CONSULT THE EXPERT h SURGERY, SOFT TISSUE h PEER REVIEWED

Cryptorchid
Neuter
Daniel D. Smeak, DVM, DACVS
Colorado State University

In dogs and cats, cryptorchidism is a orchid testicles may appear small or atrophied and
may not be readily palpable (particularly in cats),
condition in which one or both testicles determining ectopic location and planning sur-
have failed to descend into the scrotum gery can be challenging.
generally by 2 to 4 months of age.1 In
History & Clinical Signs
dogs, incidence ranges from 1% to 15%
A thorough patient history should be obtained and a
depending on the distribution of breeds complete physical examination performed. Further
in the study region.1 Most patients with diagnostic tests are warranted to determine neuter
status or presence of retained testicular tissue in
cryptorchidism do not show signs of
dogs with an unknown neuter history and no palpa-
illness unless testicular neoplasia or ble testicles on examination. This is particularly
torsion have developed. important if there are signs of feminization or
evidence of a concurrent condition (eg, prostatic
Cryptorchid testicles can be situated in the original disease, perineal hernia, perianal adenoma) over-
location of fetal testicular development, around the represented in intact dogs. Congenital absence of
caudal pole of the kidney, along the path of testicu- one (ie, monorchism) or both (ie, anorchism) testi-
lar descent, in the inguinal ring, or in the subcuta- cles has been reported but is rare in small animals.4,5
neous tissue between the ring and base of the
scrotum.2 Cats lose testosterone-dependent penile spines
within 13 to 24 weeks of being neutered, so cats
In dogs, ≈50% of cryptorchid testicles are intra- with penile spines and/or cats that demonstrate
abdominal; in cats, most ectopic testicles (ie, testi- urine spraying or produce odiferous urine and
cles located anywhere other than in the scrotum) have no palpable testicle(s) should be further eval-
are found in the inguinal region.3 Because crypt- uated using hormonal testing.6

September 2021 cliniciansbrief.com 21

CONSULT THE EXPERT h SURGERY, SOFT TISSUE h PEER REVIEWED

Diagnosis be readily identified and are rarely confused with

Retained Testicles other structures. Those located in or just external to
If a retained testicle is suspected, hormone tests the inguinal rings may be more difficult to palpate.
should be pursued to evaluate potential retained
functional testicular tissue. Both human chorionic A fat-filled vaginal tunic or inguinal lymph node
gonadotropin (HCG) stimulation and anti-Müllerian may feel similar to a testicle; however, differentia-
hormone biomarker tests can determine if a dog or tion is possible with ultrasonography. A normal
cat has retained functional testicular tissue. testicle is hypoechoic to surrounding fat and has a
homogeneous medium echotexture with or with-
The anti-Müllerian hormone concentration in neu- out a mediastinum testis, which is a mass of con-
tered or anorchid dogs is expected to be low (0.08- nective tissue consistently seen as a 0.2-cm linear
0.12 ng/mL) as compared with the concentration hyperechoic structure in the central long axis of
cutoff value (>5.5 ng/mL) in intact or cryptorchid the testis.10 Intra-abdominal testicles are usually
dogs.7,8 For the hCG stimulation test, a baseline palpable only when enlarged.
serum sample for testosterone levels should be col-
lected, hCG (50 IU/kg) should be administered After other external locations have been excluded
IM, and a second sample should be collected 2 and the cryptorchid testicle is determined to be
hours later. A significant rise (>100%) in testoster- intra-abdominal, abdominal radiographs may
one levels in the postinjection sample can indicate reveal an enlarged testicle (torsed or cancerous)
functional testicular tissue.9 that appears as a rounded soft tissue mass in the
caudal abdomen. Normal-sized intra-abdominal
Ectopic Testicles testicles are rarely palpable and are not visible on
If only a single testicle is found in the scrotum, the routine abdominal radiographs.
testicle should be pushed both dorsally and crani-
ally toward the prescrotal region. The testicle will A recent study showed that ultrasonography can
then move to one side of the midline, and the side it be effective for the detection of cryptorchid testi-
moves toward should be noted. The ectopic testicle cles, with a sensitivity of 96.6% for abdominal
will be on the contralateral side. Ectopic testicles in testicles and 100% for subcutaneous testicles.10
the prescrotal region, unless severely atrophied, can Testicular torsion is also readily diagnosed with
ultrasonography.11

