Genital and Uro Genital Surgical conditions

Transcription

1 Genital and Uro Genital Surgical conditions The Genital Tract Female

2 The reproductive system is composed of: Ovaries Oviducts Uterus cervix vagina. The ovaries are the site of production of the unfertilized eggs during a season roughly every 6 months in the dog. It is also responsible for many of the hormones produced during the reproductive cycle and the maintenance of pregnancy. The eggs passes from the ovaries into the oviducts. This is where fertilization by the sperm takes place. The eggs then pass into the uterus. The developing embryos mature within the uterus. Male

3 The male reproductive system in a male is made up: scrotum testicles epididymis deferent ducts spermatic cords prostate penis urethra There are two testicals which are situated within the scrotum, Inside the testicles are seminiferous tubules which are responsible for the production of sperm. Sertoli cells fill the area around the tubules, supporting the tubules and providing nutrition to the sperm cells. The Leydig cells of the testicles are responsible for the production of the male hormone testosterone. The epididymis is responsible for storing and carrying sperm to the ductus deferens prior to ejaculation. The sperm stays in the epididymides for a relatively long period of time, allowing the cells to mature. Spermatic cords are composed of vessels and nerves which nourish the testicles. The ductus deferens are also contained inside the spermatic cords. The ductus runs into the abdominal cavity through the inguinal canal, then leaves the abdomen, running through the prostate and ending at the urethra. The exact function of the prostate gland is unknown, it is thought that it secretes substances necessary to protect and activate the sperm. The penis has three portions: 1) the root 2) the body 3) glans.

4 The root and body are made of spongy tissue surrounding a bone known as the os penis. The glans is soft and swells with blood during sexual stimulation. It keeps the penis locked into the female dog s vagina, allowing the dogs to tie to each other to promote successful passage of sperm from the male to the female. Covering the penis is the prepuce, a tubular piece of skin which protects the penis. Female reproductive tract disease Male reproductive tract disease Ovary Prostate Ovarian cyst Benign prostatic hypertrophy Ovarian Tumour Prostatic cyst Uterus Paraprostatic cyst Pyometra Prostatic infection Uterine tumour Prostatic tumour Vagina Testicles Vaginal tumour Orchitis Vaginal Prolapse Testicular tumours Vaginitis Cryptorchidism Vaginal Penis Hyperplasia Vulva Penile tumour Transmissable venereal tumour Transmissable venereal tumour Paraphimosis

5 Hormones involved in reproduction Female Several hormones regulate oestrus, (the reproductive cycle in female animals) Follicle stimulating hormone (FSH) FSH initiates the growth of the follicle. It is secreted from the anterior pituitary gland in the brain. Luteinizing hormone: Luteinizing hormone (LH) also stimulates the growth of the follicle, it also stimulates the rupture of the ova from the ovary. oestrogen: oestrogen is secreted by the ovary. It functions are to prepare the uterus for pregnancy. It also causes the female secondary sexual characteristics. Progesterone: Progesterone is secreted from the corpus luteum (the area that the ova was ruptured from the ovary in early in pregnancy). Later in pregnancy progesterone is secreted by the placenta and is responsible for maintaining pregnancy. Prostaglandin: Certain prostaglandins are essential in the reproductive cycle at specific points. The destruction of the corpus luteum, rupture of the follicle, and uterine contractions at birth are stimulated by reproductive prostaglandins. Gonadotrophin Releasing Hormone (GnRH): GnRH is released by the hypothalamus. It tells the pituitary to release LH and FSH It controls sperm production and testosterone levels. Follicle stimulating hormone (FSH) FSH is released by the anterior pituitary and stimulates the production of sperm in the testes

