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Both prescrotal and perineal approaches to castration of adult dogs have been described in the literature. The prescrotal technique can be used more frequently because it is easier to exteriorize the testicles and spermatic cords.1 A scrotal approach is preferred for castration of cats, small mammals, large and small ruminants, horses, and pigs.1-6 A scrotal approach for castrating adult dogs has also been used to safely castrate dogs of any age.7,8  In dogs, this approach offers advantages that include improved cosmesis and decreases in anesthetic and surgical times, incision length and subsequent surgical trauma, postoperative discomfort and self-trauma, and scrotal hematoma formation.7-11 

The scrotal approach had significantly reduced odds of self-trauma and a 30% reduction in surgical time.

In a study comparing postoperative complications of adult dogs castrated through prescrotal and scrotal approaches, no difference in the occurrence of hemorrhage, pain, or swelling was noted 72 hours after the procedure.10,11 The scrotal approach had significantly reduced odds of self-trauma and a 30% reduction in surgical time.10,11 In the authors’ clinical training program, junior and senior veterinary students have performed 984 scrotal castrations in adult dogs between 2010 and 2014. A total of 11 postoperative complications were identified, all the result of factors independent of the surgical approach (eg, postoperative hemorrhage caused by incomplete ligation of the spermatic cord). 

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Patient Selection

Contraindications to Scrotal Approach for Elective Canine Castration

  • Bilateral cryptorchidism
  • Pyoderma, trauma, abscessation, or ischemia of scrotal tissue
  • Known unsanitary postoperative environment

Patients selected for scrotal castration should undergo the same screening as for any other elective surgical procedure; they should be free from severe systemic disease that would prohibit administration of anesthesia, and caregivers must be willing to provide standard postoperative care. Removal of cryptorchid testicles should not be attempted via a scrotal approach; however, in dogs with unilateral cryptorchidism, the fully descended testicle may be removed via a scrotal approach. Other contraindications to the scrotal approach include pyoderma, abscessation, trauma, or ischemia of scrotal tissue. 

The postoperative environment should also be assessed. Because of the anatomical position of the canine scrotum, the scrotal incision site could come into contact with the ground when the patient is in a sitting or lying position. A clean, dry environment for at least the first 3 postoperative days is recommended to minimize the occurrence of surgical site contamination (see Contraindications to Scrotal Approach for Elective Canine Castration).

Related Article: Canine Cryptorchidism

Benefits & Drawbacks

The risk for inadvertent ligation or accidental laceration of the urethra during closure of a prescrotal castration is eliminated with the scrotal approach.

A scrotal approach to canine castration can be performed on any dog for which prescrotal castration is appropriate. In the authors’ experience, the procedure carries the benefits of reduced time to locate, manipulate, and isolate the testicle prior to the initial incision as well as reduced time in closing the incision. In most cases, incision length is smaller than in prescrotal castrations because of the increased mobility and maneuverability of the testicle in the scrotal (vs prescrotal) position. In addition, the scrotal skin is more elastic, allowing for easier exteriorization of the testicle through a smaller incision as the skin stretches. These improvements in surgical efficiency translate into reduced anesthetic and surgical times, factors well-correlated with reduced risk for surgical-site infections.12,13 The risk for inadvertent ligation or accidental laceration of the urethra during closure of a prescrotal castration is eliminated with the scrotal approach; in addition, less suture is implanted, resulting in decreased procedural cost. 

Another benefit of the scrotal approach becomes apparent in the event of incomplete ligation of the spermatic cord resulting in postoperative hemorrhage. As the incision is only partially closed, postoperative hemorrhage is readily identified and can often be addressed through the existing surgical site. Postoperative hemorrhage in a patient that underwent an alternate castration approach is often more difficult to detect until the scrotum begins to swell. The authors have not encountered a case of postoperative hemorrhage in which the spermatic cord retracted into the abdomen and was not retrievable through the original surgical site; this is likely secondary to the comparatively more distal location of spermatic cord ligation with the scrotal approach.

Another benefit of the scrotal approach becomes apparent in the event of incomplete ligation of the spermatic cord resulting in postoperative hemorrhage.

The major disadvantage of a scrotal approach is the likelihood of a small amount of postoperative drainage, which many pet owners would find objectionable. Continuous drainage of frank blood or the presence of blood clots suggests the need for reassessment. Gentle tissue handling, a vasoconstrictive splash block (eg, 1 part epinephrine [1 mg/mL] to 9 parts 2% lidocaine), and a scrotal wrap can help minimize this occurrence (Table). Such drainage should cease by the time the patient is discharged (ie, within a few hours), particularly if patients are hospitalized postoperatively. 

Related Article: The Case: "Routine" Dog Neuter That Has Gone Awry

TABLE
BENEFITS & DRAWBACKS OF A SCROTAL APPROACH FOR ELECTIVE CANINE CASTRATION
BenefitsDrawbacks
Reduced anesthetic timeShort-term postoperative drainage common
Reduced surgical time 
Reduced costs 
Reduced use of suture material 
Decreased incision size 
Reduced pain and self-trauma 
No risk of urethral ligation, laceration, or suturing 
Ready identification of postoperative hemorrhage 
Reduced likelihood of scrotal hematoma formation 
Reduced likelihood of seroma formation 
BenefitsDrawbacks
  • Reduced anesthetic time
  • Reduced surgical time
  • Reduced costs
  • Reduced use of suture material
  • Decreased incision size
  • Reduced pain and self-trauma
  • No risk of urethral ligation, laceration, or suturing
  • Ready identification of postoperative hemorrhage
  • Reduced likelihood of scrotal hematoma formation
  • Reduced likelihood of seroma formation
  • Short-term postoperative drainage common

 