In cases in which ultrasonography and radiogra-

phy are not available or the pet owner chooses not
Both testicles should be to use this method, surgical exploration and
removal of the testicle can be pursued.
removed in cryptorchid
patients, even when one Both testicles should be removed in cryptorchid
patients, even when one testicle is in a normal
testicle is in a normal scrotal location.3 This condition is strongly sus-
scrotal location.3 pected or known to be genetic in certain dog (eg,
toy breeds, boxers, bulldogs) and cat breeds.1,3 In
addition, undescended testicles are up to 13 times
more likely to become neoplastic than normally
located testicles and are more prone to torsion12;
both testicles should always be submitted for
hCG = human chorionic gonadotropin
histopathology. Surgical placement of an ectopic

22 cliniciansbrief.com September 2021

testicle in the scrotum (ie, orchiopexy 13) has been underlying epigastric vessels. Dissection should
reported but is not recommended. be continued down to the inguinal ring and vagi-
nal process; in cryptorchid dogs, the process
Surgical Removal appears as a small, sausage-shaped pouch-like
Prescrotal Testicles structure that may be partially filled with fat. Fat
The testicle should be pushed toward the midline and connective tissue from the vaginal process
and an incision made through the skin and super- should be dissected and the end of the process
ficial subcutaneous layer. The spermatic cord and grasped with Allis tissue forceps. The vaginal pro-
the testicle should be dissected free of surround- cess should be carefully inspected and the ingui-
ing soft tissue and should be double mass ligated. nal extension of the gubernaculum (Figure 1)
The scrotal testicle should be removed using a identified; this is seen as a thin band of fibrous tis-
standard prescrotal neuter method. sue (2-4–mm thick in dogs, 1-2–mm thick in cats)
exiting the inguinal canal and extending from the
External Inguinal Testicles apex of the vaginal tunic toward the scrotum.
If the cryptorchid testicle is palpated in the subcu-
Continues h
taneous tissue of the inguinal region, an incision
should be made directly over the ectopic testicle to
expose and remove it. Because the testicle may be
deep in the inguinal fat pad, dissection should be
A
performed carefully to identify and avoid damage
to the nearby pudendoepigastric vasculature. The
testicle and spermatic cord should be dissected
free of surrounding soft tissue and the procedure
completed using a standard method.

Testicles Within or
Deep to the Inguinal Canal
Inguinal Approach
An inguinal approach may be chosen when the
location of the testicle is unknown; most abdomi-
nal ectopic testicles and those caught in or just
deep to the inguinal canal can be removed with
B
this approach.14 If a spermatic cord extending cau-
dally from the inguinal ring is found during early
extra-abdominal dissection, the cord should be
dissected, the subcutaneous testicle dissected free
of surrounding soft tissue, and a routine closed
neuter performed.

Skin should be incised 4 to 6 cm in a longitudinal

direction over the inguinal ring area and promi-
nent vaginal process, which is an embryonic out- d FIGURE 1 Limited inguinal approach in which the gubernacu-
pouching of parietal peritoneum that extends lar extension is grasped and pulled caudally to expose the
through the inguinal ring. The author prefers to vaginal process (A; arrow). The vaginal process is incised with
continued traction of the gubernaculum (B; arrow), and the
incise slightly lateral to the fatty tissue under the connected testicle is exposed (arrowhead). Images courtesy of
fifth mammary gland to avoid damaging the Journal of the American Veterinary Medical Association

