IN-DEPTH INTERACTIVE: REPRODUCTIVE DISORDERS – PATHOLOGY TO TREATMENT


on mating ability or ejaculatory bleeding have not been investigated. A stallion with refractory SCC involving the fossa glandis has been treated success- fully with intralesional injection of bleomycin in con- junction with electrotherapy to improve drug permeability (G. Kelly, personal communication, 2014). Although outcomes have been variable for more generalized penile tumors, both nonsurgical and surgical interventions have been attempted. Topical application of 5% 5-flurouracil (at 14-day intervals), with or without surgical debridement, for treatment of SCC of the external genitalia of stal- lions has been reported to be successful,17 as has intralesional injection of cisplatin.18 Electropulsa- tion methods might further enhance the efficacy of less cell-permeable chemotherapeutic drugs such as bleomycin or cisplatin, but additional studies in horses are required to determine effectiveness. Electrochemotherapy has proved to be advanta- geous in several species.19 The possible long-term negative effect of some cytotoxic chemotherapeutic agents on spermatogenesis must be considered be- fore implementing this form of therapy.20 Surgical approaches are the best way to treat de-


fects (rents) of the pelvic urethra, as sexual absti- nence alone, even when prolonged, is generally unsuccessful. Subischial urethrotomy can be used as a corrective measure, as can subischial corpus spongiotomy (subischial incision that extends into the corpus spongiosum penis but does not enter the urethral lumen).13 Either of these methods is thought to allow mucosal healing by preventing es- cape of cavernous blood through the urethral defect at the time of micturition. With these surgeries, a minimum of 60 days of postsurgical sexual rest is generally recommended prior to recommencement of breeding activities. Three refractory cases were treated in our hospital (Texas A&M University) by primary closure of the defect through a subanal sur- gical approach combined with urethral endoscopy to readily identify the defect and monitor its surgical closure. Surgical correction was successful in all three cases. Buccal mucosal urethroplasty was re- ported to be successful for treatment of hemosper- mia in one stallion with a urethral defect, but the surgical approach included a subischial urethrot- omy.21 Others have reported excellent results with laser treatment in combination with subischial cor- pus spongiotomy; however, the value of laser as a primary treatment for urethral defects remains open to question.22 Others have reported that en- doscope-directed laser tissue soldering is an effec- tive technique for surgical repair of hypospadias in humans.23 Seminal vesiculitis can be difficult to treat suc- cessfully, but it seems to be most effectively treated with voluminous lavage of the affected vesicular glands via an endoscopic approach, followed by in- stillation of antibiotics that are appropriate for the offending etiologic agent. Subsequent massage of the vesicular glands per rectum may aid in distrib-


uting the antibiotic within the glandular luminae. The procedure can be repeated daily for 5–7 days. Care should be taken to avoid use of antimicrobial drugs that are caustic to mucosal tissues. Systemic administration of antimicrobials is oftentimes unsuccessful because of inability of many of these to gain access into the accessory genital glands. Those antimicrobials with high lipid solubility, high pKa (i.e., reduced tendency for proton dissociation), and low protein-binding capacities are reported to dif- fuse most effectively into the accessory genital glands. Fluoroquinolones reportedly meet these criteria, with good resulting concentrations in acces- sory gland fluids of rats, dogs, men, and horses24–27; however, treatment of one stallion with systemic enrofloxacin did not correct the chromic seminal ve- siculitis long term. In men, incorporation of spe- cific oral nutritional supplements (saw palmetto extract, bearberry extract, and Lactobacillus sporo- genes) with systemic fluoroquinolone treatment im- proved elimination and recurrence rates of bacterial prostatitis, compared with fluoroquinolone treat- ment alone.26


3. Poor Sperm Quality (Teratozoospermia, Necrozoospermia, Oligospermia)


The equine breeding industry abounds with stal- lions with reduced semen quality, primarily owing to the fact that stallions typically become sires based on their pedigree, performance record, and confor- mation rather than reproductive health. In addi- tion, many sires remain sexually active as they become aged, and such stallions tend to develop age-related deterioration in testicular/epididymal function. As such, veterinary intervention and more intensive reproductive management are needed to maximize the fertility of these stallions. Poor semen quality generally presents itself in the


form of oligospermia (reduced sperm number in se- men), necrozoospermia (elevated percentage of dead or motionless sperm in semen), and/or teratozoo- spermia (elevated percentage of malformed sperm in semen). Logically, stallions that are affected by one condition oftentimes are affected by all three conditions. Diagnosis is based on collection and microscopic analysis of semen. An important component of a breeding soundness examination is to determine the number of sperm produced by a stallion at daily sperm output (DSO). This entails depleting ex- tragonadal sperm reserves (by collection of semen for 5–7 consecutive days) before determining actual DSO.28 Furthermore, measurement of testicular volume allows one to predict DSO.29–31 Efficiency of testicular function can then be determined using the following formula: (actual DSO/predicted DSO)  100. Lowered spermatogenic efficiency is indicative of a disruption in spermatogenesis and is associated with reduced sperm output.32,33 This condition can be temporary if the underlying cause can be identified and eliminated. It can also be


AAEP PROCEEDINGS  Vol. 61  2015 259


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