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Proofed by Dr. Erik Johnson DVM
Below is a vet-level comparison of (1) standard prescrotal orchiectomy versus (2) scrotal approaches, and where scrotal ablation (scrotectomy) fits in. I’m going to be explicit about terminology first, because “scrotal surgery” can mean two very different things:
- Scrotal incision orchiectomy (a “scrotal approach”): you remove the testes through an incision on the scrotum (common in cats; increasingly used in dogs in some settings). This is still a straightforward castration, and the scrotum remains.
- Scrotal ablation (scrotectomy): you remove the scrotal skin/tissue (often combined with orchiectomy). This is not the same as simply making a scrotal incision.
I’ll compare prescrotal incision vs scrotal approach orchiectomy, then discuss when/why to add scrotal ablation, with case-based examples from the literature.
Key structures you think about regardless of approach:
- Spermatic cord (testicular artery/vein, pampiniform plexus, ductus deferens, associated fascia)
- Vaginal tunic (closed vs open technique decisions)
- Scrotal dartos and very thin scrotal skin (highly mobile, very vascular, heals well but bruises/swells easily)
- Urethra (ventral midline, caudal to the prescrotal incision site but relevant in deep dissection/complications)
The three “families” of castration procedures in dogs
1) Standard
prescrotal orchiectomy
(most common in general practice)
Concept: One midline incision cranial to the scrotum; both testes are exteriorized through that incision (by “milking” each testis cranially), ligated, removed, and the skin is closed.
Why it’s the default:
- Familiar to most clinicians; easy instrument/hand positioning.
- Incision is in thicker skin than scrotum and is often perceived as “cleaner” and less tempting to lick.
- Easy to place buried subcuticular patterns; predictable cosmetic closure.
Downsides (common themes):
- In some dogs, there’s more traction/tunneling to exteriorize the testes, which can increase tissue trauma.
- Empty scrotum can remain prominent in older/large dogs (owner cosmetic dissatisfaction).
- Post-op scrotal edema/seroma/hematoma can still happen because the scrotal dead space remains, especially in large, pendulous scrota. Today’s Veterinary Practice explicitly highlights scrotal hematoma as an important complication and notes severe cases may require scrotal ablation as treatment.
- Rare but serious: iatrogenic urethral trauma has been described during routine prescrotal orchiectomy.
2)
Scrotal approach orchiectomy
(incision on scrotum; scrotum not removed)
Concept: Access the testes directly through scrotal skin (often one midline ventral scrotal incision, or separate incisions). In some high-volume settings, scrotal incisions may be left partially open or closed with tissue adhesive depending on protocol (varies by patient age/setting).
Evidence-informed advantages
- Shorter surgical time in some studies
A Veterinary Evidence critically appraised topic summarized a large comparison (Woodruff et al., 2015) where the scrotal approach averaged ~3.6 min vs ~5.1 min for prescrotal (timed at one site) and found reduced odds of self-trauma with scrotal incision (OR ~0.51). - Similar overall complication rates (with a few nuances)
In that same appraisal, hemorrhage/pain/swelling were not significantly different between incision locations in the monitored window, while self-trauma differed.
In a separate large pediatric shelter cohort (Miller et al., 2018), a sutureless scrotal castration protocol was significantly faster than a traditional prescrotal approach and was reported as safe in that setting. - Feasibility/safety with modern hemostasis tools
A 200-case prospective observational study reported scrotal approach orchiectomy using a vessel-sealing device as feasible with low complication rates (study-specific definitions and context matter).
Tradeoffs / disadvantages
- Some surgeons worry about more swelling/bruising simply because scrotal skin is thin and highly vascular—though controlled studies don’t always show clinically meaningful differences.
- Cosmesis is operator- and patient-dependent (scrotal incision can look very good; can also look “messy” briefly due to bruising).
- Protocol sensitivity: closure method, patient age, activity restriction, and lick prevention can heavily influence outcomes.
A practical interpretation of the evidence:
For many healthy dogs, both prescrotal and scrotal approaches are defensible; outcomes hinge more on patient factors (age, scrotal conformation, behavior/licking risk), technique details (open vs closed), hemostasis quality, and aftercare than on the incision location alone. The best comparative synthesis I found supports “broadly similar complication profiles,” with scrotal approaches showing shorter time and less self-trauma in at least one large comparative dataset.