September 2021 cliniciansbrief.com 23

CONSULT THE EXPERT h SURGERY, SOFT TISSUE h PEER REVIEWED

Controlling hemorrhage during this procedure enlarged testicle cannot be pulled into the subcuta-
enables isolation of the minute structures (ie, neous space, or a friable gubernacular ligament
gubernaculum, vaginal tunic). ruptures during traction, causing the testicle to
retract and become lost in the abdominal cavity.
A small incision into the vaginal process should be
made and the interconnected epididymal ligament, Abdominal Testicles
ductus deferens, and tail of the epididymis identi- Ventral Midline Approach
fied. Continued traction should be applied on any A ventral midline approach can be used if the testi-
of these structures or the gubernacular ligament cle is enlarged and pathologic. This approach
while the testicle is pulled through the inguinal should be selected when a complete abdominal
ring (see Author Insight). The spermatic vessels exploration is also necessary, as bilateral intra-
and ductus can be double-ligated separately after abdominal testicles can be readily removed. An
the testicle is exteriorized. If the inguinal rings are incision should be made on the midline from the
enlarged during the procedure, several interrupted umbilicus caudal, paramedial, and extended to
sutures can be placed in the external inguinal ring (at least) the midpoint of the prepuce. The incision
at the cranial aspect while avoiding nearby neuro- should be extended to obtain ideal exposure, allow
vascular structures. easy removal of a torsed or enlarged neoplastic tes-
ticle, and inspect local lymph nodes and associated
A paramedian approach should be used if no testi- pathology.
cle is found, the gubernaculum is not identified, an
Paramedian Approach
The paramedian approach is the author’s preferred
method for unilateral cryptorchid neuters when the
AUTHOR INSIGHT ectopic testicle cannot be located with imaging or
In some older dogs (eg, patients with a testicle enlarged palpation, is in the abdomen, or is trapped in the
due to a tumor), the inguinal ring may need to be inguinal canal and laparoscopic equipment is
enlarged. This can be accomplished by incising the unavailable.15 This approach avoids dissection
cranial aspect of the external inguinal ring to permit final around the prepuce, and the incision is lateral to
passage of the ectopic testicle through the canal. the epigastric vasculature. Minimal undermining
is required; therefore, dead space is minimized. No
additional retraction is needed because the dissec-
tion plane runs directly from the skin incision to
the abdomen. Before entrance is made into the
abdomen, the surgeon should proceed to the ingui-
nal ring region to determine whether the testicle
can be easily and digitally palpated or whether a
spermatic cord can be identified extending caudal
to the inguinal ring in the subcutaneous tissue. In
these cases, a further caudal incision is needed for
the skin and subcutaneous tissue to expose and
excise the testicle.

dF
 IGURE 2 An incision is made parallel and lateral to the nipple The longitudinal incision should be centered lateral
line (and lateral to the course of the caudal superficial
and parallel to the nipple line and midway between
epigastric vessel that is faintly visible). The incision extends
from the level of the preputial orifice to just cranial to the the tip of the prepuce and the vaginal process (Fig-
inguinal ring. ure 2). The skin and subcutaneous tissue should be

24 cliniciansbrief.com September 2021

sharply incised and, before approaching the abdo- Avoiding Intraoperative
men, an index finger should be moved along the Complications Due to Poor Exposure
loose connective tissue plane just superficial to the A paramedian approach can help avoid inadvertent
abdominal fascia. The inguinal ring area should be ureteral avulsion or prostatectomy. To avoid dam-
palpated carefully for a testicle. If a testicle is not age to the ureter or prostate, the structure isolated
found, the index finger should continue to push in the caudal abdomen should be confirmed to be a
along the fascia until it is caudal to the inguinal testicle. Aggressive pulling or tissue retraction
ring and superficial to the pubic bone, then the fin- should be avoided when attempting to expose a
ger can be swept laterally to identify a spermatic cryptorchid testicle. Retraction of a ureter misiden-
cord. If a spermatic cord is found, the incision tified as a ductus deferens could cause damage or
should be lengthened caudally and the neuter can even avulsion. If a spay hook is used to snare the
be completed. ductus deferens, the tissue connected to the ductus
deferens should be carefully inspected. The prostate
If no cord can be palpated, the testicle is either in can be mistaken for a cryptorchid testicle; careful
the abdomen or, more rarely, stuck in or deep to inspection can help avoid this mistake.16 In addi-
the inguinal canal. A longitudinal incision should tion, both the prostate and testicle are connected to
be created just medial to the myofascial line
through the external abdominal oblique fascia
and continued past the internal abdominal oblique
fascia, with blunt spreading between the rectus
abdominis muscle fibers (Figure 3). The thin peri-
toneal layer below should be identified, and the
epigastric vessels deep and medial to the incision
should be avoided.