What You Will Need

  • Small-sized, low-powered, electric clippers
  • Antiseptic scrub
  • Sterile surgical castration pack
    • Surgical drapes
    • 4 Huck towels
    • 4 towel clamps 
    • Operating room scissors 
    • 4×4 gauze
    • Carmalt or mosquito forceps
    • Needle drivers
    • Thumb forceps
    • #10 or #15 surgical blade
  • Sterile gloves
  • 0, 2-0, or 3-0 monofilament suture 
  • Green tattoo ink and tissue adhesive 

Optional:

  • Clean 3”×3”gauze square and self-adherent bandaging tape 
  • 9:1 mixture of 2% lidocaine and epinephrine (1 mg/mL)
Small, low-powered clippers appropriate for use in clipping scrotal hair (shown with a 22-gauge, 1-inch, over-the-needle, IV catheter for size comparison).
References and author information Show
References
  1. MacPhail CM. Surgery of the reproductive and genital systems. In: Fossum TW, ed. Small Animal Surgery. 4th ed. St. Louis, MO: Elsevier Mosby; 2013:780-855.

  2. Jenkins JR. Soft tissue surgery. In: Quesenberry KE, Carpenter JW, eds. Ferrets, Rabbits and Rodents: Clinical Medicine and Surgery. 3rd ed. St. Louis, MO: Elsevier Saunders; 2012:269-278.

  3. Lightfoot T, Rubinstein J, Aiken S, Ludwig L. Soft tissue surgery. In: Quesenberry KE, Carpenter JW, eds. Ferrets, Rabbits and Rodents: Clinical Medicine and Surgery. 3rd ed. St. Louis, MO: Elsevier Saunders; 2012:141-156.

  4. Moll HD, Pelzer KD, Pleasant RS, Modransky PD, May KA. A survey of equine castration complications. JEVS. 1995;15(12):522-526.

  5. Gilbert RO, Fubini SL. Surgery of the bovine reproductive system and urinary tract. In: Farm Animal Surgery. Fubini SL, Ducharme NG, eds. St. Louis, MO: Elsevier Saunders; 2004:351-427.

  6. St. Jean G, Anderson DE. Surgery of the swine reproductive system. In: Farm Animal Surgery. Fubini SL, Ducharme NG, eds. St. Louis, MO: Elsevier Saunders; 2004:565-575.

  7. Bushby PA. Surgical techniques for spay/neuter. In: Shelter Medicine for Veterinarians and Staff. 2nd ed. Miller L, Zawistowski S, eds. Ames, IA: Wiley-Blackwell; 2013:625-645.

  8. Johnston DE and Archibald J. Male genital system. In: Canine Surgery. 2nd ed. Archibald J, ed. Santa Barbara, CA: American Veterinary Publications; 1974:703-749.

  9. Woodruff KA, Rigdon-Brestle K, Bushby PA. Scrotal castration as a safe and effective means of male canine sterilization. In: Proceedings of the North American Veterinary Conference. 2014; Orlando, FL. 

  10. Woodruff KA. Scrotal castration as a safe and effective means of male canine sterilization. Mississippi State University College of Veterinary Medicine. http://sun.library.msstate.edu/ETD-db/theses/available/etd-03262013-153929. Published 2013. Accessed May 2015.

  11. Woodruff K, Bushby PA, Rigdon-Brestle K, Huston C. Scrotal castration versus prescrotal castration in dogs. Vet Med. http://veterinarymedicine.dvm360.com/scrotal-castration-versus-prescrota.... Published May 2015. Accessed May 2015.

  12. Eugster S, Schawalder P, Gaschen F, Boerlin P. A prospective study of postoperative surgical site infections in dogs and cats. Vet Surg. 2004;33(5):542-550.

  13. Nicholson M, Beal M, Shofer F, Brown DC. Epidemiologic evaluation of postoperative wound infection in clean-contaminated wounds: A retrospective study of 239 dogs and cats. Vet Surg. 2002;31(6):577-581.

  14. Bushby PA. Efficient dog and cat spay/neuter techniques. In: Proceedings North American Spay/Neuter Conference. 2014; Austin, TX. http://www.spayneuterconference.com/sessions. Published 2014. Accessed May 2015.

  15. Looney AL, Bohling MW, Bushby PA, et al. The Association of Shelter Veterinarians veterinary medical care guidelines for spay-neuter programs. JAVMA. 2008;233(1):74-86.

Authors

Brian A. DiGangi

DVM, MS, DABVP University of Florida

Brian A. DiGangi, DVM, MS, DABVP, is clinical assistant professor of shelter medicine at University of Florida. A graduate of University of Florida, Dr. DiGangi serves as board president for the Association of Shelter Veterinarians. Dr. DiGangi completed clinical externships in shelter medicine and exotic animal medicine and was the first shelter medicine resident to graduate from University of Florida. He has published research on feline adoption, pregnancy detection, and immunology.

Matthew Johnson

DVM, MVSc, DACVS (Small Animal) University of Florida

Matthew Johnson, DVM, MVSc, DACVS (Small Animal), is clinical instructor of small animal surgery at University of Florida. A graduate of University of Florida, he spent 3 years in general practice before completing a rotating internship and several surgical internships, followed by a surgical residency at Western College of Veterinary Medicine in Saskatoon, Saskatchewan. Postresidency experience included orthopedic- and sports medicine-exclusive practice as well as private referral practice.

Natalie Isaza

DVM University of Florida

Natalie Isaza, DVM, is clinical associate professor and clinical service chief for the Veterinary Community Outreach Program clerkship at University of Florida. On graduating from University of Florida, Dr. Isaza completed a rotating internship in small animal medicine and surgery at Cornell University. After 4 years of small animal private practice in southern California, she returned to academia, first at Kansas State University, then at University of Florida. 

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