Surgical management of testicular ectopia in a dog: A case study

Introduction

Anatomical existence of both the testes in scrotum plays a vital role in gonadal physiology, required for maintenance of optimum reproductive health (O'Donnell et al., 2017) [9] . In late pre-natal life or early post-natal life the gonads descend from their embryonic lumbar position to the final destination, i.e. scrotum via inguinal ring; typically, between six and eight weeks of birth testes become palpable within the scrotum (Yates et al., 2003; Amann and Veeramachaneni, 2007) [12,2] . Outside inguinal ring or extra-scrotal existence of testes is generally referred to as Ectopic testes or Testicular ectopia, which may be either intraabdominal (abdominal) or extra-abdominal (subcutaneous); or even canalicular (within Inguinal canal wall) (Rao and Lakshman, 2004; Amann and Veeramachaneni 2006; Khan et al., 2018) [11,1,7] . If the condition is left untreated in a dog, several serious health complications like testicular torsion, testicular tumours, inguinal hernia, hormonal imbalances etc. may arise (Dubey et al., 2016) [5] . Hence, immediate surgical intervention, preferably orchiectomy or orchidectomy is recommended in canine once diagnosed. Ultrasonography plays a pivotal role in pre-surgical confirmatory diagnosis. In the present communication a confirmed case of ectopic testes and its surgical management was placed on record in a Spitz for the first time from this part of the country.

Materials and Methods

Case history & clinical findings

A two and half years old male Spitz weighing 9.3 kg was reported to Dept. of Veterinary Clinical Complex, with asymmetric bilateral swelling near penis (Fig. 1.a.) but with no other problem. On comprehensive clinical examination the animal was found to be clinically healthy with normal vital parameters viz. Body Temperature: 101.4 O F; Heart Rate: 98 beats per minute (bpm); Pulse Rate: 95 bpm; Respiration rate: 23 breaths-pm. Digital palpation of both the masses revealed a betel nut sized uniformly fluctuating (within a confined space), round, smooth texture, firm mass with a closely attached stripe/cord like structure on right side giving a testis like feel and an almond sized (tiny) analogous structure on left side. No pain, hernia ring and fluid-filled consistency could be detected over physical examination. Plain ultrasonography (USG) of right testis revealed moderately homogeneous echo-textured oval structure with a thin peripheral, hyperechoic covering (indicative of tunica albuginea). At the center hyperechoic irregular structures or lines and caudally an isoechoic structure closely attached to it with a hyperechoic thick center line (indicative of tail of epididymis) could be detected (Fig 1 .e). These findings are identical to testis. At the same time, absence of testes in the scrotum was also recognized (Fig 1 .a). Based on these findings, the condition was diagnosed as Ectopic Testis and subjected to bilateral orchiectomy or orchidectomy under balance anaesthetic combination by the next day. Balance anaesthesia was induced by Dexmedetomidine @ 5 µg/kg body weight (bwt) and Ketamine Hydrochloride @ 5 mg/kg bwt administered intramuscularly (IM) following 10 to 12 hours fasting and pre-anaesthetic administration of Atropine Sulphate @ 0.04 mg/kg bwt IM. The maintenance was done by intravenous (IV) administration of Ketamine and Diazepam mixture at 1:1 ratio via a single syringe. Following aseptic surgical technique, linear incisions were made over each swelling to exteriorize both the ectopic testes. Orchiectomy was performed similar to the standard neutering procedure. Removed testes were presented in Fig. 1.c. Surgical incision was closed by subcuticular suture using Polyglactin 910 No. 4-0 suture materials for subcutaneous tissue and locked stitch pattern using black braided Silk No. 2-0 for skin (Fig. 1

.d).

Post operatively, a course of Ceftriaxone and Sulbactam (EXACT injection: Excellar Healthcare Pvt. Ltd.) @ 20 mg/kg b.wt. IV twice daily for 7 days, Meloxicam (Melonex inj: Intas Pharmaceuticals Ltd.) @ 0.3 mg/kg b.wt. IM once daily (OD) for 5 days, Pheniramine maleate (Anistamineinj: Intas Pharmaceuticals Ltd.) @ 0.5 mg/kg b.wt. IM OD for 7 days along with a multi-vitamin muti-mineral oral supplementation (Zipvitsyp: Intas Pharmaceuticals Ltd.). Surgical site was covered with sterile bandage using antiseptic ointment (Poly XLR ointment: Excellar Healthcare Pvt. Ltd.). Subsequently regular antiseptic dressing of the surgical site from 72 hours onward was advised till suture removal (which was done on 8 th post operative day). Application of Elizabethan collar and clean dry confinement was also advised.

Results

The animal returned to normal health within three postoperative days and an uneventful progressive recovery could be observed within fifteen post-operative days following suture removal.

Discussion

Testicular ectopia can be unilateral or bilateral (Dubey et al., 2016) [5] ; in the present communication we reported bilateral ectopic testes. Probability of mal-positioned testis/testes in small breeds of dogs were reported to be more, out of which commonly encountered breed is Spitz alike the present case (Dubey et al., 2016; Rafee et al., 2016) [5,10] . Due to the masking effect of long hair coat or sometime due to unawareness, this condition is overlooked unless it leads to serious issues like testicular torsion, testicular tumours, hormonal imbalances etc. (Murthy et al., 2015; Dubey et al., 2016) [8,5] . However, in the present case the owner reported with a complaint of hernia, which was finally confirmed as [4,6,5] . Though the USG findings of the right testis were not on par with a normal testis but identical to a testicular structure giving a confirmatory observation against the finding of digital palpation in this case. Since the left testis was tiny, no clear image could be obtained. Since both the testes were not in their original anatomical location, natural growth of the same had not properly occurred giving a coarse appearance in USG. Use of USG in diagnosis of ectopic testes was also reported by Murthy et al., 2015 [8] and Bigliardi et al., 2015 [3] . The most recommended treatment is bilateral castrations, which prevent further complications (Dubey et al., 2016) [5] , as observed in this case too. Combination of Alpha-2 adrenoceptor agonists with Ketamine for inducing balance anaesthesia had been reported (Dubey et al., 2016) [5] . In this case we used Dexmedetomidine with Ketamine which provided comparatively better unconsciousness, analgesia and muscle relaxation. The animal was found to be clinically healthy without any complication till the communication of this article indicating effectiveness of the surgical management attempted.

Conclusion

The authors of the article would like to conclude from the aforesaid report that, careful thorough clinical investigation including diagnostic imaging support helps in diagnosis and differential diagnosis and finally selecting the appropriate therapeutic measures of clinical cases and particularly for the present case.

Acknowledgment

We acknowledge Associate Dean, LCVSc, AVFU, Joyhing, North Lakhimpur-787051, Assam, for allowing publication of the case.

Conflict of Interest Not available.

Financial Support Not available.

References

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