Reproductive Disorders PDF

Reproductive Disorders 24 CHA P TE R Patricia A. Schenck...

Reproductive Disorders 24 CHA P TE R Patricia A. Schenck C. Specimen collection PROSTATE GLAND DISORDERS 1. Ejaculate specimen I. Clinical signs a. The dog should be handled in a quiet A. Clinical signs are varied. Systemic signs include environment, and exposure to a female in depression, anorexia, and vomiting. Hematuria or estrus may be helpful blood dripping from the prepuce are the most b. Advantages are that this technique is safe, common clinical signs inexpensive, easy to perform, and gives B. Other clinical signs include urethral discharge, specimens for bacterial culture stranguria, fecal tenesmus, diarrhea, recurrent c. Disadvantages are that this specimen is urinary tract infection, abdominal distension, not useful for cytology, a positive bacterial caudal abdominal pain, lumbar pain, hindlimb culture does not localize the disease, and stiffness, hypertrophic osteopathy, hindlimb the animal must be compliant pitting edema, urinary incontinence, infertility, 2. Prostatic wash specimens are useful for impaired libido, perineal tumor, sepsis, or microbiology and cytology testicular tumor a. Urine or urethral contamination may II. Physical examination occur, and if there is concurrent bacterial A. Rectal examination is essential. Palpate ventrally cystitis, microbiology results cannot be for the prostate and dorsally for lymph nodes interpreted B. Evaluate the prostate gland for size, location, b. Rectal massage may not reach the prostate symmetry, pain. Normally the prostate is symmet- and can rupture a prostatic abscess ric, bi-lobed, within the pelvis, moveable, and not 3. Urethral brush specimen painful. As the prostate enlarges, it may move cra- a. Advantages include localization, urethral nially; thus, concurrent abdominal palpation is contamination is minimized, and useful sometimes useful cytologic and microbiologic information is C. Abdominal palpation may reveal the presence of obtained a mass, distension, or pain b. However, the specimen brush cannot be III. Diagnostic tests reused, so the technique is expensive, the A. Laboratory findings prostate gland may not be reached for effec- 1. Neutrophilic leukocytosis is often associated tive rectal massage, and vigorous massage with bacterial prostatitis. Increased alkaline may rupture an abscess phosphatase (ALP) may accompany bacterial 4. Ultrasound-guided prostatic aspirate uses prostatitis or neoplasia ultrasound to guide the insertion of a needle 2. Urine sediment examination or culture may be into the prostate gland negative in dogs with bacterial prostatitis or a. Advantages are that it localizes the source abscess of bacterial infection and is relatively safe 3. Prostatic fluid cytology or culture is necessary b. Disadvantages are that sedation and for diagnosis of bacterial prostatitis anesthesia are usually necessary, special- B. Imaging ized equipment and skill is required, and 1. Abdominal radiography may reveal associated aspiration of an abscess or tumor can lead disorders such as prostate enlargement or to peritonitis or seeding the abdomen with asymmetry, mineralization, lymph node en- neoplastic cells largement, bone periosteal reactions, urine or 5. Prostate gland biopsy fecal retention a. Evaluate coagulation status 2. Iliac lymph node enlargement and prostate b. Approaches include transperineal, transab- mineralization are often associated with pros- dominal, laparotomy, laparoscopy tatic neoplasia c. Sedation or anesthesia is necessary 3. Ultrasound examination may evaluate prostate d. If ultrasound is not available, biopsy size and location and help to obtain biopsy through laparotomy is the most accurate specimens technique 342  CHAPTER 24 Reproductive Disorders 343 IV. Disorders H. Prostatic neoplasia A. Benign prostatic hyperplasia (BPH) 1. Adenocarcinoma and transitional cell carci- 1. BPH is the most common prostate disorder noma are most common 2. Dihydrotestosterone is the main androgen 2. Castration does not prevent the development promoting hyperplasia of prostatic tumors 3. Castration is an effective treatment 3. Metastasis to lymph nodes, bones, and organs 4. Megestrol acetate or finasteride can be used in is common breeding dogs without a loss of fertility 4. Intraoperative radiation therapy is the treat- 5. Estrogens should not be used ment of choice but is not recommended if 6. Delmadinone acetate, an androgen inhibitor, metastases are present can be used but is contraindicated for 5. Prostatectomy is associated with complica- breeding dogs tions including urinary incontinence and B. Cystic hyperplasia urethral stricture 1. Multiple fluid-filled cysts result from 6. Castration is of questionable benefit, and obstruction of glandular excretory ducts chemotherapy is not effective 2. Usually associated with BPH and squamous 7. Total androgen blockade with luteinizing metaplasia hormone (LH)–releasing hormone, or C. Squamous metaplasia ketoconazole has benefit by blocking 1. Caused by estrogen stimulation either from an androgen synthesis exogenous source or a Sertoli cell tumor V. Surgical highlights 2. Castration is the treatment of choice. Discon- A. The hypogastric and pelvic nerves are closely as- tinue any exogenous source of estrogen sociated with the vasculature