The surgeon should bluntly puncture and digitally

widen the peritoneum; the ectopic testicle usually
pops into the field. If no testicle is readily appar-
ent, an index finger can be used to sweep and
d FIGURE 3 Separate fascias of the external and internal abdom-
snare the ductus deferens. If the ductus cannot be
inal oblique muscles are incised, exposing the fibers of the rec-
isolated, the bladder can be caudally reflected to tus abdominis.
expose both ductus deferens as they approach the
prostate. The respective ductus should be gently
pulled to determine if the attached testicle can be
pulled into the approach. If this is not successful,
the ductus can be judiciously pulled cranially with
one hand and the ductus followed to the internal
inguinal ring. If the ductus runs into the inguinal
ring, the skin incision should be expanded and an
inguinal approach should be adopted (Figure 4).

The paramedian approach repair is initiated with

combined closure of the internal and external
abdominal fascia edges in a simple continuous pat-
d FIGURE 4 After the fibers of the rectus abdominis muscle are
tern. Subcutaneous and skin layers can be closed bluntly divided, the testicle is identified and retracted from the
routinely. abdomen to expose the ductus and testicular vasculature.

September 2021 cliniciansbrief.com 25

CONSULT THE EXPERT h SURGERY, SOFT TISSUE h PEER REVIEWED

the ductus; however, the ductus runs dorsal and

medial to the prostate and lateroventral to the testi-
cle. An abdominal testicle is more freely attached
and is easily retracted into the field for ligation
unless trapped in the inguinal canal (Figure 5). If
the testicle is not readily retracted into the field, the
ductus can be followed laterally toward the internal
inguinal ring. If the ductus runs into the inguinal
canal, the inguinal approach can be adopted.

Laparoscopic Approach
When laparoscopy is available, it provides excep-
tional visualization for testicle identification and
removal and is the author’s preferred method for
removing unilateral and bilateral intra-abdominal
testicles.
dF
 IGURE 5 Left paramedian approach to remove a free left
abdominal cryptorchid testicle Laparoscopic-Assisted Technique (2-Port)17
A 6-mm cannula should be safely inserted on the
midline just caudal to the umbilical scar via a Has-
son or Veress needle technique. The abdominal
cavity should be insufflated, and a 0-degree rigid
laparoscope should be inserted through the can-
nula. The abdominal cavity should be explored
first. If the ductus is followed to the internal ingui-
nal rings, the scope can be removed and the
approach converted to inguinal in order to iden-
tify and remove the ectopic testicle. If an abdomi-
nal testicle is identified (Figure 6), a second 6-mm
port should be inserted in a position ventral and
slightly lateral to the testicle. The second cannula
placement should be directly visualized with the
scope. The testicle should be pulled with laparo-
scopic graspers through the lateral port, which
can be expanded to remove an enlarged testicle.
The cryptorchid testicle should be routinely
ligated and removed outside the abdominal cavity.

