procedure. Patients who have undergone this procedure may be showing up more and more frequently in clinics across Pinellas County and across the country for that matter. This procedure is currently the preferred technique where I work at Pinellas County Animal Services, so I speak from experience when I say it is a very beneficial technique, and one that may be finding its way into general practice more and more in the near future. So why is it that prescrotal castrations are performed on dogs by the mass majority of practicing veterinarians while many other species including cats, sheep, goats, pigs, horses, bulls and exotic pets routinely undergo scrotal castrations? According to an article by Phil Zeltzman, DVM, DACVS, CVJ “here’s the answer: there is no good reason other than habit, comfort, status quo and possibly a few misconceptions.” So let’s work through the procedure as well as similarities and differences and the pros and cons of the scrotal technique.
The first and potentially the most important part of the scrotal approach is the surgical preparation of the patient. When shaving the surgical site it is important to use small clippers with a sharp blade. It is imperative to avoid razor burn or laceration while shaving. Doing this can lead to a much higher incidence of self-mutilation post operatively. It is better for the patient to leave a small amount of hair around the length of a five o’clock shadow than to cause micro abrasions which can allow bacterial infiltration and secondary infection.
The surgical approach is very straight forward. Isolate the first testicle to be removed and make a small incision (usually approximately 1/3 the length of the testicle itself) either over or just adjacent to the median raphe. Once the testicle is exteriorized and the tissues are stripped down to reveal the isolated spermatic cord, your preferred surgical technique (open vs closed, single vs double ligation, etc.) may be implemented. Once the testicle has been severed from the cord, confirm hemostasis and return to the body. Repeat the procedure with the second testicle.
As far as the closure is concerned there are a few basic schools of thought. On one hand some surgeons prefer to leave the incision open to heal by second intention or partially open with only one or two subcutaneous sutures tacking it closed. Both techniques allow for some drainage. The other approach is to close completely using skin glue and or intradermal sutures allowing no drainage to occur. Unfortunately there have not been sufficient studies to determine the “ideal” closure technique. At this point it comes down to surgeon’s preference until further research is done. I prefer to allow some drainage as I have found a seemingly lower incidence of seroma or scrotal hematoma formation however I urge anyone interested in performing the scrotal approach to explore the closure options for themselves.
While there are many pros to this technique delineated in a recent Clinician’s Brief article put out by the University of Florida, only one drawback was listed. That is the possibility of postoperative drainage. They denote that this can be managed by performing a splash block of epinephrine and lidocaine (mixed in a ratio of 1 to 9, respectively) for added analgesia and vasoconstriction. Another few tricks would be to apply a pressure bandage for a brief period of time postoperatively, ice the surgical site, ALWAYS keep an Elizabethan collar on the patient, consider scrotal ablation when indicated, and consider keeping the patient overnight to ensure inactivity. The pros which were mentioned in this article consisted of reduced surgical and anesthetic time, reduced suture material, smaller incision, less pain and self-trauma, elimination of risk of urethral ligation/laceration/suturing, easy identification of postoperative hemorrhage, lower incidence of scrotal hematoma formation, and reduced likelihood of seroma formation.
In summation, the scrotal approach to orchiectomy should start to become well known to all veterinarians in the years to come. Becoming informed now as to how the procedure is done, its pros, and its cons will help to further your knowledge of veterinary medicine, and prepare you for when you may be presented with a pet that has undergone this procedure. As a bonus, hopefully some of you will give the procedure a try for yourself! Your staff, clients, patients, and even your clinic operating budget may greatly benefit from it.
Erik Pindar, DVM
Pinellas County Animal Services