Vol. 21, No.
3 March 1999 V 20TH ANNIVERSARY
CE Refereed Peer Review
FOCAL POINT
★ Prepubertal gonadectomy
procedures are technically
simple, and any veterinarian
comfortable with traditional-age
gonadectomy can safely perform
pediatric gonadectomy.
KEY FACTS
■ Scientific studies have addressed
the effects of prepubertal
gonadectomy on the skeletal,
physical, and behavioral
development of dogs and
cats.
■ According to a recent study,
prepubertal gonadectomy
does not increase morbidity
or mortality on a short-term
basis.
■ Perioperative antimicrobials are
not generally needed for patients
undergoing prepubertal
gonadectomy.
■ Techniques for prepubertal
gonadectomy involve minor
modification of the standard
procedures used for traditional-
age animals and do not require
special skills or equipment.
Prepubertal
Gonadectomy in
Dogs and Cats—Part II*
Texas A&M University
Lisa M. Howe, DVM, PhD
ABSTRACT: Since the 1993 approval of early-age gonadectomy by the American Veterinary
Medical Association, it has become a common procedure performed on shelter animals. Vet-
erinarians need to be aware of the technical differences between surgery performed on young
puppies and kittens and that on mature animals. In addition, although pediatric physiology dif-
fers from adult physiology, numerous anesthetic protocols have been found to be safe and ef-
fective for pediatric patients. Familiarity with the anesthetic and surgical procedures also in-
volves anticipation of the outcome.
M
any humane organizations and veterinarians have been promoting pre-
pubertal gonadectomy as a solution to pet overpopulation. Part I of
this article reviewed the evolution of prepubertal gonadectomy and
discussed important anesthetic and presurgical considerations; Part II summa-
rizes studies on the safety of performing prepubertal gonadectomy and describes
the surgical procedures.
The concept of prepubertal gonadectomy has engendered controversy among
veterinarians.1–7 Because scientific data regarding the ideal age at which dogs and
cats should be neutered are lacking, some veterinarians are reluctant to perform
gonadectomy on pediatric patients, citing concerns about potential long-term
effects. Such concerns include stunted growth1,2; vaginitis1–2; perivulvar dermati-
tis2–5; urethral obstruction in male cats2,5; urinary incontinence5,6; dermatolog-
ic,2,5 endocrine,2,5 cardiac,2 and behavioral abnormalities1,3,5; impaired immuno-
competence 8; and obesity. 2,5,7 Most of these concerns, however, have been
unfounded.9–13
RESEARCH STUDIES
Experimental
Two scientific studies at the University of Florida objectively addressed the ef-
fects of prepubertal gonadectomy on the skeletal, physical, and behavioral devel-
opment of dogs and cats.9,12,13 One study9 involved 32 dogs, and another12,13 in-
volved 31 cats that were randomly divided into 3 groups: animals neutered at 7
weeks of age, animals neutered at 7 months of age, and nonneutered animals
*Part I of this two-part presentation appeared in the February (Vol. 21, No. 2) 1999 issue
of Compendium.
Small Animal/Exotics 20TH ANNIVERSARY Compendium March 1999