dF
 IGURE 6 A cryptorchid testicle identified adjacent to the
Single Incision Multiport Technique
urinary bladder with a laparoscope. Image courtesy of Journal The author prefers a single incision laparoscopic
of the American Veterinary Medical Association surgery (SILS) multiport technique18 for cryptor-
chid neuter when a minimally invasive approach is
elected. This involves a single incision; multiple
instruments can be inserted simultaneously for
visualization, grasping, retracting, and vessel
SILS = single incision laparoscopic surgery
sealing. Unlike the 2-port technique, the SILS port

26 cliniciansbrief.com September 2021

site does not need to be expanded to remove an to the abdominal cavity should be adopted, and a
enlarged testicle because the port is removed first. finger should be used to sweep and pick up the duc-
tus deferens, which should be gently pulled up and
An SILS port should be placed on the ventral mid- followed until the testicle is found. If the ductus
line at the umbilical scar using a Hasson approach. extends to the internal inguinal ring and the testi-
Appropriate-sized cannulas should be inserted in cle cannot be teased into the abdomen for removal,
the port and the abdomen insufflated. After explo- dissection of the external inguinal ring can be per-
ration with the scope, a grasper can be used to hold formed and the gubernaculum isolated. The guber-
and retract the ectopic testicle. A vessel sealing naculum should be firmly pulled up until the testicle
device should be used for hemostasis. If a vessel is dissected from the inguinal ring. The testicle can
sealer is not available, the vessels and ductus can then be routinely removed.
be ligated as described with the 2-port technique.
While the freed testicle is being grasped, the port Postoperative Care & Complications
should be pulled out of the abdominal wall, and the For all mentioned procedures, the author recom-
testicle should be routinely ligated and removed. mends a peri-incisional block with administration
The incision can then be routinely closed. of a prolonged-acting local anesthetic agent (eg,
bupivacaine [1 mg/kg]) as the wound is closed.
Cryptorchid Neuter for Cats When no contraindications exist, NSAIDs (eg, car-
Testicles that are palpable in the subcutaneous tis- profen, 4.4 mg/kg PO every 24 hours or divided
sue should be removed longitudinally by incising and given every 12 hours, dogs only) should be
directly over the inguinal testicle. Once the testi- administered for 3 to 5 days after surgery. Follow-
cle is exposed, it should be bluntly dissected and up on the biopsy results and consultation with the
removed after routine ligation of the spermatic owner regarding further examinations or diagnos-
cord. In cases in which the testicle cannot be pal- tics may be needed. The incision site should be mon-
pated, which is common, a caudal ventral midline itored for local signs of ensuing seroma, infection,
approach should be used to incise from the umbili- or dehiscence. An Elizabethan collar may be needed
cus to 1-cm cranial to the pubic brim. No prepuce to prevent self-trauma. The patient can resume rou-
overlies the linea alba in cats, so a simple direct tine activity following suture removal.
approach can be used.
Complications after cryptorchidectomy are
The midline fascia should be exposed using a uncommon, and most are local and self-limiting.
sharp, careful dissection of the inguinal fat off the Serious complications are rare and include dehis-
underlying fascia until the inguinal canal area is cence, hemorrhage from insecure pedicle ligation,
exposed. The inguinal ring should be inspected for inadvertent ureteral avulsion or ligation, and
the gubernaculum or spermatic cord. If a sper- inadvertent prostatectomy. n
matic cord is found extending caudally from the
ring, blunt dissection should be performed around
the spermatic cord and the cord pulled cranially to
expose the testicle. In many cases, the testicle may
appear as an indistinct, small, soft tissue struc- The SILS port site does not need
ture at the terminal end of the spermatic cord; the
mass and terminal cord should be removed.
to be expanded to remove an
enlarged testicle because the
If only the gubernaculum is found extending from
the canal, the testicle is either free in the abdomen
port is removed first.
See page 61 for references.
or caught at the inguinal canal. A midline approach

September 2021 cliniciansbrief.com 27

CONTINUED FROM PAGE 27

NOCITA
®

(bupivacaine liposome injectable suspension)