and are necessary D. Prostatic infection for micturition and continence. Avoid damage to 1. Infection is usually ascending, and causes are these nerves during any surgical procedure prostatic hyperplasia or cysts, urinary tract B. The prostate gland encompasses the male urethra infections, altered urine flow, urethral abnor- at the neck of the urinary bladder malities, or immune dysfunction C. The prostate is found in the pelvic cavity until 2. Escherichia coli, Staphylococcus, Proteus mirabi- about 4 years of age and is entirely within the lis, Streptococcus, and Mycoplasma are the most abdomen by about 10 years of age common causes D. Surgical procedures require a ventral midline 3. Fungal organisms such as Blastomyces, Crypto- incision coccus, or Coccidioides can also cause prostatitis E. Urinary incontinence is common with total 4. Antibiotics for treatment should be lipid soluble prostatectomy to penetrate the prostate. Most effective antibi- F. If prostatectomy is performed because of pros- otics include trimethoprim-sulfa, clindamycin, tatic neoplasia, metastasis is common to the enrofloxacin, erythromycin, chloramphenicol, median iliac lymph nodes, periprostatic tissue, and oleandomycin. Antibiotics should be given urinary bladder, pelvic structures, and lung for a minimum of 4 weeks 5. A good initial treatment choice is trimethoprim- DISORDERS OF THE TESTES sulfa, enrofloxacin, or chloramphenicol 6. Evaluate patient for septicemia or peritonitis I. Clinical signs 7. Castration decreases the potential for recur- A. Infertility is common. There may be no clinical rence but should not be performed until the signs patient has been receiving antibiotics for a B. Pain and inflammation may be caused by infec- few weeks tion, trauma, torsion, or immune-mediated dis- E. Idiopathic prostatitis ease. Swelling or a stiff gait may be noted, and 1. Cause is unknown, but the signs are similar to licking of the scrotum may be observed those of bacterial prostatitis C. Feminization may result from Sertoli cell tumors 2. Castration is probably beneficial. Antibiotics, II. Physical examination corticosteroids, anticholinergics, and muscle A. Two equal-sized and shaped testicles should be relaxants have been used palpable in the scrotum. Testicular size can vary F. Paraprostatic cysts with breed and individuals 1. Paraprostatic cysts are adjacent to the pros- B. Cryptorchidism is diagnosed on physical tate gland and result from fluid accumulation examination. Undescended testicles may often in embryologic remnants be found lateral to the prepuce or in the 2. Surgery is recommended. Antibiotics may also inguinal area be needed if there is septicemia or peritonitis C. An enlargement of one testicle suggests neopla- G. Prostatic abscesses sia, granuloma, spermatocele, varicocele, inflam- 1. Abscesses occur as a sequel to infection with mation, or torsion obstruction of excretory ducts or as second- III. Diagnostic tests arily infected cysts A. Laboratory tests aid in the diagnosis of inflamma- 2. Surgery is recommended. Antibiotics may also tory diseases, infectious diseases, neoplasia, and be needed if there is septicemia or peritonitis infertility 344 SECTION II SMALL ANIMAL B. Brucellosis testing b. Contamination from the urogenital tract can 1. Usually tested using rapid slide agglutination test occur 2. False-positives occur, so positive results c. With infection, there should be more than should be confirmed by serology 105 colony-forming units/mL. Chronic C. Imaging: Ultrasound evaluation can detect infections can yield negative cultures undescended testicles or tumors E. Fine-needle aspiration and biopsy D. Semen evaluation 1. Can reveal organisms, inflammatory cells, 1. Collection of semen neoplasia, sperm. Chronic inflammation a. Semen collection is relatively easy in the makes collection of fine-needle aspirates dog but difficult in the cat difficult b. Retract the prepuce caudally and manually 2. Biopsy is indicated to investigate azoospermia stimulate the penis. Collect semen using an if no other cause is found. Orchitis is an artificial vagina or into a sterile cup uncommon complication c. There are three fractions to a canine F. Testicular feminization syndrome. Demonstrate ejaculate bilateral testes, XY chromosomal status, and (1) First: Small volume or clear prostatic positive response to human chorionic fluid gonadotropin (2) Second: Milky white sperm-rich fluid IV. Congenital disorders (0.5 to 5 mL) A. Cryptorchidism (3) Third: Large volume of clear prostatic 1. Common hereditary disorder. Toy breeds, fluid boxers, German shepherd dogs, and Persians d. Do not collect semen from an animal with are predisposed obvious inflammation of the testes 2. Unilateral is more common than bilateral. 2. Color, consistency, and cytology Bilateral cryptorchidism causes sterility a. Presence of blood may indicate a traumatic 3. Castration is the treatment of choice collection or prostatic disease B. Male pseudohermaphroditism. Dogs have XY b. A nonopaque second fraction indicates oli- chromosomes, testes (usually cryptorchid), and gospermia, and flecks of discolored debris external or internal female genitalia are consistent with purulent material C. Testicular feminization syndrome c. An air-dried slide of semen can be stained. 