3)
Orchiectomy + scrotal ablation (scrotectomy)
(remove scrotum)
Concept: Castrate and remove excess/diseased scrotal tissue, closing the skin where scrotum used to be. This is commonly:
- Therapeutic (scrotal disease, necrosis, severe trauma, chronic dermatitis, tumors, severe hematoma)
- Adjunctive/cosmetic (older large dogs with big pendulous scrota where dead space is a problem)
When it’s favored
- Large, pendulous scrotum in older dogs → higher perceived risk of post-op dead-space issues (seroma/hematoma), or owner strongly prefers removal.
- Scrotal pathology: chronic ulcerative dermatitis, severe inflammation, traumatic injury, necrosis.
- Salvage for complications: severe scrotal hematoma/skin compromise after castration (explicitly noted as sometimes requiring scrotal ablation).
- Required component of a scrotal urethrostomy (different procedure, but illustrates common pairing).
- International guidance: WSAVA reproduction-control guidelines include circumstances where orchiectomy with scrotal ablation is required when scrotal skin is damaged.
Disadvantages / added morbidity
- More tissue dissection and a larger wound → typically more bleeding risk and potentially more post-op discomfort than simple castration (depends on technique and patient).
- Increased need for meticulous hemostasis because scrotal tissues are vascular.
- More meaningful risk of complications tied to bigger surgery (seroma, infection, dehiscence), though it can reduce long-term dead-space problems in selected dogs.
Comparative pros/cons by clinical priority
A) Surgical efficiency (time, exposure, ease)
- Prescrotal: efficient and familiar; can be slower if testes are difficult to “milk” cranially or if traction is significant.
- Scrotal approach: often faster in high-volume hands; supported by time findings in comparative review summaries.
- Scrotal ablation: adds time and steps; typically reserved for specific indications.
B) Hemostasis / bleeding
- Prescrotal: generally predictable; bleeding risks relate more to ligature security and technique (open vs closed) than incision location.
- Scrotal approach: scrotal skin bleeds easily superficially, but deep pedicle control is similar; modern vessel-sealing devices have been reported as workable in scrotal approach series.
- Scrotal ablation: greatest superficial bleeding potential because you’re removing vascular skin/dartos—requires disciplined hemostasis planning.
C) Swelling, hematoma, seroma, and “dead space”
- Prescrotal: can leave a pendulous, empty scrotum that becomes a dead space → predisposes to scrotal swelling/hematoma in some dogs; severe hematoma may need scrotal ablation.
- Scrotal approach: proponents argue less dead-space trauma because you’re not tunneling; evidence suggests overall complication rates are similar, but self-trauma may be lower.
- Scrotal ablation: removes the dead space entirely (when that’s the problem), but is a bigger surgery.
D) Self-trauma (licking) and wound complications
- Comparative data summarized in Veterinary Evidence suggests lower odds of self-trauma with scrotal incision in one large study.
Real-world behavior varies: some dogs obsess over any incision; others ignore both.
E) Cosmetic outcome / owner satisfaction
- Prescrotal: small cranial scar; but scrotum remains.
- Scrotal approach: may yield minimal visible scarring (especially once hair regrows), but early bruising may look dramatic.
- Scrotal ablation: “cleanest” appearance long-term in dogs with redundant scrotum, but requires owner counseling about bigger incision and aftercare.
F) Special populations
- Pediatric/high-volume shelter medicine: scrotal protocols are well-described, fast, and appear safe in large cohorts (with appropriate systems).
- Concurrent surgeries (example: perineal hernia repair): incision placement may be chosen to align with concurrent operative fields; a study compared caudal scrotal castration with perineal hernia repair vs prescrotal castration in that context.
- High-risk anatomy/complications: prescrotal orchiectomy has published cases of urethral injury; while rare, it’s a real consideration when the dissection becomes atypical.
“Surgical technique” discussion (vet-level, but not a DIY manual)
Open vs closed technique matters at least as much as incision location
One controlled study (Hamilton et al., 2014) found dogs undergoing open orchidectomy were more likely to develop scrotal complications than closed (in that cohort).
This is a reminder that if you’re comparing outcomes, you should stratify by:
- open vs closed
- hemostasis method (suture ligatures vs vessel-sealing)
- age/weight/scrotal conformation
- closure method and aftercare constraints
Prescrotal orchiectomy: what changes the risk profile
Risk tends to climb with:
- large/pendulous scrotum (dead space)
- exuberant activity post-op
- inadequate lick control
- coagulopathy, endocrine disease, concurrent infection/dermatitis
- difficult exteriorization (more traction/tissue trauma)
Today’s Veterinary Practice highlights scrotal hematoma as a key complication, sometimes requiring scrotal ablation, and also discusses accidental urethral trauma as an uncommon but serious complication.