13.3 mg/mL
For local infiltration injection in dogs only
For use as a peripheral nerve block in cats only
Local anesthetic
References Single use vial
1. Romagnoli SE. Canine cryptorchidism. Vet Clin North
Am Small Anim Pract. 1991;21(3)533-544. Caution:
Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian.
2. Khan FA, Gartley CJ, Khanam A. Canine cryptorchidism:
an update. Reprod Domest Anim. 2018;53(6):1263-1270. Before using this product, please consult the Product Insert, a summary of which follows:
3. Yates D, Hayes G, Heffernan M, Beynon R. Incidence DOG Indication:
of cryptorchidism in dogs and cats. Vet Rec. For single-dose infiltration into the surgical site to provide local postoperative analgesia for cranial cruciate
2003;152(16):502-504. ligament surgery in dogs.
4. de la Puerta B, Baines S. Surgical diseases of the genital CAT Indication:
tract in male dogs 1. Scrotum, testes and epididymides. For use as a peripheral nerve block to provide regional postoperative analgesia following onychectomy in cats.
In Pract. 2012;34(2):58-65. DOG Dosage and Administration:
5. Millis DL, Hauptman JG, Johnson CA. Cryptorchidism NOCITA is for single dose administration only. A dose of 5.3 mg/kg (0.4 mL/kg) is administered by infiltration
and monorchism in cats: 25 cases (1980-1989). J Am Vet injection into the tissue layers at the time of incisional closure for dogs. A single dose administered during
Med Assoc. 1992;200(8):1128-1130. surgical closure may provide up to 72 hours of pain control.
6. Aronson LR, Cooper ML. Penile spines of the domestic CAT Dosage and Administration:
cat: their endocrine-behavior relations. Anat Rec. NOCITA is for administration only once prior to surgery. Administer 5.3 mg/kg per forelimb (0.4 mL/kg per
1976;157(1):71-78. forelimb, for a total dose of 10.6 mg/kg/cat) as a 4-point nerve block prior to onychectomy. Administration
prior to surgery may provide up to 72 hours of pain control.
7. Gharagozlou F, Youssefi R, Akbarinejad V,
Mohammadkhani NI, Sharpoorzadeh T. Anti-Müllerian Contraindications:
hormone: a potential biomarker for differential Do not administer by intravenous or intra-arterial injection. If accidental intravascular administration
occurs, monitor for cardiovascular (dysrhythmias, hypotension, hypertension) and neurologic (tremors,
diagnosis of cryptorchidism in dogs. Vet Rec.
ataxia, seizures) adverse reactions. Do not use for intra-articular injection. In humans, local anesthetics
2014;175(18):460. administered into a joint may cause chondrolysis.
8. Themmen APN, Kalra B, Visser JA, et al. The use of
Warnings:
anti-Müllerian hormone as diagnostic for gonadectomy
Not for use in humans. Keep out of reach of children. NOCITA is an amide local anesthetic. In case of
status in dogs. Theriogenology. 2016;86(6):1467-1474. accidental injection or accidental topical exposure, contact a physician and seek medical attention
9. England GCW, Allen WE, Porter DJ. Evaluation of the immediately. Wear gloves when handling vials to prevent accidental topical exposure.
testosterone response to hCG and the identification of Precautions:
a presumed anorchid dog. Do not administer concurrently with bupivacaine HCl, lidocaine or other amide local anesthetics. A safe
J Small Anim Pract. 1989;30(8):441-443. interval from time of bupivacaine HCl, lidocaine or other amide local anesthetic administration to time of
10. Felumlee AE, Reichle JK, Hecht S, et al. Use of NOCITA administration has not been determined. The toxic effects of these drugs are additive and their
ultrasound to locate retained testes in dogs and cats. administration should be used with caution including monitoring for neurologic and cardiovascular effects