1. Dogs have XY chromosomes but partial or Inflammatory cells or organisms may be complete failure of masculinization identified 2. Castrate: This is an X-linked inherited trait, 3. Sperm count so 50% of male offspring from a female carrier a. Use of hemocytometer to determine the are affected, and 50% of female offspring are number of sperm per milliliter of ejaculate. carriers Multiply by the volume of the ejaculate to V. Acquired disorders of the testes determine total sperm count A. Infectious orchitis-epididymitis b. A normal ejaculate contains more than 1. Can arise from trauma, hematogenous spread, 200 million sperm cells urinary tract, or prostate 4. Motility and morphology 2. Aerobic bacteria are the most common. a. Evaluate a drop of ejaculate placed on a Brucella canis is also an important cause. warm microscope slide; 70% of sperm Mycoplasma, Blastomyces, canine distemper should be motile virus, feline infectious peritonitis, and b. Morphologic abnormalities should not be rickettsial infections may also occur present in greater than 20% of sperm 3. Castration and antibiotic therapy are curative c. Primary abnormalities include cytoplasmic 4. Brucellosis is not always eradicated even if droplets, thickened midpiece, or misshaped long-term antibiotic therapy is used. These heads. Distal cytoplasmic droplets may dogs should be castrated indicate epididymal disease B. Immune-mediated orchitis: An immune response d. Secondary abnormalities such as coiled or to spermatozoal antigens occurs when the bent tails or detached heads occur in the blood-testis barrier is broken. Orchitis results epididymis and distally with lymphocytic infiltration of the testes 5. Semen ALP C. Testicular neoplasia a. Epididymis produces ALP, and a low activity 1. Common in dogs; uncommon in cats. More in semen indicates the absence of epididy- common in cryptorchid dogs mal fluid 2. Primary tumors include Sertoli cell, interstitial b. Azoospermia can result from blockage of cell tumors, and seminoma. They are typically the epididymis. Normal semen ALP is above slow to metastasize and are usually an inciden- 4000 international units per liter tal finding in older dogs 6. Semen culture 3. Sertoli cell tumors can cause feminization, a. To diagnose infectious orchitis-epidiymitis, including hair loss, testicular atrophy, and use either semen sample or testicular squamous metaplasia of the prostate fine-needle aspirate 4. Castration is the treatment of choice  CHAPTER 24 Reproductive Disorders 345 D. Trauma can lead to inflammation or ischemia D. Drug eruption E. Testicular torsion E. Trauma 1. Can occur in descended or undescended testes F. Self-mutilation associated with orchitis, 2. There is an acute onset of pain with swelling of granuloma, or pruritus the testicle and spermatic cord G. Scrotal hernia in which abdominal contents 3. Castration is the treatment of choice herniated through a defect in the inguinal ring. F. Secondary testicular disorders occur secondary Swelling in the scrotum is noted, and strangula- to endocrine diseases such as hypothyroidism, tion of the hernia can cause severe pain diabetes mellitus, and hyperadrenocorticism II. Diagnosis and treatment G. Other testicular diseases A. Identify the underlying cause via thorough 1. Spermatocele is a dilation of the duct system medical history and appropriate testing that contains sperm. It is usually benign B. Ultrasound may help identify tumors, scrotal 2. Varicocele is a dilation of the spermatic vein. It hernia, or testicular adhesions can be benign but may thrombose C. Scrotal hernia repair includes castration and 3. Sperm granuloma develops when sperm cells closure of the defect in the inguinal ring accumulate in the spermatic ducts D. Scrotal ablation may be performed in the case of VI. Surgery severe lesions A. Anatomy III. Surgery 1. In the scrotum, the testis is covered by perito- A. Indications include trauma, neoplasia, ischemia, neum (parietal and visceral vaginal tunics) and abscess, orchidectomy in older dogs, and the tunica albuginea (a white fibrous capsule) urethrostomy 2. The caudal ligament connects the testis and B. Surgery is done with the animal in dorsal recum- epididymis to the parietal vaginal tunic bency. The skin is incised in an elliptical, curvilin- 3. The pampiniform plexus in the spermatic cord ear fashion near the base of the scrotum. Transect is the major blood supply the scrotal septum and close the subcutaneous B. Orchidectomy in the dog tissue and skin 1. When testes are in the scrotum, either a closed C. Postoperative analgesia should be considered, or open technique can be used and self-inflicted trauma should be minimized. a. Make the incision in the prescrotal skin on Complications include hemorrhage, infection, and the midline. Expose the testes either by dehiscence leaving the parietal vaginal tunic intact or by incising through it DISORDERS OF THE PENIS AND PREPUCE b. Double-ligate the spermatic cord using absorbable material I. Clinical signs may include preputial discharge, hem- c. Transect and close the subcutaneous tissue orrhage, abnormal urination, pain, swelling, inflam- and skin using absorbable sutures mation, persistent erection, or failure to copulate 2. Cryptorchidism II. Physical examination should also include a rectal a. Make an incision on the ventral midline examination from the