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non cancerous risks spay neuter
Non-cancerous conditions associated with spay/neuter status in the canine
Gonadecotmy (GX) represents the most common set of surgeries performed in small animal veterinary medicine in the USA. The most common surgeries in bitches are ovariohysterectomy (OHE) or ovariectomy (OX) via ventral midline approach, or via laparoscopy. The most common surgery in dogs is castration (CX) via either prescrotal or scrotal approach. These are the procedures with which students are routinely taught surgery skills and are considered extremely safe in the USA. However, in the past two decades, there has been increasing awareness of the potential ramifications of these surgeries on individual animals and much discussion both within and outside the veterinary community has focused on the potential risks associated with gonadectomy or leaving an animal intact.1-4 The primary societal pressure to perform GX surgeries in the USA is the continuing overpopulation of unwanted dogs and cats and the perception that routine GX will reduce this population.5,6 Researchers found that intact animals were at greater risk for relinquishment7 and unwanted offspring from owned and feral animals represent a major factor contributing to the population of shelter-animals.5 Supporting the efficacy of spay-neuter programs that were established in the late 1970s and 1980’s, several studies have documented declining trends in shelter intake and animals euthanized during the past two decades,6,8 mirrored by increasing prevalence of neutered animals in private households in the USA. Recent studies suggest that 64-75% of dogs in the USA are neutered.3,5 In addition, GX is frequently performed to promote individual animal health. Several studies examining longevity and health in dogs found that neutered animals live longer and are less likely to suffer from serious reproductive diseases, such as pyometra and non-cancerous prostatic disease, mammary and reproductive tumours of females, roaming and associated traumatic events, disorders related to pregnancy or parturition and unwanted hormone-associated behavior.1,9,10 In contrast, numerous recent publications have identified specific complications associated with GX in individual animals and the effectiveness of spay/neuter programs for population control has been difficult to document, with conflicting results among studies.1,2,6,8 Because of the conflicting and confusing data available, there is an urgent need for veterinarians to have a nuanced approach to recommendations and to be prepared to discuss the benefits and risks of surgical GX with owners, public interest groups and policy makers. We herein make an effort to succinctly summarize the most important data regarding non-neoplastic health conditions affected by neuter-status. Neoplastic conditions will be addressed in a separate review in this journal and are not the focus of this paper. Major non-neoplastic conditions that have been linked with neuter-status include the following: pyometra, surgical complications, ovarian remnant syndrome, behavioural problems/anxiety, prostatic disease, urinary incontinence, cystitis, obesity, hip dysplasia and cruciate ligament rupture.4,11-21 In addition, numerous other conditions have been reported anecdotally, but are not as well supported in the literature. Rough calculation based on these data would suggest that GX increases the risk of an animal suffering from one or more of the disease above by approximately 20-30%, with urinary incontinence, cystitis, joint disorders and behaviour being the most significant factors for long-term survival and quality of life. This contrasts with intact animals, which are at risk for fewer diseases, but at a higher rate. Bitches are frequently affected by pyometra, while dogs are most affected by prostatic disease, with a 25% and 80% incidence, respectively.1,2,11,22 In addition to these health related factors, social factors must be weighed. An owner’s inability to control an intact animal in order to prevent unwanted pregnancy or willingness to manage reproduction related conditions may outweigh health concerns in many instances. On the other hand, history with orthopaedic disease or chronic incontinence in a previous pet may lead other owners to delay neuter, understanding the consequences of increased security and preventive veterinary measures as the animal ages. The behavioural data present an additional conundrum. Behavioural problems represent one of the most common reasons for animal relinquishment to a shelter (40% of dogs).3,5 The most common behavioural problems cited are aggression toward people or dogs, destructive behaviour and inappropriate elimination.3,5 Of these, inter-dog aggression has been shown to be positively affected by GX, while aggression toward people and anxiety related conditions (including submissive urination, separation anxiety and storm phobias) were increased in neutered populations and may further be exacerbated by early neuter.14,23-26 Thus, while sterilization is an important component of population control, routine recommendation of early GX may actually increase an animal’s risk of relinquishment to a shelter.14 In many instances, it is likely that no “ideal” choice exists and owners should be aware of the potential complications associated with either GX or leaving an animal intact. Further, as more data become available regarding the relationship between genetics, age at GX and onset of disease, the recommendation may be different for different individuals within a single household. Veterinarians are best suited to help their clients understand material read on the internet and elsewhere and are ideally situated to advise special interest groups and policy makers regarding animal health and welfare. To this end it is vital that veterinarians be able to present balanced and scientifically sound information on the health-effects of neutering, behavioural expectations of neutered animals and effective population management techniques.