6 Luteinizing hormone (LH): LH is also called ICSH or interstitial cell stimulating hormone. It is released by the anterior pituitary and stimulates testosterone production by the testes Andosterone: This is less abundant and less effective than testosterone and is also made by the testes Testosterone: Testosterone is made by the interstitial cells in the testes. It stimulates secondary sex characteristics in males and helps stimulate spermatogenesis in the testes. It does this with FSH Inhibin: Inhibin is released by sertoli cells in the testes when the cells are low in nutrients to feed developing sperm cells It acts as a negative feedback and goes to brain to slow down the release of FSH and GnRH Common Diseases of female reproductive system Problems of the ovaries Cystic ovaries Cystic ovaries are quite common in older bitches, in particular bitches that have not had a litter and have not been neutered. One of the signs that a bitch may have this are that the bitch stops having seasons. There may also be a persistent watery red discharge after a normal season with thickening of the vulva. Male dogs may be interested in her although she will not allow mating. Occasionally the cysts become so large that they can cause distension of the abdomen. Ovariohysterectomy will cure this condition.

7 Ovarian tumours Ovarian tumours are quite rare in the bitchand when they do occur they can be benign or malignant. Signs can be very variable but any older bitch having abnormal seasons, (often longer than normal), a swollen or discharging vulva, or mammary enlargement could have an ovarian tumour. With benign and early malignant tumours surgery will generally cure this condition, although malignant growths can quickly spread to the kidneys, liver and lungs. Pyometra (cystic endometrial hyperplasia) A pyometra is the accumulation of pus within the uterus. It is most commonly seen in middle aged or older dogs that have never had a litter and are unneutered. The bitch usually present shortly after a season (4-6 wks). This is much more common a condition in the bitch than in the queen because the prolonged progesterone phase of the cycle only occurs in queens which have ovulated In normal queens ovulation only occurs after mating. Cause After oestrus in the bitch, progesterone levels rise and remain high. This stimulates thickening of the endometrium and an increase in the number of glands in the endometrium Excess fluid may accumulate in the uterus as a result of secretion from the glands and if bacteria can enter causing infection to develop It can also be induced by the use of progestogens and oestrogen hormones for medical conditions The uterus becomes a large pus filled sac and bacterial toxins enter the bloodstream and cause typical signs

8 Can be open (open cervix, with discharge) or closed (closed cervix, no discharge) Signs: Vomiting Polydipsia Polyuria Depression Lethargic Anorexia Increased Neutrophil count Diagnosis Usually based on the clinical signs An enlarged uterus may be palpated but is more commonly recognized on radiographs or using ultrasound Treatment: Medical treatment to stabilize the patient prior to surgery Intensive fluid therapy Hartmanns Ovariohysterectomy Intense post op nursing Antibiotic therapy

9 False Pregnancy (Pseudopregnancy) This is classically a condition of dogs Causes No one knows why some bitches develop false pregnancies and others don t, it can be regarded as a normal physiological occurrence If a bitch develops signs of a false pregnancy following one oestrus she is likely to continue to develop similar (or even more severe) signs after subsequent oestrus cycles Signs Clinical signs develop between 6 and 12 weeks after the end of oestrus and may last for many months Behavioural Nesting and adoption of objects Mammary development, lactation and mastitis Diagnosis Easily recognized but the owner may become confused as to whether the dog is pregnant or not Treatment Most cases will resolve spontaneously over time. Avoid stimulating lactation as this will often prolong the condition so use of a buster collar is advisable. Severe or persistent cases may require hormonal treatment but the most successful course of action is neutering. Bitches should not be neutered until all signs have resolved (and not for at least 3 months after the end of oestrus) Neutering whilst the condition persists may result in continuous clinical signs

10 Mastitis Cause Mastitis is seen in lactating animal (after whelping or pseudopregnancy) and is cause by blocked milk ducts or bacterial infection Signs Hot swollen, painful mammary glands Signs of systemic illness Anorexia, depression and pyrexia Diagnosis Examination of the mammary glands Collection of a milk sample for bacteriology Treatment Regularly emptying the mammary glands Hot compresses Antibiotics if systemic infection Uterine Tumours Uterine tumours are fairly unusual but if present they can be benign or malignant. If caught early enough spaying the bitch will cure the disease. Unfortunately malignant tumours can spread to the liver and lungs, and prove fatal.

