Rocky, a cute 5-year-old, 20 lb Shih Tzu, was in trouble.
He had a large, firm, painful mass in his groin area.
It was about the size of your fist.
His belly appeared to be distended.
Where are testicles supposed to live?
Although he was never neutered, he had no testicles in his scrotum (or sac).
Normally, testicles are located inside the belly in a fetus, and are supposed to “descend” or travel down to the scrotum during early puppyhood.
Occasionally, one or both testicles don’t travel all the way down.
They can stay in the belly or stop in the groin area (called the inguinal area).
Rocky had a condition called “cryptorchidism.” He was a “cryptorchid.”
Testicles in an abnormal location have an increased risk of becoming a tumor.
So the suspicion was that the big mass was a tumor of the left inguinal testicle (in the groin area).
And we suspected that the right testicle was still in the belly.
How did it all start?
His owner remembers: “It started with a small bump on his belly. Since it was small, we thought it was a bug bite. Then we noticed it was even bigger, the size of a tangerine, and firm. I absolutely did not realize how serious the condition was.”
This led to an appointment at Rocky’s family vet and 2 emergency clinics.
Thankfully, Rocky’s owner found out about HRVSS and got in touch with us.
After a long heart-to-heart with Rocky’s owner, we took him to surgery, which had several steps.
PLEASE NOTE THAT THE PICTURES BELOW ARE VERY GRAPHIC.
THEY ARE NOT FOR THE FAINT OF HEART !!!
This is how Rocky’s belly looked like before surgery.
Rocky’s multiple-step surgery
1. Left testicle removal
Removing the fist-sized mass was delicate but straightforward. We used multiple sutures to tie off the big vessels that were “feeding” the mass.
The mass was sent to the lab to get biopsied.
2. Belly surgery
The next step was to open the belly (laparotomy surgery) to remove the right testicle.
Imagine our surprise when instead of a testicle, we found a giant mass that appeared to be full of fluid!
It was the size of a large grapefruit !!!
It was so big, that it pushed on the organs in the belly.
We removed a quart (1 liter) of yucky, brown fluid from the mass.
Only then were we able to safely remove the deflated structure.
A new suspicion emerged: this was a cyst attached to the prostate.
This is called a para-prostatic cyst, or possibly an abscess.
The tissue was sent to the lab to get biopsied.
And a culture of the fluid was sent to the lab, to determine which bacteria caused it, and which antibiotic should be used.
If bacteria were found, then that would confirm that the fluid was pus.
Can you imagine living with 1 quart (or liter) of pus in your tiny Shih Tzu belly (he weighed 20 lbs)?
All other organs looked normal, but there was no right testicle to be found!
3. Right testicle removal
We then found the mysterious testicle deep in the groin (or inguinal) area.
We were able to remove it through a small incision in the skin.
After placing a few stitches, the testicle was out.
It was also sent out to the lab for a biopsy.
Despite a long anesthesia, Rocky recovered smoothly.
After 1 night in the hospital on IV fluids, pain medications, and antibiotics, he went home the next day.
Why is being cryptorchid a big deal?
What’s the moral of Rocky’s story?
What his loving owner didn’t realize at the time, is that a cryptorchid dog should be neutered ASAP to eliminate the issues Rocky faced:
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without testicles, there is no risk of testicular tumors.
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without testicles, the prostate shrinks, which pretty much eliminates the risk of a cyst or an abscess.
About a week after surgery, the lab results were as follows:
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The culture came back negative – the yucky stuff was not pus, just gross brown fluid.
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The left testicle – the huge one – was a Sertoli cell tumor, which is fairly common. Surprisingly, there were traces of a uterus inside this testicle!
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The right testicle – the tiny one – was atrophied, meaning it had shrunk over time. Surprisingly, there were traces of a uterus inside this testicle!
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The giant fluid-filled mass in the belly was confirmed to be a para-prostatic cyst – a cyst attached to the prostate. And are you ready for this? There were traces of a uterus inside this cyst!
After a few exchanges with the pathologist who read the biopsies, the main suspicion is a condition called Disorder of Sex Development (DSD).
The vast majority of Sertoli cell tumors are benign, although a few of them can spread (metastasis). So statistically, Rocky should do well.
Rocky’s owner very kindly commented: “You and your staff – what can I say!!! From the immediate response to Rocky’s needs, to Kat’s advice, to your Sunday night call, to the welcoming reception, to the text with his picture in recovery, his discharge package with personalized notes and his certificate, and Michelle explaining everything to me. Amazing. I have shared with everyone how well he has been looked after and the wonderful aftercare as well.”
If you would like to learn how we can help your pet with safe surgery and anesthesia, please contact us through www.HRVSS.com
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Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified
Pete Baia, DVM, MS, DACVS