Saturday, April 9, 2016

Retained Testicles in a Canine. What to do and how much it will cost. Surgery photos included.


This is Diesel. He is a two year old Shiloh Shepherd who was just rescued by our good friends at Black Dogs and Company Rescue. He is truly handsome with that black face and mesmerizing eyes, but he has a secret; a hidden potentially deadly secret. 

Diesel and his Black Dogs and Co. rescue mom.

Diesel was purchased at 8 weeks old by his first family. They have had him for his whole two years. In that two years he has not been neutered and his testicles never descended into the scrotum. He is what we call a bilateral (both sides) cryptorchid.

When it comes to the old saying about "what you can't see.." well, it turns out it really can hurt you. Not having testicles in the place they belong,, well, that can kill you. 

Retained testicles are not common. In 10 years I have seen two large breed dogs have a complete failure to launch. In the first case the client just forgot to take heed to my warnings when I could not find his testicles at his puppy visits. He also refused to allow me to go searching for them in his dogs abdomen when he arrived for his neuter and they were no where to be found. We found them three years later when he was very sick and dying from massive amounts of cancer in his abdomen. The retained testicles had grown into large cancerous masses that had invaded every organ they were engulfing. Why does this condition have the potential to be so dangerous? Because testicles are intended to be carried around outside of the body where it is cooler. 

Let's talk about anatomy and normal male development;

Testicles are supposed to descend out of the abdomen within the first few months of life. 

Real-Life Tip; If they have not descended in to the scrotum by 5 months old it is very unlikely that they ever will. By 9 months old I recommend that my clients schedule their pets neuter and we palpate for them under sedation or anesthesia. Either way go find them and remove them! Don't sit back and think there isn't a problem because you cannot see it. There is a problem, don't wait for it to become one that costs your dog his life.

Real-Life Tip; All cryptorchid pets should be neutered. There is a genetic component to this condition and the retained testicles are very likely to become cancerous. Estimates are that this type of cancer is 13 times more likely than dogs whose testes are in the scrotum. In my opinion if they are retained in the abdomen THEY WILL BECOME CANCEROUS AND BY THE TIME YOU FIGURE THAT OUT IT WILL BE TOO LATE TO CHANGE YOUR DOGS PROGNOSIS. Most of these dogs will not be clinically affected by the retention of the testes until they are older than 2 years. Some of these dogs can also suffer from testicular torsion.  The cords that the teste descends from twist like a yo-yo on the end of a string, cause strangulation of the blood supply, swell and then begin to die. This is an acutely painful condition that requires immediate surgical intervention.

Diesel, like most pets with this condition, looks and acts completely normal. This is the biggest reason most people don't think that they need to intervene in this condition. It is a secret silent hidden killer. 

Diesel prepped for his neuter on the surgery table.
Head to the left, inguinal area shaved.
The black pigmented skin is the empty scrotal sac.

For all of the cases that I see like this I recommend that my clients allow me to place their pet under general anesthesia so I can palpate the entire area between the scrotum to the inguinal rings (the small opening in the bottom of the abdomen that is the passageway from  the abdomen to the scrotum) and along the distal part of the inguinal area. In some pets there is a pocket of fat just in front and along the sides of the base of the back legs. An undescended testicle is often smaller than normal and often buried in this fat pad. Often I cannot palpate these until the pet is completely relaxed (under anesthesia) and allows me to probe the area. 

The hunt begins..
I get lots of calls for estimates on these surgeries. I always tell people that in some cases these surgeries can be rather long and somewhat frustrating. If the testicles are not between the inguinal rings and the scrotum you have to go inside the abdomen and look for them. In the abdomen they can be  significantly smaller than normal and live anywhere between the kidney and the caudal (towards the tail) part of the abdomen/pelvis. In some cases I have felt like I am trying to find a needle in a haystack. 


I once had a cat with bilaterally retained testicles. It took me over an hour to find them. One of them was so small (about the size of a grain of rice) that I had to submit it to the pathologist to positively identify it.


The first testicle is about half the size it should be. 