11 Vaginal problems Vaginal prolapse This can be seen in some bitches during a season. The floor of the vagina becomes very red and swollen, so much so that it prolapses out through the vulval lips to appear as a red distended balloon. It is not a particularly painful condition although the bitch may often make it painful by traumatising the swelling and introducing infection. The swelling will also stop successful mating should one be planned. The prolapse can be removed, although after removal haemorrhage is a risk. The bitch can be given hormones to stop the season, or the season can be left to finish naturally, when the swelling will go down. The dog should be spayed to prevent a recurrence. Vaginal tumours Vaginal tumours are normally benign, sometimes occurring as multiple tumours. They grow under hormonal control from the ovaries and can be described as being similar to fibroids in humans. They may just cause a swelling at the back end of the dog, but if they appear higher up the vagina, they interfere with urination and can cause constipation. Spaying the bitch will stop the tumours growing, and in some dogs the tumours even partially regress. However if the tumours are very large, they may need to be surgically removed. As most are benign and do not spread, removal will cure the problem. Mammary masses These vary from benign cystic changes to more malignant tumours but it is impossible to tell what a lump is just by looking at it. A biopsy of the mass should be taken under anaesthetic. The affected mammary gland or glands should be removed with a margin of normal tissue. The whole mass can then be sent away for histopathology. As most malignant mammary tumours tend to spread to the chest it is a good idea to radiograph the lungs before surgery.

12 Other Problems Urinary incontinence Owners will often notice a wet patch or patches appearing where a bitch has been lying or sleeping. The problem is often more pronounced if another condition like diabetes or kidney disease is increasing water consumption. A urine sample should be taken and checked for infection it may also be beneficial to take a blood sample to assess kidney function Urinary incontinence generally responds well to treatment with drops or tablets although medication will be required long term. Perivulval Dermatitis This is a skin condition that is found around the vulva. Dogs that have this lick the affected area, particularly after urinating. It is caused by folds of skin or long hair trapping urine around the vulva, so is more common in overweight or long haired animals. Perivulval dermatitis improves with antibiotics, cleaning with antiseptic and using barrier creams to protect the area. Weight loss or clipping will also help. Surgery to resect the skin folds of very fat dogs is occasionally necessary. Males Retained testicals Before birth the male dogs testicles are present in the dogs abdomen. At birth, they descend through the groin area and into the scrotum. This should be complete by 6 8 weeks of age. In some puppies, one or both of the testicles may fail to descend at all. This condition, known as cryptorchidism or an undescended testicle. The retained testicle remains within the body and is prone to high temperature of the pelvic cavity, making the affected testicle incapable of producing sperm.

13 Undescended testicles have a high risk of developing into a tumour dog ages. This condition has a genetic component, so dogs with an undescended testicle should not be bred. Other problems which may occur in the testicles are inflammation known as orchitis or torsion, which occurs when the testicle becomes twisted on itself. Both of these conditions can cause considerable pain as well as infertility. The epididymis may also become inflamed due to bacterial or viral infections, trauma, or diseases of the immune system. Prostatic disease The most common problem that occurs in the prostate is benign prostatic hypertrophy (BPH). In un-neutered dogs, the continual influence of testosterone causes the prostate to gradually enlarge. The enlargement may block both the urinary tract and the rectum causing the dog to strain when he relieves himself. Other problems of the prostate can include infection, cysts, and tumors, which are usually malignant. Signs Enlargement of the prostate can cause compression of the colon resulting in tenesmus Infection and neoplasia may result in haematuria Pain, weakness or swelling of the hind limbs can occur with severe prostatic disease Systemic signs such as weight loss, anorexia and fever may be seen with infection or neoplasia

