A Surgical Case Report by Monepet Clinic

Male dogs that reach the senior generation without castration often develop perineal hernia.
There is a muscle group that prevents the organs inside the pelvic cavity from protruding, called the pelvic diaphragm.
These muscles become thin or defective due to aging and sex hormone secretion, and organs in the pelvis jump out from the gaps in the muscles to form a hernia under the skin.
A hernia is a condition in which an internal organ or the like has escaped from a site that should have been.
This condition is called a perineal hernia.
The organs to escape are the prostate, the bladder, and the rectum.
In the case of the rectum, a flexing rectum can cause seizures or constipation during defecation.
It is not possible to defecate on its own, and the owner may put a finger in the anus and remove it.
In the case of the bladder, the urethra is squeezed, resulting in urination disorder and urgent surgery is required.
This time, it is Chibi who is a 10-year-old no castrated hybrid.
The picture below is the ass up.

As shown in the photo above, the left perineal area was swollen, and he came to the hospital for having become extremely breathy when urinating.

Hematuria was also mixed, so it was urgent to carry out surgery.

The swollen part probably has a hernia protruding
under the skin, so make a careful incision.

What do you think of this jumping out thing?
Actually it's prostate. The periprostatic cyst is
called effusion fluid is stored inside.

In fact, even if the solution inside the prostate cyst was aspirated, the prolapsed prostate could not be returned to its original position through the hernia hole.
Swollen prostate with reservoir fluid was became much larger than the bladder.

After all, the lower abdomen was opened and the prostate prolapsed to the perineum was pulled into the abdominal cavity.

At the right end of the picture above is the bladder. At the far left is the prostate after aspiration of the inner solution.

We considered total prostate removal here, but we assume that we finish only by carrying out castration because there is a possibility of deteriorating the quality of life after surgery due to complications such as bleeding and urinary incontinence after surgery did.

Then return to the perineum and move on to the operation to close the hernia.
Conventionally, there is no definitive version of this perianal hernia reduction operation, and the muscles constituting the pelvic diaphragm mentioned above (exterior anal sphincter, levator ani, internal occlusal muscle, epigastric muscle etc.) are sutured well , How to close the hernia hole has been reported.

This time, I used silicone as an artificial material to close the hernia hole.
The advantage of this silicon plate is that the operation time
is short.
There is an advantage that even if the pelvic diaphragm is contracted or thin, it can be adapted because it is not necessary to apply a large amount of tension to pull in the muscles. The picture below is a silicon plate.

Stitch firmly to the surrounding muscles, and make sure that the silicon plate is not rattling or floating, and then the skin is sutured.

You can see that the perineal area is not the same as before the operation and there is clear.
The subsequent progress is good.

This recurrent surgery for the perineal hernia has a high recurrence rate, and it has been reported in the United States that it is 10 to 46% in the procedure using just the muscle of the pelvic diaphragm.
After all, I would like to have castration surgery earlier than to fix this disease and try for the onset prevention.

Written by Dr.Yoshihiro Itou, Monepet Clinic 2012 all right reserved.