IN-DEPTH INTERACTIVE: REPRODUCTIVE DISORDERS – PATHOLOGY TO TREATMENT


though scrotal pain was not evident.71 A 360- degree spermatic cord torsion generally causes acute scrotal pain and scrotal enlargement from local edema and hemorrhage from severe vascular com- promise. Unrelenting signs of colic and a stilted gait may be evident. Typically this type of torsion is unilateral and permanent; however, temporary torsions are possible and can result in recurrent attacks. Factors predisposing to spermatic cord torsion are poorly understood. Elongation of the caudal ligament of the epididymis or proper liga- ment of the testis and/or an excessively long mesor- chium reportedly encourage spermatic cord torsion.71,72 The torsion can be intravaginal (ex- cluding the parietal layer of the vaginal tunic) or extravaginal (including the parietal vaginal tunic). Diagnosis of 180-degree torsion is relatively easy


and based on identifying the location of the bulbous cauda epididymis and caudal ligament of the epidid- ymis within the scrotum. The caudal ligament of the epididymis is a remnant of the gubernaculum testis. It typically remains as a small fibrous struc- ture attached to the cauda epididymis, and is gen- erally palpable through the scrotal wall. Under normal circumstances, these structures are located on the caudal pole of the testis. Their presence in the cranial scrotum, with no attendant clinical signs, indicates a 180-degree torsion of the sper- matic cord. With a 360-degree torsion of the sper- matic cord, the cauda epididymis and caudal ligament of the epididymis are palpated in their proper scrotal position, but acute scrotal pain, often with scrotal enlargement and edema are evident. Palpation of the scrotal contents becomes difficult as scrotal edema and swelling progress. A primary differential diagnosis for torsion of the spermatic cord is inguinal/scrotal herniation. Examination of the suspect vaginal ring by palpation per rectum helps differentiate these conditions. Treatment strategies for an enlarged scrotum are dependent on the underlying cause. Treatment of acute scrotal trauma initially is aimed at controlling local inflammation, edema and hematoma forma- tion. Gentle cold-water irrigation of the site is an important, yet inexpensive, corrective action. Cold application sessions should not exceed 20 minutes and should be applied at 3- to 4-hour intervals. Local blood flow is reduced by using this cold appli- cation strategy, thus minimizing tissue edema and hemorrhage. Short-term topical cold application offers beneficial cooling effects that can last up to several hours, and also provides a degree of analge- sia. However, continuous application of cold tem- perature can actually increase local blood flow and lymphatic permeability. These changes can negate the beneficial effects. Cold water sprays are not recommended given that they can cause additional skin damage if tissue has been compromised. Sys- temic anti-inflammatory and diuretic medications are useful adjuncts to local therapy for controlling inflammation and edema. Prophylactic antibiotic


264 2015  Vol. 61  AAEP PROCEEDINGS


therapy also should be instituted to prevent second- ary infection. A tetanus toxoid booster is recom- mended if the horse has not been vaccinated against tetanus within the past year. Emollients should be applied to the skin intermittently to protect it against maceration. Significant intrascrotal hem- orrhage leads to permanent testicular damage due to the insulating effect of secondary fibrous tissue formation. To save the compromised testis, surgi- cal removal of the organized blood clot can be at- tempted 4–7 days after injury, but the prognosis for the affected test is quite guarded. If the condition is chronic, with pronounced atrophy of the ipsilat- eral testis, the affected testis could be removed sur- gically, along with any attendant fibrotic tissue. This may promote some compensatory hypertrophy (and increased sperm production) of the remaining testis.73 Scrotal lacerations generally incite marked tissue swelling. Such wounds should be cleaned thoroughly then treated locally to control bacterial infection and progressive cellulitis. Lac- erations in this tissue generally do not heal by first intention because of pronounced tissue compromise and swelling. Nonetheless, wound closure is gen- erally indicated to cover exposed testes and their tunics. When lacerated, the parietal vaginal tunic should be sutured after thoroughly cleansing the vaginal cavity with balanced salt solution contain- ing antibiotics. Surgical debridement of subcuta- neous tissues should be followed by skin closure with nonabsorbable nonreactive suture material. If a seroma forms in the subcutaneous tissue, drain- age should be established. Although targeted treatment of testicular tumors


has been attempted to prolong the breeding life of selected stallions with bilateral involvement, prompt orchiectomy is the primary treatment for all testicular neoplasms, regardless of type. Owners must be advised if the neoplasm is potentially ma- lignant. As a precautionary measure, radical re- moval of the attached spermatic cord is advised and the excised spermatic cord should be evaluated his- tologically for evidence of metastatic lesions. Rad- ical scrotal ablation should accompany orchiectomy if the tumor has invaded peritesticular tissues. Excision of adjacent lymphatic chains is indicated if metastasis is suspected. Chemotherapy is used in conjunction with surgery to treat men with meta- static testicular tumors, but this therapeutic strat- egy has not been perfected in the horse. Treatment of hydrocele is aimed at removing the underlying cause of the hydrocele, if it can be iden- tified. Hydroceles associated with some underlying conditions, (e.g., infectious conditions, ascites, or malnutrition) may take some time to resolve. The fluid can be removed by aseptic needle aspiration. Exercise may help control fluid accumulation in some cases; yet improvement may only be transient. Fluid usually reaccumulates when drained from the vaginal cavity unless an inciting factor for the hy- drocele is identified and corrected. Mild cases of


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