Extra ligatures are needed on both sides of the testicle because it did not descend and does not hang at the bottom of its blood supply and muscles. 


Finding number testicle number two. Still smaller than normal and still needing extra care to remove.


In all Diesels surgery was not difficult. His testicles were easily found just inside the caudal abdomen. His surgery was about $400.

If you have a puppy, or unneutered dog that does not have descended testicles please talk to your vet about it. Please also discuss when it is best to neuter. If your vet can't give you an estimate that you are comfortable with seek a second opinion or ask for intra-operative photos with your invoice.

Diesel post-op.
He is on his way to a new home with a clean bill of health,
and a better chance at a longer happier and healthier life.

I thought it might be helpful if I included some photos of what a routine dog neuter looks like. As you can see Chief is a German Shepherd about 8 months old.


He obviously has two testes, each in their own scrotal sac, right where they belong.


Getting prepped for a routine neuter..


In most dog neuters in the USA the dog is placed on their back and the testes are advanced out of the scrotum and removed through a small incision just cranially (toward the head) of the scrotal sac.


The testes are removed from the scrotum. Chief's neuter is done.


The finished project. One small incision just cranial (in front of) the scrotum.


Ace. 6 month old cryptorchid feline. This is Ace.


The left testes is where it belongs.. the right is just slipping in and out of the inguinal ring. I was only able to palpate it when he was under general anesthesia.


Luckily for all of us I was able to advance the right testicle almost in to the scrotal sac. He had a near routine neuter. A cat neuter at my practice is $60.


One you get your fingers on a slippery elusive teste you hold tight. I did not want to have to open up Ace's abdomen to find this one. It is safer, easier, cheaper, and better if the neuter can be done by the scrotum. The little dot at my thumbnail is the penis. As you can see there is not much room to cut and manipulate on cats.


Prepped for a cryptorchid neuter on Ace. Interestingly the occurrence of testicular cancer in cats with retained testicles is much lower than dogs. But, these cats will still produce testosterone which produces stinky Tomcat urine, spraying and aggressive behavior.


A happy bunch of boys leave the clinic.



Take Home Points;
1. Neuter a cryptorchid by 8 months old.
2. Ask for an estimate before surgery. The most expensive cryptorchid surgeries are when the testicles are within the abdomen. An experienced veterinary surgeon should be able to find them quickly and easily in a young dog and most of these surgeries can be done relatively close to the routine neuter estimate. In  some rare cases we cannot find them at all. These cases must be monitored closely post-op. 
3. Older dogs with retained testicles are at a significantly increased chance of testicular cancers. An exploratory surgery should be done as quickly as possible to remove the testicles if they are not in the scrotum.

Pet questions can be asked for free if you visit Pawbly.com. Pawbly is an open online pet community dedicated to educating, empowering and inspiring pet parents around the globe. 

I can be found at Jarrettsville Vet in Jarrettsville Maryland for appointments, or visit us on Facebook

I am also on Twitter @FreePetAdvice.

25 comments:

  1. Fascinating. People like me are so grateful God made people like you! Thank you for your dedication and love for animals.

    ReplyDelete
    Replies
    1. Thank you! and thank you for all that you do to help pets.. it takes a village and I am proud to be a part of it with you.

      Delete
  2. My dog Leo has surgery today to find the lost testie. Reading this helped. Thank you!

    ReplyDelete
    Replies
    1. best wishes to you both!
      thank you for the note.

      Delete
  3. Hello Dr. Magnifico,
    My puppy Oliver is a unilateral cryptorchid and is scheduled to be neutered next month. My vet, though seemingly very good, is young and only a couple years removed from veterinary school. Do you think a competent but, young doctor can possess the ability to perform a procedure of the magnitude properly or should I look for an older doctor with more experience. I know it varies from doctor to doctor, but generally speaking would you put your confidence in a well-credentialed but young doctor?

