CRYPTORCHID CASTRATION A"cryptorchid"is an animal in which one or both testicles are out of sight, the organ (or organs) never having descended into the scrotum. It is an abnormality common to all species, but the veterinary surgeon is more frequently called in to operate upon horses than any other class.
If one testicle only is out of sight the animal is called a"monorchid"or single cryptorchid; if both are hidden, the term double cryptorchid is applied. An animal without any testicles at all, either inside or outside the abdomen, is called an"anorchid."The term"rig"or"ridgling"is the country name for any variety of cryptorchid.
In the horse the removal of the testicle is generally a matter of necessity, for a cryptorchid is usually very vicious and treacherous in dis position, and even though the animal may have been of an apparently quiet disposition for some years, experience has taught that it can never be absolutely trusted.
A cryptorchid in which both testicles are really inside the abdomen, although able to copulate, cannot procreate his species; although if one testicle has normally descended into the scrotum, stock will result.
The condition is hereditary and can be propa gated through the female line? 1 Ca8tration and Ovariotomy (Holxlay), p. 40. Published by W. & A. K. Johnston, Ltd., Edinburgh.
Method of Operating on the Horse. - The patient is thoroughly starved for twenty-four or, better still, forty-eight hours, before operat ing, and water only allowed in limited quantity. The ordinary castrating rope answers well for casting and securing purposes, a"back"rope being adjusted to assist in spreading the legs well apart. Chloroform should always be used, both on humane grounds and for the convenience of the operator. Chloral hydrate can be used, but chloroform is unquestionably the best.
The site of incision and surrounding parts should be shaved and cleansed, and as regards this I have for many years given up the use of soap and water, and either swabbed the parts thoroughly with petrol or painted with iodine. The only instruments required are a scalpel and forceps, two or three pairs of artery forceps, a director, needle and silk, scissors, and an ecraseur. A long flexible blunt seton needle is also of service sometimes to enter the abdomen, as is also a small sharp-edged silver-plated tube about 2 inches long with 3 feet of rubber tubing attached, in order to remove the contents of any cystic condition which may be present.
An incision is made through the skin over the scrotal region on the side under which it is suspected that the testicle lies (and here the operator must recollect that because a scar may be present it does not necessarily follow that the testicle has been removed from that side), and a director inserted. The scalpel is thus able to be used without injuring the inguinal plexus of veins, and after that the whole of the opening of the wound is to be done by tearing with the fingers. The fingers are then held wedge-shaped and the hand gradually rotated downwards to the bottom of the inguinal canal. The inner inguinal ring is not actually entered, and if no trace of cord or testicle is detected in the canal the operator carefully scratches a hole through the abdominal muscle with his middle and third fingers, and enters the abdomen. Sometimes the testicle can be felt and withdrawn at this stage without the necessity of introducing the whole hand, although more often than not the hand must be inserted. Once inside, the testicle is sought for, and when found with drawn and removed by the ecraseur. Care must be taken not unconsciously to pass the testicle in the inguinal canal, nor to remove a lymphatic gland or a hard piece of by mistake. Sometimes the epididymis is in the canal and the body of the testicle in the abdomen, and it is not uncommon for each to be excised separ ately. Sometimes the epididymis is pulled into the abdomen and the complete testicle is ex tracted by the ecraseur at one and the same time through the wound in the abdominal wall.
As guides by which to make a methodical search one attempts to find either the spermatic artery or the vas deferens, from either of which the testicle may be traced up. When found, the testicle is recognized by its shape, by the fact that the epididymis is attached to it, by its flabbiness and smooth surface, and because it is a body by itself. Pressure upon it, if the patient is not deeply anaesthetized, will cause struggling. After removal by the ecraseur and careful cleansing of the wound, the edges of the latter are sutured, the sutures being about half an inch apart. The animal is then allowed to get up, and as regards after-treatment the diet should be sparing for at least a week. The middle sutures are removed three or four days later and the parts treated antiseptically like any ordinary wound.
If the operator has rigidly followed the rules of careful antiseptic procedure, and a clean place is selected for the patient afterwards, the proportion of losses is infinitesimal, and the patient is convalescent within a week or ten days.
Abnormalities. These are many and curious. In the first place, the size and shape of the testicle is often quite out of the common. The size may be small, or it may be enormous and due to a cystic condition or to the presence of tumour tissue. If cystic, the contents may be merely fluid or it may be accompanied by tumours of various sizes and varieties. It may contain teeth (incisor or molar), hair, or nests of the Strongylus armatus worm. Whatever is present must be removed, and sometimes the size of the tumour necessitates a large wound through which it has to be withdrawn.
Sequelm. If the operation is performed under anaesthesia and in a reasonable time so that the patient is not exhausted, the sequel is usually an absolute success and the horse is convalescent within a week or ten days, or at worst within three weeks.