References 1. Root Kustritz MV: Effects of surgical sterilization on canine and feline health and on society. Reprod Domest Anim 2012;47(Suppl 4):214-222. 2. Reichler IM: Gonadectomy in cats and dogs: a review of risks and benefits. Reprod Domst Anim 2009;44(Suppl 2):29- 35. 3. Trevej R, Yang M, Lund EM: Epidemiology of surgical castration of dogs and cats in the United States. J Am Vet Med Assoc 2011;238:898-904 4. Muraro L, White RS: Complications of ovariohysterectomy procedures performed in 1880 dogs. Tierarztl Prax Ausg K Kleintiere Heimtiere 2014;42:297-302. 5. Marsh P: Replacing myth with math: using evidence-based programs to eradicate shelter overpopulation. Concord(NH): Town and Country Reprographics; 2010. 6. Scarlett J, Johnston N: Impact of a subsidized spay neuter clinic on impoundments and euthanasia in a community shelter and on service and complaint calls to animal control. J Appl Anim Welf Sci 2012;15:53-69. 7. Patronek GJ, Glickman LT, Beck AM, et al: Risk factors for relinquishment of dogs to an animal shelter. J Am Vet Med Assoc 1996; 209:572-581. 8. Morris KN, Gies DL: trends in intake and outcome data for animal shelters in a large U.S. metropolitan area, 1989 to 2010. J Appl Anim Welf Sci 2014;17:59-72. 9. Hoffman JM, Creevy KE, Promislow DEL: Reproductive capability is associated with lifespan and cause of death in companion dogs. PLoS ONE 2013;8: e61082. 10. Neilson JC, Eckstein RA, Hart BL: Effects of castration on problem behaviors in male dogs with reference to age and duration of behavior. J Am Vet Med Assoc 1997;211:180-182. 11. Hagman R, Lagerstedt AS, Hedhammer A, et al: A breed-matched casecontrol study of potential risk-factors for canine pyometra. Theriogenology 2011;75:1251-1257. 12. de Bleser B, Brodbelt DB, Gregory NG, et al: The association between acquired urinary sphincter mechanism incompetence in bitches and early spaying: a case-control study. Vet J 2011;187:42-47. 13. Ball R, Birchard SJ, May LR, et al: Ovarian remnant syndrome in dogs and cats: 21 cases (2000–2007). J Am Vet Med Assoc 2010;236:548-553. 14. Spain CV, Scarlett JM, Houpt KA: Long-term risks and benefits of early-age gonadectomy in dogs. J Am Vet Med Assoc 2004;224:380-387. 15. Thompson MF, Litster AL, Platell JL, et al: Canine bacterial urinary tract infections: new developments in old pathogens. Vet J 2011;190:22-27. 16. Seguin AM, Vaden SL, Altier C, et al: Persistent urinary tract infections and reinfections in 100 dogs(1989–1999). J Vet Intern Med 2003;17:622-631. 17. Arnoldn S, Hubler M, Reichler I: Urinary incontinence in spayed bitches: new insights into the pathophysiology and options for medical treatment. Reprod Domest Anim 2009; 44(Suppl 2):190-192. 18. Okafor CC, Pearl DL, Lefebvre SL et al: Risk factors associated with struvite urolithiasis in dogs evaluated at general care veterinary hospitals in the United States. J Am Vet Med Assoc. 2013;243:1737-1745. 19. Okafor CC, Lefebvre SL, Pearl DL, et al: Risk factors associated with calcium oxalate urolithiasis in dogs evaluated at general care veterinary hospitals in the United States. Prev Vet Med 2014;115:217-228. 20. Torres de la Riva G, Hart BL, Farver TB, et al: Neutering dogs: effects on joint disorders and cancers in golden retrievers. PLoS ONE 2013;8: e55937. 21. Witsberger TH, Villamil JA, Schultz LG, et al: Prevalence of and risk factors for hip dysplasia and cranial cruciate ligament deficiency in dogs. J Am Vet Med Assoc 2008;232:1818-1824. 22. Berry SJ, Coffey DS, Strandberg JD, et al: Effect of age, castration, and testosterone replacement on the development and restoration of canine benign prostatic hyperplasia. Prostate 1986;9:295-302. 23. Hart BJ: Effect of gonadectomy on subsequent development of age-related cognitive impairment in dogs J Am Vet Med Assoc 2001;219:51-56. 24. Bamberger M, Houpt KA: Signalment factors, comorbidity, and trends in behavior diagnoses in dogs: 1,644 cases (1991–2001). J Am Vet Med Assoc 2006;229:1591-1601. 25. O’Farrell V, Peachy E: Behavioural effects of ovariohysterectomy on bitches. J Small Anim Pract 1990;31:595-598. 26. Zink MC, Farhoody P, Elser SE, et al: Evaluation of the risk and age of onset of cancer and behavioral disorders in gonadectomized Vizslas. J Am Vet Med Assoc 2014;244:309-319
C. Scott Bailey College of Veterinary Medicine, North Carolina State University, Raleigh, NC

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