14 Diagnosis Palpation of the prostate by rectal examination Visualised by ultrasound or radiography Prostate biopsies using ultrasound guidance Treatment Most prostatic conditions can be improved by castration Antibiotics Surgical drainage if pockets of infection or cysts Treatment of prostatic tumours is difficult and the tumours will often metastasise quickly. Radiotherapy may ease the clinical signs

15 Paraphimosis Causes The erect penis becomes too enlarged to slide back inside of the prepuce. Once the prepuce becomes tight on the root of the penis it acts like a tourniquet. Blood can flow into the penis under pressure but cannot escape so the condition continues to get worse Signs Swollen red penis permanently protruded Diagnosis Visual examination Treatment Cold ice pack application to reduce swelling Lubrication of the penis and gentle massaging of he prepuce over the penis *this is an emergency situation it may be necessary to cut the prepuce to get the penis retracted Testicular tumours There are three tumours commonly associated with the testical 1. Sertoli cell tumours 2. Interstitial cell tumours 3. Leydig cell tumours Although they each have an equal incidence the most important of these is the sertoli cell tumour

16 1. Sertoli cell tumours Causes Usually related to a retained testicle Signs Enlarged testicle (often with atrophy of the other testicle) Feminisation signs attractiveness to male dogs Hair loss is common Bone marrow suppression due to high oestrogen levels Diagnosis Clinical signs Histological assessment of the mass after removal of both testicals Treatment Castration Met checks should be made

17 Signs of disease Clinical history consultation with the veterinary surgeon Analysis of the dog s blood and urine. This will help rule out any systemic infections which may be causing the problems. Serologic testing of the blood can indicate the presence or absence of Brucellosis, a bacterial infection that is often the cause of reproductive tract disorders in male dogs. X-rays of the abdomen can point out problems with internal structures, as can ultrasound inspection of the prostate and testicles. If a tumour is suspected, your vet may take a biopsy of solid tissues or may aspirate the liquid from a fluid-filled tumour for microscopic analysis. If there are concerns regarding the animals fertility a sperm sample should be obtained and examined under the microscope

18 Drugs commonly used in the management of genital tract diseases Females Antiprolactins Males Delmadinone acetate Bromocriptine and cabergoline are used for the management of false pregnancy in bitches A progestogen given as a depot injection with long lasting effects Used in the management of many forms of prostate disease and as a chemical form of castration Proligesterone It produces reduced libido but not infertility Acts like progesterone used for oestrus control and the treatment of false pregnancies Oestradiol benzoate Oestradiol benzoate Treatment of misalliance Do carry a risk of bone marrow suppression Used to treat prostate hypertrophy Methyl testosterone Acts to reduce prolactin which is thought which is thought to cause the signs of false pregnancy (behaviour changes and lactation) Also used for suppression of oestrus in the bitch

19 Caesarean Section Referred to as a Cesarotomy or hysterotomy is the delievery of a foetus by incision through the abdominal wall and uterus Indications Dystocia (difficult birth) Dystocia can develop from the following situations: Maldeveloped foetuses Oversized foetuses Malpositioned foestuses Small pelvic canal size of dam Previous pelvic trauma of dam Insufficient dilation Uterine inertia (lack of contractility of the uterus The objective of a caesarean section is to remove all the foetuses from the uterus as swiftly as possible It is generally performed in an emergency but is often planned for brachycephalic breeds or animals with a previous history of dystocia A short acting anaesthetic is used to reduce stress to the pups and the operation is performed as quickly as possible to ensure minimal anaesthetic time. The puppies are passed to a circulating nurse who ensures they are healthy and able to breath unaided. It is vital that these puppies are kept warm until their mother is awake

20 The uterus was closed using dissolving stitches then the abdomen was closed using a hidden, dissolving stitch in the skin; much more comfortable than conventional skin stitches. It is vital that the patient is kept a close on eye and monitored with her puppies. The puppies should be able to feed as soon as possible. Intervention should only happen if the mother is not accepting her puppies or is having difficulty feeding