umbilicus to pubis while avoiding A. The prepuce should move freely, and the penis the prepuce should be easily extruded. There should be no b. Locate the intraabdominal testis pain. A small amount of greenish discharge is c. Double—ligate the vessels and ductus normal in dogs but not in cats deferens B. The penis should be moist, light pink, with a pal- d. Transect and remove the testis pable os penis in dogs. Fractures of the os penis e. Routine closure of the abdomen may be palpable. In cats, sedation may be 3. Complications include bruising, inflammation needed. The intact male cat should have small of the scrotum, hemorrhage, or infection barbs on the penis C. Orchidectomy in the cat 1. Investigate any swelling, and in cases of 1. Incise the scrotum and expose the testis trauma, pass a urethral catheter to assess 2. Ligate the spermatic cord either with absorb- patency able suture material or with the spermatic 2. If the penis is erect, determine whether the pre- cord itself puce is restricting the retraction. The preputial 3. Remove the testis skin may be inverted, or there may a ring of 4. Do not suture the scrotum hair encircling the penis. If there is no preputial restriction, try applying a cold compress III. Diagnostic tests DISORDERS OF THE SCROTUM A. Tests may include complete blood cell count I. Causes (CBC), serum chemistries, urinalysis, cytology, A. Contact dermatitis from soaps and other imaging, or karyotype analysis substances B. With balanoposthitis, large numbers of bacteria, B. Neoplasia such as squamous cell carcinoma, mast toxic neutrophils, or fungal organisms may be cell tumor, malignant histiocytic disease identified on cytology. Cytology may also reveal C. Environmental injury from frostbite or sunburn neoplastic cells 346 SECTION II SMALL ANIMAL C. Culture of the preputial discharge is usually not B. Trauma helpful 1. Damage may be evident, or there may only be D. Radiographs may reveal a fractured os penis. signs of swelling, inflammation, and pain Contrast retrograde urethrography can evaluate 2. Clean and suture as needed. Systemic antibiot- the patency of the urethra ics should be used in the case of open wounds. E. Karyotype analysis requires fresh blood submit- The penis should be extended two to three ted in lithium heparin and may be necessary for times per day and cleansed with dilute sex differentiation disorders chlorhexidine to prevent adhesions. Ensure IV. Congenital disorders are uncommon. Clinical patency of the urethra signs result from the inability to extend the penis C. Foreign body out of the prepuce or the inability to retract the 1. Can include plant material and other small ma- penis terials and can result in swelling, inflammation, A. Persistent penile frenulum and balanoposthitis 1. This condition results when the surface of 2. Objects may become lodged in the prepuce or the glans penis and the preputial mucosa fail may encircle the penis, resulting in constriction to separate along the ventral midline. This D. Neoplasias are uncommon leaves a thin band of connective tissue 1. Transmissible venereal tumor (TVT) is seen joining the ventral midline of the penis and in young dogs as a red, irregular mass on the prepuce penis. It is sexually transmitted and can also 2. The penis is unable to extend from the affect females. TVT may undergo spontaneous prepuce remission, or it may require treatment with 3. This band of tissue is not very vascular, and vincristine or radiation therapy treatment consists of surgically cutting the 2. Preputial tumors are usually mast cell tumors band and controlling any bleeding or TVT B. Hypospadia 3. Urethral tumors can involve the penis. 1. Abnormal closure of the urethral tube results Osteosarcoma of the os penis has been in abnormal urethral openings anywhere along reported the urethra. Commonly the abnormal opening E. Balanoposthitis is inflammation of the penis and is on the ventral penis, but it may extend prepuce through the scrotum to the perineum 1. Usually caused by bacteria, which can be sec- 2. Hypospadia is caused by an androgen receptor ondary to malformation, trauma, foreign body defect and may be associated with abnormal 2. May also be due to herpesvirus or fungal development of the penis and prepuce agents (blastomyces) 3. Most common in Boston terriers 3. Common in dogs but uncommon in cats C. Penile hypoplasia can occur with failure of mas- 4. Clean the prepuce with antiseptic, apply topi- culinization or XX sex reversal syndromes where cal antibiotic cream, and treat the underlying ambiguous genitalia are noted cause. An Elizabethan collar may be necessary 1. If androgens are present during development, to prevent licking female pseudohermaphroditism may result. F. Paraphimosis occurs when the penis is unable to Clitoral enlargement may mimic penile retract into the prepuce hypoplasia 1. Penile mucosa adheres to the prepuce, the pre- 2. Urine may pool with penile hypoplasia and puce rolls inward, and prevents the retraction cause irritation of the prepuce of the penis D. Phimosis occurs if the preputial opening is too 2. This can lead to edema, ischemia, and necrosis small to allow extension of the penis. Urine pools of the penis in the prepuce and causes irritation 3. Sedation or anesthesia may be necessary. E. Os penis deformity may result in