(sexually intact control group). able outcomes were reported

Dogs and cats neutered at 7
weeks and 7 months of age
showed delayed radiographic
closure of the distal radial
growth plate compared with
that of sexually intact con-
trols. These findings suggest
that instead of causing stunt-
ed growth, prepubertal go-
nadectomy may actually in-
crease an animal’s stature. In
dogs, gonadectomy did not
affect the growth rate, food Figure 1—This tattoo on a kitten indicates that it will have had Massachusetts SPCA,17 more
intake, weight gain, or depth an ovariohysterectomy. Tattooing pediatric patients hopefully than 350 puppies and kit-
of back fat. In cats, adult prevents unnecessary confusion or surgery in the future.
body weight and body fat
were similar in animals neu-
tered at 7 weeks and 7 months of age; however, sexually
intact cats weighed less than did cats neutered at 7
months of age and had less body fat than did both
groups of neutered cats.
Another argument against early neutering of male
kittens is urethral obstruction. Stubbs and coworkers,13
however, showed that the urethral diameter (deter-
mined by contrast retrograde urethrography) of male
kittens neutered at 7 weeks of age was similar to that of
males neutered at 7 months of age and intact cats.
In animals undergoing early neutering, lack of the
gonadal hormones responsible for normal development
of external genitalia can affect their appearance. In the
University of Florida studies,9,12 the external genitalia of
both male and female cats and dogs were infantile in
appearance.
The effect of gonadectomy on behavioral characteris-
tics (activity level, playfulness, vocalization, aggression,
excitement, affection) was also evaluated; few differ-
ences were found among the groups. Some exceptions
included greater intraspecies aggression and fewer
demonstrations of affection in sexually intact cats,
higher activity levels in both groups of neutered dogs,
and increased excitability in male dogs neutered at 7
weeks of age.9,12,13
The effect of prepubertal gonadectomy on the func-
tion and maturation of the immune system in dogs and
cats has not been studied. If immune responses are de-
pressed in these patients, clinically detectable increases in ministered during anesthetic induction or if a lapse in
postoperative morbidity or mortality are not apparent.
Clinical
Based on responses to questionnaires sent to pet
owners by an American Society for the Prevention of
Cruelty to Animals (ASPCA) shelter in Oregon, favor-
for 200 dogs and 120 cats
neutered at 6 to 12 weeks of
age. 14 In general, undesir-
able effects were not noted.
Faggella and Aronsohn10,15,16
showed no significant inci-
dence of morbidity or mor-
tality in approximately 100
kittens and 100 puppies that
underwent prepubertal go-
nadectomy at 6 to 14 weeks
of age. In another study by a
tens underwent early neuter-
ing with no serious compli-
cations or deaths.
In a recent study of animals at Texas A&M Universi-
ty,11 I examined the short-term results and complica-
tions of prepubertal gonadectomy in 1988 dogs and
cats. Animals in the study were divided into three
groups based on their estimated age: group 1 animals
were younger than 12 weeks of age, group 2 from 12 to
23 weeks of age, and the third group 24 weeks of age or
older. Complications detected during anesthesia,
surgery, and the immediate postoperative period (7 days)
were recorded and classified as major (requiring treat-
ment and resulting in increased morbidity or mortality)
or minor (requiring little or no treatment and causing
minimal increase in morbidity). The study showed that
prepubertal gonadectomy of puppies and kittens did
not increase short-term morbidity or mortality com-
pared with gonadectomy performed in traditional-age
dogs and cats. Based on the study findings, gonadecto-
my can be safely performed in prepubertal dogs and
cats.
SURGICAL PROCEDURES
General Guidelines
Perioperative antimicrobial therapy is not indicated
during gonadectomy unless a break in aseptic tech-
nique occurs, a preexisting bacterial dermatologic con-
dition is present at or near the surgical site, or another
medical condition necessitates antibiotic therapy. If in-
dicated, intravenous cefazolin (22 mg/kg) can be ad-
aseptic technique occurs.
All patients undergoing prepubertal gonadectomy
should be tattooed to identify neutered animals, there-
by preventing unnecessary abdominal exploratory
surgery in the future. The recommended tattoo site is
the prepubic area in females (Figure 1) and the inguinal