Vet Radiol Ultrasound. 2012;53(5):581-585. related to toxicity.
11. Miyabayashi T, Biller DS, Cooley AJ. Ultrasonographic The safe use of NOCITA in dogs or cats with cardiac disease has not been evaluated.
appearance of torsion of a testicular seminoma in a The safe use of NOCITA in dogs or cats with hepatic or renal impairment has not been evaluated. NOCITA is
cryptorchid dog. J Small Anim Pract. 1990;31(8):401- metabolized by the liver and excreted by the kidneys.
403. The ability of NOCITA to achieve effective anesthesia has not been studied. Therefore, NOCITA is not
12. Hayes HM Jr, Pendergrass TW. Canine testicular indicated for pre-incisional or pre-procedural loco-regional anesthetic techniques that require deep and
tumors: epidemiologic features of 410 dogs. Int J complete sensory block in the area of administration.
Cancer. 1976;18(4):482-487. The safe use of NOCITA in dogs for surgical procedures other than cranial cruciate ligament surgery has not
been evaluated.
13. Kawakami E, Naitoh H, Ogasawara M, et al.
Hyperactivation and acrosome reaction in vitro in The safe use of NOCITA in cats for surgical procedures other than onychectomy has not been evaluated.
spermatozoa ejaculated by cryptorchid dogs after The safe use of NOCITA has not been evaluated in dogs or cats younger than 5 months old.
orchiopexy. J Vet Med Sci. 1991;53(3):447-450. The safe use of NOCITA has not been evaluated in dogs or cats that are pregnant, lactating or intended for
14. Steckel RR. Use of an inguinal approach adapted
breeding.
from equine surgery for cryptorchidectomy in dogs DOG Adverse Reactions:
and cats: 26 cases (1999-2010). J Am Vet Med Assoc. Field safety was evaluated in 123 NOCITA treated dogs. The most common adverse reactions were
2011;239(8):1098-1103. discharge from incision (3.3%), incisional inflammation (2.4%), and vomiting (2.4%).
15. Smeak DD. A limited paramedian approach for CAT Adverse Reactions:
cryptorchid castration & cystotomy in male dogs. Oral Field safety was evaluated in 120 NOCITA treated cats. The most common adverse reactions were elevated body
presentation at: WVC 90th Annual Conference; March 6, temperature (6.7%), surgical site infection (3.3%), and chewing/licking of the surgical site (2.5%).
2018; Las Vegas, NV. Storage Conditions:
16. Vititoe K, Pack L. Anuria due to inadvertent Unopened vials should be stored refrigerated between 36° F to 46° F (2° C to 8° C)
prostatectomy during cryptorchidectomy. Can Vet J. NOCITA may be held at a controlled room temperature of 68° F to 77° F (20° C to 25° C) for up to 30 days in
2013;54(7):675-678. sealed, intact (unopened) vials. Do not re-refrigerate. Do Not Freeze.
17. Miller NA, Van Lue SJ, Rawlings CA. Use of laparoscopic- How Supplied:
assisted cryptorchidectomy in dogs and cats. J Am Vet 13.3 mg/mL bupivacaine liposome injectable suspension in 10 mL or 20 mL single use vial. 10 mL supplied
Med Assoc. 2004;224(6):875-878. in 4-vial carton. 20 mL supplied in a single vial carton and 4-vial carton.
NADA 141-461, Approved by the FDA
18. Runge JJ, Mayhew PD, Case JB, Singh A, Mayhew KN,
Culp WTN. Single-port laparoscopic cryptorchidectomy US Patent: 8,182,835; 8,834,921; 9,205,052
in dogs and cats: 25 cases (2009-2014). J Am Vet Med
Assoc. 2014;245(11):1258-1265.

Manufactured for: Aratana Therapeutics, Inc., Leawood, KS 66211

Additional Information is available at www.aratana.com or by calling Aratana Therapeutics at 1-844-272-8262.
NOCITA is a registered trademark of Aratana Therapeutics, Inc. © Aratana Therapeutics, Inc.
NOC-0088-2 August 2018

September 2021 cliniciansbrief.com 61 September 2021 cliniciansbrief.com 61