deviation of the Cleanse and lubricate the penis, and remove penis and cause problems with copulation constricting hair or foreign material. Apply a V. Acquired penile disorders cool compress to reduce edema, and restore A. Priapism is persistent, abnormal penile erection the normal anatomic position of the penis. If 1. Priapism is a medical emergency. Stasis of the there is mucosal damage to the penis, apply blood due to failure of venous outflow from the topical antibiotic cream erect penis can lead to ischemia and necrosis 4. If the damage to the penis is severe, amputa- 2. Protect the penis against exposure and damage tion may be necessary with frequent applications of sterile lubricant. Replace the penis in the prepuce and apply a DISORDERS OF THE OVARIES AND UTERUS temporary pursestring suture at the orifice if necessary I. Disorders of the ovaries 3. If nonischemic, antihistamines or anticholiner- A. Ovarian remnant syndrome gics such as diphenhydramine, atropine, or 1. Results from incomplete removal of all ovarian benztropine can be used. Advanced ischemia tissue at time of ovariohysterectomy and necrosis may require amputation of the 2. Signs of estrus recur between 1 and 3 years penis after ovariohysterectomy  CHAPTER 24 Reproductive Disorders 347 3. High progesterone or low LH concentrations in 6. Intense contractions should produce a puppy a spayed female suggest an ovarian remnant or kitten in less than 20 minutes 4. Treatment is to remove the ovarian remnant 7. Placentas may be delivered with each fetus or B. Ovarian neoplasia might not be delivered until the entire litter 1. Cause has been born a. Dogs: Granulosa cell tumors (associated 8. A dark green discharge is common during and with hyperestrogenism), adenoma, adeno- following labor carcinoma, germ cell tumors D. Dystocia b. Cats: Granulosa cell tumors, teratoma 1. Causes 2. Clinical signs may be absent. Granulosa cell a. Dystocia is common in dogs. Toy breeds tumors may cause signs of increased estrogen, and brachycephalic breeds are predisposed such as persistent estrus, and gynecomastia because of their large heads and small 3. Abdominal radiography/ultrasound aids in the pelvic canals diagnosis b. In cats, the Devon rex is predisposed 4. Treatment is ovariohysterectomy c. Uterine inertia may be common in some II. Diseases of the uterus breeds. It may be due to fatigue, hypoglyce- A. Pyometra mia, hypocalcemia, or an unknown cause 1. Bacteria from the lower genital tract can d. Oversized puppies can be a cause of dysto- ascend into the uterus causing infection. The cia. Oversized puppies may be more preva- most common bacteria is E. coli lent in single pup or small litters 2. Previous treatment with estrogens or proges- 2. Diagnosis: History, physical examination, and tins may predispose radiographs or ultrasound are most important 3. Clinical signs 3. Treatment a. Vaginal discharge with a history of estrus in a. If there is no obstruction, oxytocin therapy the preceding weeks should raise suspicion can be attempted. If fetus not delivered for pyometra. Vaginal discharge may not be within 30 minutes, perform cesarean section present in all cases though b. Cesarean section should be done if there is b. General signs of systemic illness are often uterine inertia, there has been failure to present (e.g., depression, dehydration, respond to oxytocin, there is evidence of an polyuria, vomiting, inappetence) oversized fetus, there is evidence of fetal 2. Diagnosis is based on history, clinical signs, death, or the female has become hypcalce- radiography, CBC showing neutrophilia, and mic or hypoglycemic vaginal cytology and culture E. Postpartum uterine disorders 3. Treatment 1. Bacterial metritis a. Fluid therapy should be aggressive and a. Occurs usually within a week after parturi- antibiotic therapy broad-spectrum tion and is characterized by a foul-smelling, b. Ovariohysterectomy is the best method of mucopurulent discharge. Systemic illness treatment may be present c. Prostaglandin therapy can be used in a b. Perform abdominal ultrasound or obtain valuable breeding female. Use of prostaglan- radiographs to detect retained fetuses dins increases the risk of pyometra during c. Ovariohysterectomy and antibiotic therapy subsequent estrous cycles are necessary B. Diseases of the pregnant uterus 2. Uterine prolapse 1. Diseases during pregnancy can result in a. Rare but can occur postparturition abortion b. Treatment is manually to reduce the 2. In dogs, infectious diseases caused by B. canis prolapsed tissue or to remove it if ulcerated and herpesvirus are most important. In cats, or necrotic feline panleukopenia virus and herpesvirus are 3. Subinvolution of placental sites most important a. Uterine involution is usually complete by 3. Most affected animals have no clinical signs 6 weeks postpartum in the dog but may last other than abortion for 3 months. A mucoid, brownish or hem- C. Normal parturition orrhagic vaginal discharge is normal. Persis- 1. Refusal of food and nesting behavior typically tent bleeding for longer than 6 weeks is the precedes parturition typical clinical sign 2. Active contractions start about 6 to 12 hours b. Usually resolves without treatment later F. Uterine neoplasia 3. Delivery of the first puppy or kitten occurs 1. Tumors are rare in dogs and cats about 2 to 