GROWTH RATE ■ BEHAVIORAL TRAITS ■ MORBIDITY AND MORTALITY

Compendium March 1999 20TH ANNIVERSARY
area in males.18 Veterinarians
should tattoo the appropri-
ate female or male sex sym-
bol along with an encircled
X. Animals can be tattooed
after the surgical site has been
clipped but before the site is
surgically prepared.
Puppy and Kitten
Ovariohysterectomy
Pediatric ovariohysterecto-
my is performed similar to
traditional-age ovariohyster- Figure 2—A pediatric canine ovarian pedicle as viewed at dence of hemorrhage.
ectomy with some modifica- surgery after double ligation.
tions. For example, the inci-
sion in puppies should begin
at least 2 to 3 cm caudal to the umbilicus (compared
with the more cranially placed incision used in adult
dogs) so the uterus can be easily exposed. The incision
is therefore nearer to the middle third of the distance
from the umbilicus to the cranial brim of the pelvis,
much as is done for adult cats. In kittens, the starting
point for the incision is similar to that for adult cats
(i.e., middle third of the distance from the umbilicus to
the cranial brim of the pelvis).
Substantial amounts of clear serous fluid may be an
incidental finding in the abdominal cavity of both pup-
pies and kittens. 10,16
The uterus can be located by look- ly placed skin sutures have routinely been used by vet-
ing between the urinary bladder and colon. If necessary,
the bladder can be exteriorized to facilitate identifica-
tion of the uterus; however, after the uterus has been
located, the bladder should be returned to the ab-
domen to minimize loss of body heat. I do not recom-
mend using a Snook ovariohysterectomy hook to locate
the uterus because delicate structures (e.g., the mesen-
tery and mesenteric vessels) surrounding the uterus can
be damaged.
After the uterus has been located, the suspensory lig-
ament can be carefully broken down to improve visual-
ization. A window should be made through the broad
ligament adjacent to the ovarian vasculature, a clamp
placed just proximal (medial) to the ovary across the
vessels (a mosquito hemostat can be used on kittens
and small puppies and Kelly, Crile, or Carmalt forceps
on larger puppies), and the ovarian vessels double ligat-
ed using 3-0 to 4-0 absorbable suture material (Figure
2). In very small pedicles, a single ligature may be suffi- of puppies is not well developed.
cient to prevent hemorrhaging.
Once the ovarian vessels have been ligated on both
sides, the remaining broad ligaments should be broken
down and the uterine pedicle ligated at the junction of
the uterine body and cervix with two fully encompass-
INCISION SITES ■ SUTURE PATTERNS ■ CRYPTORCHIDECTOMY
Small Animal/Exotics
ing uterine body ligatures,
using 3-0 to 4-0 absorbable
suture material. As an alter-
native, stainless-steel hemo-
static clips can be used on
both the ovarian and uterine
pedicles.10,16 Because uterine
tissue is extremely friable,
care must be taken to avoid
excessive traction. After the
reproductive tract has been
removed, the abdomen
should be examined for evi-
The ventral fascia (exter-
nal rectus sheath) can be
closed with either a simple
continuous or simple interrupted suture pattern using
3-0 absorbable (polyglactin 910, polydioxanone, or
polyglyconate) or monofilament nonabsorbable (nylon,
polypropylene, or polybutester) suture material. It is
important to differentiate the ventral fascia from over-
lying subcutaneous tissue, which can be difficult, par-
ticularly in young puppies. The subcuticular layer and
skin can be closed with 3-0 to 4-0 absorbable suture
material in a continuous intradermal pattern. Some
veterinarians avoid using skin sutures in pediatric pa-
tients to prevent premature removal10,16; however, loose-
erinarians at Texas A&M University, and problems
with puppies or kittens prematurely removing the su-
tures have not been encountered except when sutures
were placed too snugly.
Castration
Puppy
Because puppy testes can be difficult to identify, vet-
erinarians should ascertain through careful palpation
whether both testicles have descended before beginning
surgery. If one or both testes have not descended, cryp-
torchidectomy using standard techniques should be
performed. Because of the small size and mobility of
puppy testicles, the entire scrotal area can be clipped
and surgically prepared to include the scrotum in the
sterile field. Doing so can facilitate locating and manip-
ulating the testicles and does not cause scrotal irritation
(which can occur in adult dogs) because the scrotal sac
Male puppies can be castrated through a midline pre-
scrotal or scrotal incision. An alternative uses two scro-
tal incisions similar to those done during feline castra-
tion.16 When using a midline incision, the testicles
must be securely held underneath the incision site to
Small Animal/Exotics 20TH ANNIVERSARY Compendium March 1999

