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.

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