4 hours after contractions start 2. In the dog, leiomyoma and leiomyosarcoma are 4. It is not abnormal for a puppy or kitten to be the most common. In the cat, endometrial ade- born feet first nocarcinoma is most common 5. Deliveries can occur in rapid succession, 3. Tumors may be found incidentally or may cause or there can be about 2 hours between vaginal discharge or bleeding in some animals births 4. Ovariohysterectomy is the treatment of choice 348 SECTION II SMALL ANIMAL III. Surgery of the ovaries and uterus C. Cesarean section (Figure 24-2) A. Anatomy (Figure 24-1) 1. Ventral midline incision. Incise cautiously to 1. The ovaries are located caudal to the kidneys avoid lacerating the large uterus and are attached to the abdominal wall by 2. Exteriorize the uterus and incise in an the mesovarium. The suspensory ligament avascular area extends between the last two ribs and the 3. Move the fetus to the incision with gentle ovary. The proper ligament extends from the squeezing of the uterine horn ovary to the uterine horn. The blood supply 4. Remove fetus, remove the amniotic sac, and to the ovaries is through the ovarian arterio- tie off the umbilical vessels venous complex on the medial side of the 5. Close the uterus with absorbable suture broad ligament material in an inverting suture pattern 2. The uterus is attached to the abdominal wall 6. Lavage the uterus before returning to the by the broad ligaments. The round ligament abdominal cavity, and lavage the abdominal extends through the broad ligament and cavity if any contamination with uterine passes through the inguinal canal. The blood contents occurred supply to the uterus is mainly from the uterine 7. Complications branch of the internal iliac artery a. Puppies may be depressed from the B. Ovariohysterectomy anesthetic agents used. They may need a 1. The incision should be started at the umbilicus respiratory stimulant such as doxapram. and extend caudally down the ventral midline Keep puppies warm, and have them nurse in the dog. In the cat, the incision should be as soon as possible started a few centimeters caudal to the b. Hemorrhage, peritonitis, dehiscence, or aga- umbilicus lactia are the most common complications 2. Make sure to clamp and ligate the blood sup- ply to the ovaries. Avoid ligating the ureters. DISORDERS OF THE VULVA, Ensure that all ovarian tissue is being VESTIBULE, AND VAGINA removed 3. Remove the uterus proximal to and close to I. Congenital abnormalities: These conditions may the cervix prevent natural breeding, or they may contribute to 4. Complications chronic infections of the urinary or reproductive a. Hemorrhage is the most common tracts complication A. Vulvar hypoplasia b. Uterine stump pyometra can occur if a 1. A small vulva frequently is not associated with portion of the uterine body is not removed any clinical abnormalities c. Ovarian remnant syndrome can result 2. If perivulvar skin folds surround and recess if the ovarian tissue is not completely the vulva, inflammation and bacterial growth removed can occur d. Accidental ureteral ligation leads to hydro- 3. Secondary vaginitis, cystitis, or ascending nephrosis urinary tract infection can occur e. Urinary incontinence can occur in some 4. Topical or systemic antibiotics are used to females treat secondary infection Uterine body Cervix Suspensory ligament Uterine vessels Ovarian bursa Uterine horn Ovarian arteriovenous complex Proper ligament of the ovary Ovary Figure 24-1 Anatomy of the uterus and ovaries. (From Birchard SJ, Sherding RG. Saunders Manual of Small Animal Clinical Practice, 3rd ed. St Louis, 2006, Saunders.)  CHAPTER 24 Reproductive Disorders 349 A B C Figure 24-2 Cesarean section. A, Move the fetus toward the incision. B, Break the amniotic sac as the fetus is removed. C, Clamp and transect the umbilical vessels. (From Birchard SJ, Sherding RG. Saunders Manual of Small Animal Clinical Practice, 3rd ed. St Louis, 2006, Saunders.) 5. Episioplasty to excise excessive perivulvar skin 4. Clinical signs that may be associated are chronic folds is the treatment of choice if secondary vaginitis, discharge, cystitis, or urine pooling infections occur 5. Bands of tissue can be easily removed. B. Vulvar stenosis Complete resection of an annular stricture 1. Most common in collies and Shetland sheepdogs is difficult and time consuming 2. Common clinical sign is pain during mating II. Clitoral hypertrophy 3. Vulvar stenosis can result in dystocia, and a A. The clitoris may be enlarged with hyperadreno- cesarean section may be needed corticism, exposure to anabolic steroids, or disor- 4. Treatment is to enlarge the vulvar orifice by ders of sexual differentiation episiotomy B. Inflammation of the clitoris can lead to secondary C. Vestibulovaginal stenosis (persistent hymen) urinary tract infections 1. Persistent vertical bands of tissue at the vestib- C. Treatment is to treat the underlying cause, and ulovaginal junction, common at the cingulum any secondary problems. Clitoral resection can 2. May be due to incomplete fusion of parameso- also be performed nephric ducts III. Vulvar enlargement 3. Commonly seen in association with develop- A. Swelling is normal during estrus, but persistent mental abnormalities of the lower urinary tract swelling may suggest estrogenic stimulation from 350 SECTION