Scrotal approach orchiectomy: “why it can be gentler”
Potentially:
- less tunneling/traction to deliver testes
- shorter incision length in some hands
- faster surgery (important because time under anesthesia correlates with some risks in population medicine)
But: you still need the same deep pedicle discipline; scrotal skin itself is not forgiving of sloppy hemostasis.
Scrotal ablation: key technical principles (conceptual)
Scrotal ablation is essentially:
- planning an elliptical resection at the scrotal base (to leave enough skin for tension-free closure),
- blunt/sharp dissection to remove scrotal skin/dartos,
- protecting deep structures (urethra) while controlling superficial bleeding,
- layered closure to obliterate dead space.
A practical, clinically oriented description notes scrotal ablation is considered in older dogs with excessive scrotal tissue due to seroma/hematoma risk or cosmetic request, and outlines combining routine castration with subsequent scrotal tissue removal and layered closure.
WSAVA guidance also explicitly recognizes orchiectomy with scrotal ablation as necessary when scrotal skin is damaged.
Case studies and real-world examples
Case set 1: Large comparative outcomes (scrotal vs prescrotal)
Woodruff et al. (2015) — summarized in Veterinary Evidence (2022)
- Compared hundreds of dogs castrated via scrotal incision vs prescrotal.
- Findings summarized: self-trauma lower with scrotal incision (OR ~0.51), surgery shorter with scrotal approach at a timed site, and hemorrhage/pain/swelling not significantly different in that monitored period.
Clinical takeaway: If self-trauma is your main concern (behavioral/management constraints), scrotal approach may be a reasonable choice in appropriate hands and settings.
Case set 2: Pediatric/high-volume protocols
Miller et al. (2018) — sutureless scrotal castration
- Reported as safe and significantly faster than traditional prescrotal castration in healthy 2–5 month old dogs, with relevance to high-volume spay/neuter efficiency.
Clinical takeaway: In pediatric dogs, scrotal approaches can be extremely time-efficient, and complication profiles can be acceptable when protocols are standardized.
Case set 3: Scrotal approach with vessel-sealing technology (adult dogs)
Yiapanis et al. (prospective observational series, 200 cases)
- Scrotal approach orchiectomy with a vessel-sealing device reported as feasible and safe, with low complication rates in that context.
Clinical takeaway: Device-assisted hemostasis can support very short operative times; generalizability depends on training, device availability, and patient selection.
Case set 4: When scrotal ablation becomes “salvage surgery”
Severe scrotal hematoma after castration → scrotal ablation
- TVP notes moderate to severe scrotal hematoma can carry serious morbidity and “often requires surgical intervention through a scrotal ablation.”
Clinical takeaway: If you’re operating on a dog at higher hematoma risk (large scrotum, very active, questionable compliance), consider whether your primary approach should reduce dead space—or whether you counsel owners about the (rare) possibility of secondary surgery.
Case set 5: Rare but severe complication after prescrotal orchiectomy
Iatrogenic urethral laceration (Jones et al., 2020 case report)
- A dog developed subcutaneous urine extravasation after a routine prescrotal orchiectomy; scrotal ablation and urethrostomy were performed and the dog recovered uneventfully.
Clinical takeaway: Urethral trauma is rare, but if a post-castration patient presents with dramatic swelling/crepitus/fluid tracking, you must keep urethral injury on the list.
Case set 6: Scrotal ablation required due to severe scrotal disease
Necrosuppurative orchitis/scrotal necrotizing dermatitis after chemical sterilant (Forzán et al., 2014)
- Two dogs developed severe reactions days after injection and required scrotal ablation.
Clinical takeaway: Not a “routine neuter” scenario, but it’s a concrete example of scrotal ablation as definitive management when scrotal tissue becomes nonviable.
Decision framework (how many surgeons actually choose)
Pick prescrotal orchiectomy when:
- young to middle-aged dog, modest scrotum, good owner compliance
- you want a closed, cranial incision away from scrotal skin
- you anticipate straightforward exteriorization and closure
Pick scrotal approach orchiectomy when:
- you prioritize speed/efficiency (e.g., high-volume setting) and have protocol competence
- you want to reduce tunneling/traction to deliver testes
- you believe your patient is at higher self-trauma risk and you’re operating in a setting where your scrotal technique yields reliable closures (supported by comparative self-trauma finding).
Add scrotal ablation when:
- scrotal skin is diseased/traumatized/necrotic or otherwise needs removal (WSAVA recognizes this).
- the scrotum is very large and you believe dead-space complications or cosmetic concerns justify the added surgical magnitude (common practical indication).
- you’re treating a major complication like severe hematoma/skin compromise.
Canine_Neutering_Prescrotal_vs_Scrotal_Ablation_Clinician_Guide
