Earl’s Orchitis Update

Around two months ago, Earl came up very sick. During that illness, he developed orchitis. The working theory was his spinal cord impediment at the C-4/C-5, which has been impacting the normal function of his hind quarters, caused urinary retention thus preventing the normal expulsion of urine from the bladder. Nerve issues, such as the one Earl contends with post-neck-trauma, interrupts the way his brain and urinary system communicate thereby opening him up for infections and swelling that prevent urine from leaving his body. It’s believed that he developed a urinary tract infection that moved through his bladder into his testes and finally into his bloodstream causing peritonitis (inflammation of the lining of the belly or abdomen).

Peritonitis is a serious condition. It happens when the thin layer of tissue inside the abdomen becomes inflamed. The tissue layer is called the peritoneum. Peritonitis usually happens due to an infection from bacteria or fungi. If left untreated, peritonitis can lead to a serious infection that spreads throughout the body and can be fatal. Thankfully, he was treated early and aggressively.

Back to the bladder. Incontinence, renal impairment, urinary tract infection, stones, and poor quality of life are some complications of his neurological condition. Just like human spinal cord trauma patients, the most common complications are bladder, reproductive, and limb function impairment. The normal act of urinating requires the coordination of a neuronal circuit between the brain and spinal cord and the bladder and urethra. With Earl’s spinal cord impediment, the voluntary inhibition of the micturition reflex is lost. For humans, there’s testing and drugs that can help. For Earl, it’s just a matter of watching for problems and managing the symptoms.

In terms of Earl’s future as a breeding stallion, spinal cord injuries have a significant impact on erectile dysfunction. A spinal injury disrupts or disturbs the connection between the brain’s main centers for sexual function to the genitals. This often leads to extensive problems with erection, ejaculation and fertility. The semen quality is reduced, possibly because of altered neurogen control of sperm maturation. Therefore, it is hypothesized that his spinal cord impediment is also the root cause of his irregular and malformed semen production and erectile dysfunction.

Back to his acute illness. Within a day or two of succumbing to the infection, Earl developed orchitis in his left testicle. Orchitis is the inflammation of the testes and is a particularly uncomfortable condition. It was treated with the strongest antibiotics on the market in hopes it would clear the infection. According to his bloodwork, he’s cleared the infection and the peritonitis also improved. However, it has been two months and the enlarged testicle has not reduced in size.

Dr. Kathryn Sharbrough of Charleston Equine Clinic, who has been treating this illness from the start, came yesterday to ultrasound the testicle to better ascertain what’s happening within. You can see from the ultrasound above that his testicle is rimmed by scar tissue varying from .5″ to an excess of 1″ thick. Moreover, the cells within the testicle appear abnormal, almost degenerative in nature, like fibrosis brought on by chronic inflammation and mineralization too.

The ultrasound image below shows a side-by-side comparison of Earl’s healthy right testicle next to his affected left testicle. Note the uniformity and smoothness of the good organ verses the irregular, pockmarked, striated, unhealthy organ.

Unfortunately, there are no real cases studies revealing longterm impacts of orchitis as most result in castration. I’ve been asked over and over whether I will castrate Earl and the short answer is I don’t know. His health is the most important thing. Castration is a relatively routine surgery, but it typically performed on horses who are two years and younger. Castration of mature stallions is not without risk. I also have to factor in Earl’s delicate physical state, which makes the stakes higher in my opinion.

Though the enlarged testicle seems relatively benign at this time, it does impede the healthy testicle’s ability to thermal regulate (drop in the heat and suck-up in the cold). This will further impair Earl’s already impacted fertility. Dr. K recommended a hemi castration, which is essentially the removal of the unhealthy, enlarged testicle only. This would allow the healthy testicle to raise and lower properly, thereby providing the ideal environment for sperm production. In a normal, healthy stallion, it would also enhance sperm production in the remaining testicle. However, that’s not a given in Earl’s case, since he has neurologic impairments already impact his semen production presently.

So the big question is to take one or both. I’d hate for him to endure two procedures. There still may be a chance that the bad testicle atrophies and can remain in-situ. Only time will tell if that’s the case. In the end, Dr. K and I decided that as long as he’s stable than we’ll give him more time. He’ll be ultrasounded again in a few months. This should give us a better sense on how to proceed.