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Discussion on Cryptorchid Quandry
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New Member:
sdlacrow
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Posted on Wednesday, Feb 16, 2011 - 11:10 pm:
I purchased what I was told was a 3 year-old Tenn Walker gelding a few months ago. The person I purchased him from was not the initial owner/breeder and was sold to her as a gelding. Initially everything was fine, but a month ago started guarding the mare in the herd and being aggressive to another gelding and in general acting "studdy". I got a testosterone level done and it came back as 932 pg/mL (the ranges for this lab were geld <40, crypt 100-500, stallion 200-7000). No visible testicles, sedated and palpated (external and rectal) by vet and nothing felt at all on left and possible something felt on right. Today brought in for surgery. After anesthetized and prepped saw a scar just right of midline near scrotum. Vet made inguinal incision on left and explored area (I think into inguinal canal-he had his arm up to his elbow in the horse). Removed scar tissue, epididymus and possible piece of testicle. He did not explore the right side because the initial scar was on that side and he thought what he initially palpated was likely just scar tissue from a previous surgery where they tried to remove both testicles thru one incision. Not sure if I should have pushed the point but didn't want to act like I knew more than a vet that is well respected in the area. I'm just getting a sinking feeling because I can't imagine that the tissue I saw removed could possibly produce that much testosterone. What is the likelihood that I'm going to be making a trip to the university for an abdominal ultrasound and laproscopic surgery? Or do I have another exploratory done on the right side via inguinal incision? Or just recheck testosterone level in 1-2 months and see?
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Moderator:
DrO
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Posted on Thursday, Feb 17, 2011 - 8:23 pm:
Hello Laura,
There is no way we can predict what are the chances you may have ongoing problems but it takes very little tissue to produce significant amounts of testosterone so retest him using the HCG protocol in the article on Cryptorchidism. I would avoid just checking testosterone do to the reasons explained in the article and it may take time for the estrone sulfate levels to go down.
DrO
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New Member:
sdlacrow
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Posted on Thursday, Feb 17, 2011 - 8:38 pm:
Thanks Dr.O At what point post-sx can you do the HCG protocol to see if the surgery was successful? Also, where is a source for the HCG (I'm a small animal emergency vet and couldn't find it thru our regular suppliers)and which lab do you prefer? I sent the initial test to Antech. Thanks so much for your help.
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Moderator:
DrO
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Posted on Friday, Feb 18, 2011 - 6:21 am:
Since the HCG test measures the response of the testicular tissue present, I would think it could be done immediately. It has been several years since I have bought HCG (the breeding business is that poor locally) but believe we use to get it through Butler. I use IDEXX labs but having used Antech in the past I think they would be fine.
DrO
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New Member:
sdlacrow
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Posted on Friday, Feb 18, 2011 - 8:21 am:
Thank you so much. I will go on a HCG hunt and get that test done ASAP so I know what's going on with his parts. I'll re-post with results when I get them.
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New Member:
sdlacrow
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Posted on Monday, Feb 28, 2011 - 10:03 pm:
Well I did the HCG test and I would say the results are ambiguous. The test was done a week after the surgery. Antech lab protocol for HCG testing was baseline sample, 6000IU HCG IV, then repeat samples at 20 min, 1 hour, and 2 hours post-injection. Results are as follows- baseline=1025.6 pg/ml, 20 min post=941.46 pg/ml, 1 hr post=1428.4 pg/ml, 2 hr post=1315.8 pg/ml. The overall levels are all high and all are above the baseline sample taken before surgery, but they did not increase dramatically with the administration of HCG. His behaviour has gotten worse also--the addition of two new mares to the farm didn't help, but he did let me poke him five times for samples by myself. He hasn't gotten overtly aggressive, but is getting more disrespectful in general so I have to really stay on him. Dr.O where do you suggest I go from here? Thanks so much
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Moderator:
DrO
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Posted on Tuesday, Mar 1, 2011 - 6:26 pm:
Laura,
According to research studies you have a 95% chance of having a true gelding. Where you go depends on your goals and resources Laura.
It strikes me a reasonable position to wait two months and if you are still suspect retest the testosterone. In the meantime he sounds like you may need to get a trainer to help you get a disrespectful horse under control.