II SMALL ANIMAL cystic ovaries or ovarian tumor in the intact B. Diagnosis involves physical examination, vaginal female or an ovarian remnant in a spayed female. cytology, urinalysis, culture and sensitivity, and Ovarian remnants are more common in cats possibly endoscopy or ultrasound B. Vaginal cytology suggests estrogenic stimulation C. Treatment with mostly superficial and anuclear squamous 1. Juvenile vaginitis usually resolves without cells. Serum estradiol or progesterone may be treatment elevated 2. Bacterial vaginitis may resolve with no treat- C. Treatment is to identify the source directly by ex- ment. Medical treatment involves appropriate ploratory laparotomy antibiotics IV. Vaginal edema (vaginal hyperplasia) 3. There is no specific therapy for viral vaginitis. A. Normally occurs during the follicular phase of the Affected females should not be used in a estrous cycle, and spontaneously regresses in breeding program diestrus B. May become inflamed, ulcerated, or necrotic if INFERTILITY AND BREEDING there is protrusion of the vaginal tissue through DISORDERS AND ISSUES the vulvar orifice C. Occurs most frequently in young females during I. Female dog their first estrus cycle A. Normal estrous cycle D. Keep proliferative tissue lubricated to prevent 1. Anestrus drying. Ovariohysterectomy for dogs not a. The period between estrous cycles intended for breeding b. Low progesterone levels, high follicle- V. Vaginal prolapse stimulating hormone (FSH) levels. A. Relatively uncommon, but the Boston terrier and c. Between 4 to 18 months in duration is normal boxer breeds appear to be predisposed 2. Proestrus B. May result from dystocia a. Characterized by bloody vaginal discharge C. The protrusion has a doughnut appearance. This and vulvar swelling should be differentiated from vaginal edema b. Low progesterone levels, rising estrogen D. Keep clean and lubricated. Manually reduce the levels exposed tissues if possible. A hyperosmotic c. Typically lasts between 3 and 14 days solution (50% dextrose) can be applied to help 3. Estrus reduce edema a. Starts when ovulation occurs and the E. Ovariohysterectomy should be performed in female allows breeding females not intended for breeding b. Ovulation occurs as the progesterone level F. Surgical resection of ulcerated or necrotic tissue starts to increase, resulting in LH release may be necessary c. The vulva becomes soft, and there is a clear VI. Neoplasia (or slightly bloody) discharge A. Leiomyoma is the most common neoplasm. d. Lasts about 6 days Lipomas may also occur 4. Diestrus B. Leiomyosarcoma is the most common malignant a. Lasts about 2 to 4 months if not pregnant, neoplasm. Others include squamous cell about 8 weeks if pregnant carcinoma, adenocarcinoma, mast cell tumors, b. Progesterone levels gradually decrease hemangiosarcoma, and hemangiopericytoma. c. Vaginal smear shows a change to parabasalar C. Transmissible venereal tumor (TVT) and intermediate cells, with the appearance 1. Proliferative tumor transmitted by sexual of white blood cells contact between animals B. Abnormal estrous cycle 2. More common in younger, sexually active dogs 1. Persistent anestrus (failure to cycle) 3. May be solitary or multiple friable or a. Normal females may not cycle until cauliflower-like lesions 24 months of age 4. May be found on the oral and nasal mucosa, b. Evaluate thyroid function, cortisol produc- skin, and perineum tion, and progesterone concentration D. Complete resection is treatment of choice. c. If normal, perform karyotyping, and Chemotherapy (vincristine) is the treatment of consider endoscopy choice for multiple TVT 2. Prolonged anestrus after an estrus cycle VII. Vaginitis a. If longer than 12 months, evaluate thyroid A. Causes function, cortisol production, and proges- 1. Juvenile vaginitis generally occurs in female terone concentration dogs before the first estrus, and it usually b. Consider endoscopy to rule out ovarian resolves without treatment abnormalities, especially ovarian cysts 2. Bacterial vaginitis is uncommon but may occur 3. Split estrus cycle secondary to urinary tract infection a. The bitch enters proestrus but does not 3. Viral vaginitis is caused by herpesvirus and ovulate can result in infertility, abortion, and neonatal b. In about 4 to 6 weeks, the bitch will recycle death and ovulate  CHAPTER 24 Reproductive Disorders 351 c. Progesterone testing is useful in determin- D. Prebreeding evaluation ing ovulation in dogs with split cycles 1. Physical examination of both male and female 4. Silent estrus 2. Both should be parasite-free, have current a. A bitch can ovulate with no apparent signs vaccinations, and on heartworm of estrus preventative b. Vaginal smears and serum progesterone 3. Vaginal culture is not necessary if there are no determinations are helpful in determining clinical signs the time of ovulation 4. Brucellosis testing 5. Shortened anestrus a. The female should be tested before each a. About 4 months is needed between cycles mating (even before the first mating). b. If the breeding cycle is less than 4 months, Frequently used males should be tested infertility is common every 6 months c. Mibolerone can be given daily to delay the b. Rapid slide agglutination test is commonly onset of the estrous cycle used but can have 20% false-positives 6. Prolonged