Should we recommend castration in dogs with perineal hernia?

Canine Perineal Hernia Associated with Prostatic Disorders: Is Castration Really Beneficial? A Retrospective Study

Putinee Sangmanee 1, Attawit Kovitvadhi 2, Wijit Sutthiprapa 3, Piyathip Choochalermporn 4, Chunsumon Limmanont 1 5

Background
Prostatic disorders, driven by androgen-dependent hormones, are prevalent in older, intact male dogs and contribute significantly to the development of perineal hernia (PH). Enlarged or inflamed prostates can cause tenesmus and increased intra-abdominal pressure, leading to weakening of the pelvic diaphragm. Castration is commonly recommended alongside herniorrhaphy to reduce recurrence by eliminating hormonal influence, though its effectiveness remains debated. This study aimed to evaluate the clinical outcomes and recurrence of PH in dogs with prostatic disorders undergoing herniorrhaphy with or without castration.

Methods
This retrospective study evaluated 315 intact male dogs diagnosed with both PH and prostatic disorders treated at a single veterinary teaching hospital between 2018 and 2023. Dogs were grouped into those that underwent perineal herniorrhaphy with castration (PHC, n=184) and without castration (PHNC, n=131). Data collected included signalment, clinical signs, imaging, surgical details, and postoperative outcomes. Dogs were followed in three phases: postoperative (1–2 weeks), short-term (1–2 months), and long-term (>6 months). Statistical analyses included chi-square tests and Kaplan–Meier survival analysis.

Results
Dogs in the PHC group exhibited significantly better clinical improvement across all follow-up phases. Prostatic enlargement, heterogeneous parenchyma, and intraparenchymal cystic lesions were significantly less prevalent in castrated dogs. Although the overall recurrence rate of PH did not differ significantly between groups (PHC: 13.58%, PHNC: 16.79%; p=0.5), recurrence in the PHNC group was more often associated with unresolved or worsening prostatic disease. Notably, UTIs and other postoperative complications were more frequent in the non-castrated group. Surgical technique did not significantly affect recurrence rates, though the sacro-ischial sling method showed lower recurrence compared to other methods.

Limitations
This retrospective study relied on medical records, which may have incomplete data and varied diagnostic consistency. Selection bias could affect subgroup comparisons, and the relatively small size of some subgroups limited statistical power. Variability in surgical technique and timing of castration may confound interpretation. Advanced imaging modalities were not uniformly used. These factors restrict generalizability and suggest the need for prospective studies.

Conclusions
Castration in conjunction with perineal herniorrhaphy improves postoperative outcomes and reduces the prevalence of prostatic abnormalities that contribute to PH recurrence. While castration did not significantly reduce the overall PH recurrence rate, it mitigated recurrence specifically related to prostatic pathology. Comprehensive prostatic management, including drainage, cyst resection, or partial prostatectomy during herniorrhaphy, is crucial to long-term success. Future research should focus on prospective designs and explore standardized protocols for surgical and medical management of PH with concurrent prostatic disease.

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