DrO
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Member:
sdlacrow
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Posted on Friday, Apr 8, 2011 - 2:22 am:
Well, the testicle situation is finally resolved! After consulting with an equine surgeon at Iowa State University, he was scheduled for evaluation/surgery at the teaching hospital. His opinion was that with testosterone levels that high there was a very high probability of testicular tissue still present and recommended another surgery. His experience with the HCG test was interesting. He has found that crypts with the descended testicle removed and are mature horses that the results are not very dramatic. He theorized that those testicles are already maxed out so to speak and can't make dramatically more testosterone in response to the HCG. Of course, this was a surgeon and those guys always want to cut something 
So we went on our 4 hour road trip to the university this week. They found a gigantic testicle on the right side (opposite side of recent surgery)on ultrasound and removed it laproscopicly. Nothing was found on the left side with ultrasound or laproscope. The procedure was pretty cool. He was sedated, but standing, walked back to his stall 5 minutes after procedure and was eating hay 10 minutes later.
In hindsight, I wish I had brought him to the university in the first place. I assumed it was much more expensive to go there and I should have called and asked. Between the farm call, the local surgery, and the repeat blood tests I spent about $800 and the cost of the laproscopic procedure, ultrasound, hospitalization for 2 days, pain meds, and gas was $1100 and the problem was fixed with a much less invasive procedure. So I'm adding this guy to my list of high maintenance pets 
Since the bad behaviour only started when a mare went into heat and worsened as others started, hopefully all the naughtiness will disappear as the testosterone levels DrOp, but that we will have to wait and see. Regardless, I at least know that any future behavior issues are not chemically induced and I don't have to worry about a retained testicle becoming cancerous. Thanks again for your responses!
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Member:
lynnland
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Posted on Friday, Apr 8, 2011 - 9:59 am:
Hi Laura,
Glad to hear you got that solved. I too have learned that you can spend a whole lot more money trying the "cheap" approach first rather than calling in the big guns (figuratively, of course) first. I am sure the history of behaviour and approaches you posted will be of help to others with the same issues. Good luck with your horse.
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Member:
vickiann
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Posted on Friday, Apr 8, 2011 - 3:00 pm:
Good news, Laura.
Thanks for sharing this with us.
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Moderator:
DrO
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Posted on Saturday, Apr 9, 2011 - 12:35 pm:
Excellent story Laura. The surgeon's experience with unilateral crypts and lack of response to HCG has not been my experience but your now-gelding does appear to be one of the 5% that has not read the studies. Also concerning the testosterone levels, they could be attributed to the tissue removed by your home surgeon. But you are right, surgeons look upon a chance to cut as a chance to cure and so it was in this case.
Did they find the testicle in the canal or abdomen?
DrO
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Member:
sdlacrow
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Posted on Monday, Apr 11, 2011 - 12:23 am:
They found the testicle in the inguinal canal on the right side where the local vet thought that he palpated something. Since the right side had scarring on it and none visible on left side, he went in on the left for the surgery here locally and assumed what he palpated on the right was just scar tissue.
The university was able to localize the testicle with ultrasound prior to surgery and also were concerned about significant adhesion formation because of the two prior surgeries due to the ultrasound results. They were concerned that these adhesions could significantly increase his risk for colic in the future. Partially because of the amount of scar tissue present and partially due to wanting to evaluate adhesions more accurately were the factors that pushed toward the laproscopic approach. Good news is that not only was the testicle removed successfully, there was only one very minor adhesion that the surgeon felt was unlikely to cause any future problems.
His interest in mares has already diminished and the barn owners feel like he seems mellower overall. He has always just walked up to me when I went out to his paddock, but with them (in morning/evening feeding times) he would run around rearing/bucking/snorting/playing and just acting very full of himself, but is now acting much calmer and relaxed and wanting to be petted. So everything seems to be headed in the right direction.
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Moderator:
DrO
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Posted on Monday, Apr 11, 2011 - 7:35 pm:
Thanks Laura,
I think the main lesson above is that thorough exploration of the inguinal canals is needed to help rule out a possible cyrpt and the palpation of the canals externally is not a reliable way to rule out a deeper testicle. We did a crypt in the field on Friday where we could feel nothing on palpation but once down and opened there it was deep in the inguinal canal just outside the internal inguinal opening.
DrO
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