estrus c. If testing positive, the dog should be a. Common in young bitches having their first isolated and a confirmatory test performed estrous cycle (e.g., immunodiffusion, blood culture) b. If this occurs in older bitches, then an E. Pregnancy diagnosis estrogen-secreting ovarian cyst is a possibility 1. Ultrasound is useful after day 19 post- c. Vaginal cytology suggests estrogen as the ovulation cause of the bleeding (primarily superficial 2. Palpation is accurate within a narrow window cells) between day 23 and 30 posto vulation d. Rule out other causes of vaginal bleeding 3. Serum relaxin concentration: Serum relaxin C. Conception failure can be measured to predict pregnancy after 1. Poor semen quality: Check the stud dog for day 26 postovulation adequate semen production 4. Radiography 2. Ovulation failure: Use serum progesterone a. Useful after day 47 postovulation concentrations to pinpoint ovulation b. Commonly used to determine the number 3. Improper timing of breeding: Use serum pro- and size of pups gesterone concentrations to pinpoint ovulation F. Estrus induction 4. Improper breeding methods 1. A minimum of 4 months of anestrus is a. In the uterus and oviducts, fresh semen required lasts an average of 4 to 6 days, whereas 2. Both cabergoline and deslorelin can be used frozen semen only lasts about 12 to G. Artificial insemination 24 hours 1. Determine the time of ovulation b. A “tie” greatly increases the chance of 2. Ensure that sperm are viable and normal in conception but is not necessary appearance c. Semen must be deposited at the external 3. With the female standing, deposit semen at opening of the cervix the external opening of the cervix via an d. If the female refuses the male, ensure that insemination rod. Use aseptic technique, ovulation has taken place with serum pro- and wear sterile gloves. Digitally feather gesterone determination. Try changing the vestibule for about 1 minute, and the environment, or perform artificial restrict the activity of the female for a few insemination hours 5. Implantation failure 4. Artificial insemination may also be done trans- a. Implantation occurs about 17 to 18 days cervically or by surgical insemination directly after ovulation into the uterus b. Disease within the uterus can decrease H. Termination of pregnancy for mismating implantation 1. Drugs can be used to lyse the corpus luteum 6. Resorption and abortion during the second half of pregnancy a. Resorption of fetuses can occur up to day 2. Prostaglandin F2  or cabergoline (antiprolac- 38 postovulation tin drug) is used. Must confirm that all fetuses b. Numerous problems can cause resorption have been passed and death, including genetics, medications, II. Female cat disease, toxins A. Normal estrous cycle 7. Premature luteolysis 1. Anestrus: Cats are seasonally polyestrus and a. Progesterone is secreted by the ovary will continue to cycle throughout the year if throughout pregnancy and is required to not bred. Anestrus is longest when daylight is maintain pregnancy at a minimum b. Premature luteolysis may result in prema- 2. Proestrus ture loss of puppies a. Last 1 to 2 days c. Treat with an injectable progesterone b. Estrogen levels increase, and vocalization compound occurs 352 SECTION II SMALL ANIMAL 3. Estrus Supplemental Reading a. There is no vaginal bleeding b. The female accepts breeding by the male. Graves TK. Diseases of the testes and scrotum. In The penis of the male stimulates the vagina, Brichard SJ, Sherding RG, eds. Saunders Manual of Small resulting in LH release Animal Practice, 3rd ed. St Louis, 2006, Saunders, c. Multiple breedings are usually necessary to pp. 957-968. increase the chance of pregnancy Graves TK. Diseases of the penis and prepuce. In 4. Interestrous: If not bred, there is about a 5- to Brichard SJ, Sherding RG, eds. Saunders Manual of 14-day period before returning to proestrus Small Animal Practice, 3rd ed. St Louis, 2006, Saunders, 5. Diestrus: Progesterone concentration is pp. 973-977. elevated and lasts for about 60 to 65 days if Graves TK. Diseases of the ovaries and uterus. In pregnant and 45 to 50 days if not pregnant Brichard SJ, Sherding RG, eds. Saunders Manual of B. Ovulation induction: Ovulation can be induced by Small Animal Practice, 3rd ed. St Louis, 2006, Saunders, hormonal stimulation with gonadotropin-releasing pp. 978-991. hormone (GnRH), vaginal stimulation, or breeding Hutchison RV. Infertility and breeding disorders. In to a vasectomized male cat Brichard SJ, Sherding RG, eds. Saunders Manual of Small C. Stimulation of estrus can be accomplished by FSH Animal Practice, 3rd ed. St Louis, 2006, Saunders, administration or by maximizing the exposure to pp. 1015-1025. sunlight Kay ND. Diseases of the prostate gland. In Brichard SJ, D. Artificial insemination Sherding RG, eds. Saunders Manual of Small Animal 1. Semen is usually collected with an Practice, 3rd ed. St Louis, 2006, Saunders, pp. 949-956. electroejaculator McLoughlin MA. Diseases of the vagina and vulva. In 2. Insemination is performed similarly to the Brichard SJ, Sherding RG, eds. Saunders Manual of female dog, using a volume of about 0.1 to Small Animal Practice, 3rd ed. St Louis, 2006, Saunders, 0.2 mL of semen pp. 1001-1008. E. Estrus suppression: GnRH will stimulate ovulation and delay the start of the next cycle