The untoward sequel which may happen are those of hernia, prolapse of omentum or bowel, colic, peritonitis, septicaemia, abscess, or para phimosis.
As a rule, if hernia does not appear within a few hours, there is sufficient swelling of the tissues surrounding the wound to keep the bowel in the abdomen, although I have known descent of the bowel to occur as long as a week after wards. The chief precautions to take to prevent this sequel are to suture the wound closely and to keep the patient quietly in a standing posture with the hind legs raised for at least twenty-four hours. If hernia does occur, whether it is merely omentum or bowel, it is necessary that it shall be reduced as soon as possible. For this purpose the horse must again be cast, and the contents of the sac returned to the abdomen, the wound being closely and securely sutured.
The operator need not despair of a successful result, for many horses have done well after this untoward sequel has been attended to. It is usually a wise precaution to plug the inguinal canal with antiseptic wadding or gauze, this being removed and replaced by a fresh plug two or three days afterwards at the discretion of the operator.
Colic is usually an indication that the above untoward sequel has occurred, and as such it should never be neglected. It usually means that a loop of bowel is down in the scrotal sac, and is being pinched or perhaps strangulated. Exploration is always a wise procedure if colic lasts for more than four or five hours, and if a loop of bowel is discovered in the inguinal canal this must be returned to the abdomen as speedily as possible.
Peritonitis and septicaemia indicate that infec tion has taken place either at the time of operating or subsequently, and the prognosis must always be a very serious one. Treatment consists in the frequent and thorough cleansing of the wound, as far as may be possible, and the hypodermic injection of antipyogenic sera.
Abscess is treated in the usual way by lancing and irrigating with antiseptics.
Paraphimosis is a very troublesome condition to treat, and it may even terminate in paralysis of the penis. Scarification should be resorted to in the early stage of the swelling, together with hot fomentations and astringent lotions, whilst the organ is placed in a sling in order to give it support. Nux vomica or other nerve tonic is given internally.
Cryptorchidism in other Animals.Misplaced testicles are met with in other species besides the horse, although, if it is a food animal, the beast is usually fattened and sold, being hardly worth the trouble and expense of the operation.
In the bull it is not uncommon to find one or both testicles subcutaneously placed in the groin, or well forward in front of the inguinal canal. Occasionally they are met with in the abdomen. When they can be felt subcutane ously it is a matter of ease to remove them, and if in the abdomen, the incision by which they are reached is made in the right flank. It can be done either under cocaine, with the animal in the standing posture, or with the animal cast. Chloroform can be used if pre ferred.
Under antiseptic precautions, the incision is made in a downward and slightly diagonal direction through the skin and muscles, the testicle is sought for and removed by the aid of an ecraseur, and the parts sutured and painted with iodine daily until healed.
In the Ram cases of cryptorchidism are occa sionally brought into prominence by legal disputes, but the question of expense militates against the operation ever becoming a common one; the owner usually preferring to let the animal go to the butcher. Here, as in the bull, the incision is made in the right flank, usually without an anaesthetic, and with the operator sitting astride his patient. The when found, is removed either by the ecraseur or by torsion. The percentage of fatalities is very small.
In the Pig the flank is chosen, just as when operating upon the female, and the cord is usually scraped through, unless the animal is of large size, in which case it is removed either by the ecraseur or the clam and iron. The latter is the favourite method of the country gelder.
In the Dog cryptorchidism is not at all an infrequent source of dispute in the law courts, and on more than one occasion a vendor has been accused of castrating a puppy before sale, when in reality the animal has been a double abdominal cryptorchid.
On four separate occasions it has been the author's lot to settle such insinuations on the part of the purchaser, the result of the operation in each case being to return the castrated dogs and the perfect testicles removed from the abdomen to the disputing parties.
A cryptorchid dog is a continual nuisance to its owner, and is often treacherous too, so that castration becomes necessary. Under chloro form or morphia, and the usual antiseptic precautions, an incision about an inch long is made in the median line of the abdomen, and the forefinger or middle finger inserted in a backward direction towards the pelvis. As a rule, the testicles are easily found floating about in the pelvic region. They are withdrawn, and removed either by scraping or after ligation.
The abdominal wall is then sutured, and the wound treated in the usual way.
In the Cat the same operation applies as in the dog, and quite a large proportion of cats are found upon examination to be cryptorchids. The removal of the testicle is a necessity in a pet cat on account of the objectionable smell of the urine in an uncastrated animal. The results are excellent in every way.
Experience has taught that before a final opinion is given that the missing testicle is in the abdomen, careful search should always be made subcutaneously in the region of the groin or abdomen, for it is not difficult in cats, espe cially Persians, to overlook a small testicle in this situation. F. T. G. H.