    ReplyDelete
    Replies
    1. Hello,
      Oh, goodness, this is a tough one for me to answer. I am blatantly (over abundantly (not always a good quality) honest. I think that I would do the following.. ask the vet to sit down and talk to you about your concerns. Ideally this young vet works in a clinic with an older more experienced vet. I would also speak to them. If you are still not feeling confident I would ask a trusted friend, or your vet, for a referral. I will openly admit that some of these surgeries are quite quick and easy, and a few are frustrating nail biters. But I also admit that I only know this because I was fortunate to have clients who trusted me to try. I also openly admit that one of the great benefits to my practice is that I have 4 other amazing vets to help me if I need an extra hand, eyes, or experience.
      I hope this helps,
      very best of luck to you both.

      Delete
    2. Yes she does work in a clinic with an older more experienced vet, however I have never met him. I have spoken to my vet about my concerns and she seems very knowledgeable about the procedure and says she has done it numerous times but obviously not as many times as a vet who has been in practice for 20 or 30 years. Also my puppy has seen her and only her from the time I got him so he knows her and she knows him which I think is important. But recently I've been reading online that this surgery can be quite complex and sometimes lead to the inadvertent removal of the urinary bladder, prostate, or lymph nodes by the vet which scared me. Have you ever heard of this actually happening and would you expect something like this from a vet who is young or rather a vet who is merely careless and neglectful?

      Delete
    3. Hello,
      I have read about your concerns too, although I have never seen it happen. I understand your concerns but I suppose it comes down to one of two options; 1. trust your vet and hope for the best, or 2. seek a specialist..
      very best of luck,
      please send me a follow up with how things go.

      Delete
  4. He isn't getting neutered until March 22, so I have some time to consider my options. What would you do if you were in my situation?

    ReplyDelete
    Replies
    1. I can't answer this for you. I have done both of the options I gave you (trust the current vet, and, seek a second opinion). It is possible to do both. Go get a second opinion and then see if that exam sways your decision.
      Hope this helps

      Delete
  5. Thank you for your advice, Dr. Magnifico. But I'm still just trying to get a general sense of how risky this procedure is. I know the degree of complexity varies from dog to dog based on the location on the undescended testicle(s), but have you ever run into any major complications?

    ReplyDelete
    Replies
    1. Hello,
      the majority of these cases are quick and easy. Those that are not can be frustrating and require testing post op to rule out only one teste being formed. Have I run into major problems, yes. It is possible with every surgery regardless of how routine we presume it to be. I cannot give you anything more definitive than that. A good surgeon knows when they are in over their head, knows when to refer, and knows to be open, honest, and upfront at all times. The rest is decided by the individual patient and fate.

      Delete
  6. This is a great post! A lot good information.
    It is the first time I have a dog and I'm new to everything! I have a 1 year 2 month German shepherd. He is very sweet! I was giving him a bath and I noticed he didnt have his testicles. So I took him to the Vet today. He said his testicles are by his abdomen therefore he needs surgery. (We will do this on Friday ) I'm a little worried about complications he might have and if this will hurt him. I'm worried it's too late. What do you Think? Thank you �� also I'm not sure how much it will cost. The vet is going back send me a quote.

    ReplyDelete
    Replies
    1. Hello,
      I think that you are being proactive and doing the surgery as soon as you knew,, which are all wondeful! He's still very young and hopefully it will be an easy quick operation. As far as cost goes you need to ask your vet to try to give you a rough estimate of the cost. I think you are doing everything he needs and I applaud your taking action and following your vets advice. good luck!

      Delete
  7. This is a great post! A lot good information.
    It is the first time I have a dog and I'm new to everything! I have a 1 year 2 month German shepherd. He is very sweet! I was giving him a bath and I noticed he didnt have his testicles. So I took him to the Vet today. He said his testicles are by his abdomen therefore he needs surgery. (We will do this on Friday ) I'm a little worried about complications he might have and if this will hurt him. I'm worried it's too late. What do you Think? Thank you ��

    ReplyDelete
    Replies
    1. I think that if you have an experienced vet who is comfortable doing this surgery then you are in good hands. Best of Luck!