avoid iatrogenic trauma to kittens and alternately rec-

the penis. After exposing the ommend using stainless-
testicles and spermatic cord steel hemostatic clips or su-
in closed fashion, the sper- ture for spermatic cord
matic cords should be double ligation. Because of the
ligated with 3-0 absorbable small size of the spermatic
suture material (Figure 3) or cord, care should be taken
stainless-steel hemostatic to prevent tearing it before
clips.16 The pedicles should ligation. Incisions can re-
be examined to ensure he- main open for second-in-
mostasis and returned to the tention healing.
inguinal region.
Faggella and Aronsohn 16 POSTOPERATIVE CARE
have reported that midline Figure 3—A pediatric canine spermatic cord as viewed at surgery Animals should be moni-
and bilateral scrotal incisions after double ligation. A single midline incision is shown. tored closely for hypother-
can remain open to heal by mia, hypoglycemia, and signs
second intention with no of pain or dysphoria. Warm
adverse effects. However, I recommend closing midline water blankets, corn syrup (if dextrose-containing in-
incisions to prevent postoperative contamination with travenous fluids are not administered during sur-
urine or fecal material and gery), or additional analgesics (e.g., 0.11 to 0.22
ENDIU
hinder fat extrusion from mg/kg intravenous, intramuscular, or subcutaneous
MP the incision. One to three butorphanol diluted for easy titration) or sedatives
M’

20th

CO

S

9 - 1
simple interrupted sutures
9 9 9
(e.g., 0.0125 mg/kg intravenous, intramuscular, or
1 9 7

ANNIVERSARY (3-0 or 4-0 absorbable su- subcutaneous acepromazine diluted for easy titration)
ture material) can be placed may be necessary to ensure smooth recovery from
A LookBack in the dermal layer with the
knots buried. Alternatives
anesthesia.
In general, pediatric patients recover very quickly
include an intradermal clo- from anesthesia and can be fed a small meal 1 to 2
Because prepubertal
sure (which is sometimes hours after anesthetic recovery. Unlike traditional-age
gonadectomy was uncommon difficult to place in short patients undergoing gonadectomy, pediatric patients re-
20 years ago, controlled incisions) or tissue adhesive cover quickly from surgery and are often playing within
experimental and clinical to seal the incision. a couple of hours.
studies on its safety and outcome
had not been conducted. Today, Kitten CONCLUSIONS
such scientific studies are As with puppies, both Although pediatric physiology differs from adult
providing the information testicles should be identi- physiology, numerous anesthetic protocols have been
necessary to dispel many of the fied before anesthetizing found to be safe and effective for pediatric patients un-
myths and controversies male kittens for surgery. I dergoing elective gonadectomy. Prepubertal gonadecto-
surrounding the effects of this recommend castrating male my procedures are technically simpler and quicker than
kittens using the same tech- are traditional-age gonadectomy procedures, and any
surgery on puppies and kittens.
niques as in adult cats––ei- veterinarian comfortable with traditional-age gonadec-
Future publication of long-term
ther a closed technique with tomy can safely and efficiently perform pediatric go-
studies should clarify the role the spermatic cord being nadectomy.
of prepubertal gonadectomy tied onto itself using a mos- Preliminary evidence from experimental and clinical
and hopefully resolve quito hemostat or an open studies indicate that prepubertal gonadectomies are safe
remaining controversies. technique in which the when evaluated on a short-term basis. Results of a study
ductus deferens and sperm- conducted at Texas A&M University showed that dur-
atic vasculature are tied ing the first postoperative week, prepubertal patients
together. Aronsohn and Fag- have similar complication rates as do traditional-age ani-
gella,10 however, do not rec- mals. Extra care with prepubertal patients, however,
ommend these techniques seems warranted to minimize complications from surgi-
because of the small size of cal technique, hypothermia, hypoglycemia, and blood
the spermatic cords in young loss. Additional studies on large numbers of pediatric

SECOND-INTENTION HEALING ■ ANESTHETIC RECOVERY

Compendium March 1999
animals are needed (and are currently being conducted)
to determine long-term outcome and detect complica-
tions associated with prepubertal gonadectomy.
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Small Animal/Exotics
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308–314, 1994.
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About the Author
Dr. Howe is affiliated with the Department of Small Animal
Medicine and Surgery, College of Veterinary Medicine,
Texas A&M University, College Station, Texas. She is a
Diplomate of the American College of Veterinary Sur-
geons.