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The missing testicle that led to a shocking discovery. I arrived at the surgery recently to find a long ops list, one of which was dog castrate that one of the other vets had booked in for me. This didn’t really worry me because dog castrates are usually very straightforward and pretty quick to do. When I saw that the dog was seven years old it raised the question of ‘why now?’ Don’t get me wrong, as you will probably know, I’m a big advocate of neutering because of the health benefits but usually animals are done either very young or very old when a problem develops. I went to look at the clinical notes before we did anything and that’s when I realised that Blaze, the beautiful big spaniel in question, was what we call cryptorchid. This means that he only had one testicle that had descended in doggy adolescence and the other had never arrived. This can also happen in humans and any mammal which carries the testicles outside the body cavity in the scrotum. We always recommend removal of the internal testicle because the higher temperature inside the body can make the development of testicular cancer much more likely. In fact we would usually do that at around six months of age if the testicle hasn’t appeared. Blaze had managed to hang on to his a bit longer but the vet really felt, quite rightly, that by now we should be dealing with it. Finding and removing retained testicles can be very simple and satisfying but can also be incredibly demanding, time-consuming and frustrating. In the womb the testicles develop in the exact location that ovaries would in a female animal. As the animal grows and matures inside the testicles start to migrate down through the body cavity towards the groin. They then travel through a space called the inguinal ring and descend to their final location within the scrotum. It is the route they take that can make them tricky to find because they can literally be anywhere between the kidney and groin and in a big dog like Blaze this is a large search area! Sometimes dogs are very obliging and, once anaesthetised and on their backs, legs akimbo, you will see a little bulge in the groin where the testicle has descended most of the way but not all the way. These are always happy days and the operation doesn’t take much longer at all. I gazed intently at Blaze’s groin and palpated it for some time in the hope of finding the little bump but to no avail so we decided we would have to go in. The other fact about retained testicles that make them tricky to find is that the heat inside stunts the development and they are usually about a third of the size of the outer one. The words needle and haystack can spring to mind! We clipped Blaze up from scrotum to sternum to allow a full search and I dived in. In some cases you will find that on opening the abdomen the testicle presents itself to you and is whipped out very quickly. I had a look around in the field of view I had and could see nothing resembling my goal. The easiest next option for the elusive nut (if I may call it that) is to start at the kidney where the journey starts and then follow the cord that the testicle migrates down until you find it. I started to move the intestines to one side to get to the kidney. I couldn’t see it. I asked the nurse to tilt Blaze for me to facilitate the intestines falling with gravity to one side of the body to make the job easier. Still I couldn’t see it. Eventually I got all the small intestines out of the body and looked from the edge of the diaphragm along the top of the body cavity where the kidney should be. Still no kidney. At this point I thought I’d gone mad. How could someone with eleven years of surgical experience not locate a kidney. In order to make myself feel sane again I decided to locate the other kidney in case somehow my bearings were way off. As I reached across the abdomen to where the other kidney should be the whole situation became incredibly clear. On the other side of the body was a kidney that was about double the normal size. It was massive. A whopper. The reason I hadn’t been able to find the kidney was because it was simply not there. It is always a possibility that you hear about but I have never encountered it before. The one kidney that had developed was doing twice the work so, as Blaze grew and his requirements went up, so the one kidney had become bigger and bigger. It seemed clear that with one kidney not developing it is reasonable to assume that the testicle didn’t develop either and I was suddenly not very happy about a very lengthy anaesthetic in what could be a compromised patient. We removed his one testicle and started him on fluids to support his circulation to the one kidney. I took some bloods to run afterwards to see whether the kidney was coping with its increased work load. Blaze’s owners had not opted for the pre-anaesthetic bloods, which many people do not at that age, but, as we found out, the bloods would have been normal because the one kidney was working so well. In fact, his owners felt guilty they had put him through it but, as I pointed out, if we hadn’t gone in to find the testicle we never would have found out about the kidney. I saw Blaze for his final post-op check today and he is fighting fit, beautifully healed and just the same dog he always is. We’ll start blood testing probably every six months to catch any early signs of kidney failure but other than that he will carry on as normal, after all, as far as he is concerned, there was never anything wrong with him anyway.
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