      Delete
  8. Hi, I came across your blog while searching for info about this condition and I hope you don't mind if I ask you a question about it?
    I've recently started looking after a Jack Russell xbreed who has, through no fault of his own, been passed through a few homes. He is a real sweetheart and I took him today to get a check up and microchipping, and it turns out he has only one testicle descended. He is booked in for neutering in a few weeks, when I can get time off work to care for him post-op.

    What is worrying me is this: we estimate him to be 10+ years old. The vet had a good feel around his abdomen area and couldn't feel the undescended one, and says it may have shrunk very small. I'm worried sick they will find cancer since it has been left untreated so long!
    I know you obviously can't say one way or the other, but in your experience can dogs live with this for so long and still be cancer free? He appears 100% healthy, heart and lungs are fine, and showed no discomfort during examination. Sorry for the essay and thank you for any advice you can give

    ReplyDelete
    Replies
    1. hello,
      thank you for giving this guy a second chance. Regardless of what happens he is lucky to have you and you are doing the best with what you can as quickly as you can. Take great pride and comfort in that. If everyone was like this can you imagine how wonderful this world would be? I would recommend pre-op blood work and then a neuter/exploratory. and then it is just luck, fate and managing whatever the future holds... just like with every other pet and pet need. Be brave and who knows it might go well and be a breeze? Isn't that a much healthier way of facing an unknown? best of luck! let me know how it goes.
      krista

      Delete
    2. Thank you so much for your kind words x
      I know there isn't a lot we can do before his surgery other than spoil him with lots of kisses and try not to panic, but your comment has helped a lot and I will do my best to stay positive until we know the outcome - whatever that may be. I'll definitely let you know how it goes. Thank you again :)

      Delete
    3. Hi again! Just wanted to update you (and anyone else who stumbles across this) and let you know my boy has had his surgery and all went well! Our vet was able to located his retained testicle easily and removed through the same site as his other one. The "normal" testicle however, she felt was starting to show signs of turning nasty but she is happy that it has been removed before it progressed to a definite tumour. He is home recovering and besides being on meds for doing his cruciate ligament a damage last week, he is none the worse for wear. We are thrilled and spoiling him to bits.
      Thank you again for your kind reply, which helped an awful lot to calm my nerves pre-surgery. Your patients are lucky to have you!

      Delete
    4. Hello!
      So glad to hear that things went so well,, I want to add (to those who will follow this blog in the future) that most often these surgeries are fairly "easy", so have faith and talk to your vet about options and plans for surgery and then allow them to go find the clandestine teste! Your pups health will thank you!

      Delete
  9. We adopted our husky who we love SO MUCH at about 9 months from a rescue shelter. They originally said he was unneutered and told us they would neuter him the next day and then we could pick him up. The next morning we got a call saying that it turns out he was already neutered before arriving at the shelter and we could come pick him up. At a vet visit, she noticed that there were no scars or tattoos to signify his surgery, and there was apparently no sack. She said that the possibility of him having undescended testicles was so low that we should not bother with the blood work to see.
    He is now about a year and a half and we have had humping and aggression issues which led our trainer to question whether he was neutered. We explained the situation to her and she recommends that we get the blood test because the dominance behavior is causing such a huge burden and we worry it may result in injury. My question for you is: does this sound like a case of this? Is it going to harm him since he is now a year and a half? Should we get blood tests or X-rays?

    ReplyDelete
    Replies
    1. I recommend a blood test for progesterone AND an ultrasound. Thats what I would do,,, very best of luck! Thanks for rescuing your pup!

      Delete
  10. I have a lab puppy whose testicles have yet to descend. There is still time, but we are concerned they won't. Given the benefits of testosterone in the development of male dogs, we had not planned on neutering until he was at least 2 years old. I know you recommend neutering around 8 months if the testicles don't descend, but is there significant harm in waiting until he is at least a year old?

    ReplyDelete
    Replies
    1. Hello,
      In my opinion the harm in waiting is the unknown status of a testicle in the wrong place AND the high propensity for these to become cancerous. My preference is to neuter by 9 months old. The risk of testicular cancer outweighs the benefits of testosterone.

      Delete