A Management Protocol for Gonad Preservation in Patients with Androgen Insensitivity Syndrome.

Historically, individuals with androgen insensitivity syndrome (AIS) were managed with removal of gonadal tissue at various ages to avert the risk of gonadal malignancy. Recently, clinical practice changed, with gonadectomy being postponed until late adolescence. Adolescents and adults with complete AIS have questioned this approach. Additionally, testicular germ cell tumors are increasingly believed to be quite rare with rates as low as 0% in molecularly confirmed individuals with AIS. Gonadectomy deprives patients of the benefits of their endogenous hormones and potential fertility. Furthermore, human rights organizations advocate for deferring irreversible surgery in conditions known as differences of sex development, which includes AIS, to allow patient autonomy in decision-making. Recent literature supports an approach that uses risk stratification to manage gonads in AIS. Herein we review what is known about malignancy risk in the different subtypes of AIS and propose a management protocol for gonad retention.

The Association of Shelter Veterinarians veterinary medical care guidelines for spay-neuter programs.

As efforts to reduce the overpopulation and euthanasia of unwanted and unowned dogs and cats have increased, greater attention has been focused on spay-neuter programs throughout the United States. Because of the wide range of geographic and demographic needs, a wide variety of programs have been developed to increase delivery of spay-neuter services to targeted populations of animals, including stationary and mobile clinics, MASH-style operations, shelter services, feral cat programs, and services provided through private practitioners. In an effort to ensure a consistent level of care, the Association of Shelter Veterinarians convened a task force of veterinarians to develop veterinary medical care guidelines for spay-neuter programs. The guidelines consist of recommendations for preoperative care (eg, patient transport and housing, patient selection, client communication, record keeping, and medical considerations), anesthetic management (eg, equipment, monitoring, perioperative considerations, anesthetic protocols, and emergency preparedness), surgical care (eg, operating-area environment; surgical-pack preparation; patient preparation; surgeon preparation; surgical procedures for pediatric, juvenile, and adult patients; and identification of neutered animals), and postoperative care (eg, analgesia, recovery, and release). These guidelines are based on current principles of anesthesiology, critical care medicine, microbiology, and surgical practice, as determined from published evidence and expert opinion. They represent acceptable practices that are attainable in spay-neuter programs.

Questionnaire study of canine neutering techniques taught in UK veterinary schools and those used in practice.

OBJECTIVES: To gather information about the different techniques employed in general practice and to compare this with current undergraduate teaching. This would provide an insight into any areas of discrepancy and influences on technique in practice. METHODS: A questionnaire was composed and distributed to 407 practices throughout the UK, using a commercial mailing list. Fifty further questionnaires were distributed by final-year students to their foster practices and five were sent to practices on request. A second questionnaire was composed and sent to the members of staff responsible for teaching surgical neutering techniques at each of the UK veterinary schools. RESULTS: Completed questionnaires were received from 183 respondents. These were compared with seven questionnaires from university teachers. Only areas in which the teachers reached a consensus of opinion were directly compared. CLINICAL SIGNIFICANCE: Several areas of discrepancy between current teaching and techniques in practice were identified. A study of complications compared with technique would provide further information. There is a lack of published material or an evidence base in many aspects of surgical neutering to support one technique over another.

[Towards a veterinary-professional standard concerning castration in stallions]. / Op weg naar een veterinair-professionele standaard betreffende de castratie van de hengst.

Complications following castration are increasingly often regarded as unacceptable by the owners of horses. A veterinary surgeon can only be held responsible for the consequences of his professional procedure when castration is not performed according to the rule (lege artis), i.e. if the surgeon failed to act in accordance with professional veterinary standards. So far, there is no consensus concerning the standard regarding the castration of stallions as various techniques are being used, and as some veterinary surgeons consider complications to be a normal risk in surgery. Visceral prolapse should be considered to be the most serious complication, particularly following 'open' castration. Although exact data are not available, it is the impression of the present authors that the incidence of intestinal evisceration and inguinal hernia in stallions is increasing in the Netherlands. When high priority is given to the prevention of evisceration, the 'open' method of castration should be abandoned. To reduce the hazard of evisceration to a minimum, the (half)closed technique, which involves crushing and ligation of the spermatic cord enclosed in the vaginal tunic, is recommended. This procedure enhances the risk of wound infection and scirrhous cord. However, these complications may be reduced when a high degree of asepsis is maintained during surgery.