35. Prostatic disease Flashcards
Pathophysiology of Benign prostatic hyperplasia?
Pathophysiology
Benign prostatic hyperplasia;
> Most common prostatic disorder
> Enlargement of the prostate gland under the influence of sex hormones
- Typically, In middle-aged to older entire males
Pathophysiology of prostatic/paraprostatic cysts?
Prostatic/Paraprostatic cysts:
- Cystic structures within the prostate gland or adjacent to the prostate (paraprostatic)
- Prostatic cysts are typically secondary to benign hyperplasia, but can also be secondary to Infections and neoplasia
Prostatic neoplasia pathophysiology?
Prostatic neoplaslia
-Least common prostatic pathology
-Most commonly adenocarcinoma, can get signs of hypercalcaemia
- +/- Systemic lllness if leads to peritonitis
- Mass lesions or pain on caudal abdominal palpation
> Poor prognosis
Prostatitis and prostatic abscessation pathophsiology?
Prostatitic and Prostatic abscessation
- lnflammatlon of the prostate gland usually due to Infections of the urinary tract
- May be secondary to hyperplasia or urinary tract disorders and can lead to abscessation
- Typically signs of systemic illness, can get septic peritonitis If It ruptures
Acute prostatitis:
- Dysuria, stranguria, haematuria
- Pyrexia and signs of systemic illness lethargy
+/- Pain on prostate palpation, +/- caudal abdominal pain
- Enlarged prostate can be asymmetrical
+/- Blood or purulent discharge from penis independent of urination
+/- Haematuria, bacterluria, pyuria
Chronic prostatitis:
- Reoccurring pyrexia and UTI
- Usually not systemically ill
* +/-. Pain on prostate palpation, can be symmetrically enlarged
Clinical signs?
Clinical signs:
- Stranguria, haematuria, urinary Incontinence, blood dripping from pen ls (Independent of Urination)
- Tenesmus, dyschezia, haematochezia
- Abdominal pain or caudal abdominal swelling
- Pyrexia, lnappetance
- +/- Perineal hernia secondary to straining
- Altered hindlimb gait
Differential diagnosis?
- Other causes of tenesmus and dyschezla
- Other causes of urinary tract disease
Diagnostics?
Diagnostics:
- General physical examination:
- Abdominal palpation: Lumbosacral and caudal abdominal pain
- Rectal examination: Prostatic palpation, enlarged and painful
Urinalysis:
- May not be helpful in diagnosis, urinalysis and culture may be negative, despite prostatic disease
- Fine needle aspirates: Cytology and culture, leaked fluid can cause peritonitis
- Prostatic wash: Cytology and culture
- Imagery:
- Radiology:
Prostatic enlargement
- Utlrasonography:
- Prostatic disease: Prostatomegaly, cysts, neoplasia, peri-prostalic fluid and Inflammation
Sublumbar lymph node enlargement
Biopsy specimens
- Haematology and biochemistry
Benign prostatic hyperplasia treatment?
Benign prostatic hyperplasia:
- Castration is essential for non-breeding dogs, reduction in prostate size over 4 weeks
- Anti-androgens e.g. Delmadinone acetate {Tardak®) can take up to 5 days for an effect
- Enema for constipation, faecal softeners
Treatment of prostatitis and prostatic abcessation?
Prostatitis and prostatic abscessation:
> Antibiotics:
- Trimethoprim-sulpha 15mg/kg BID and/or enrofloxacin 5mg/kg PO/IV SID
- Ideally 4 weeks and then stopped based on negative prostatic fluld culture
* Change based on culture and sensitivity of prostatic fluid
* Chronic prostatitis:
o Antibiotic choice should be based on culture and sensitivity
o Long course at least 8 weeks, then repeat culture
- Prostatic involution:
* Castration
* Anti-androgens e.g. Delmadinone acetate (Tardak®) can take up to 5 days for an effect
- If peritonitis or very large abscess:
Surgery
* IV antibiotics and supportive therapy
Treatment prostatic/ paraprostatic cysts?
Prostatic/Paraerostatic cysts;
- Fine needle drainage but usually reoccurs
- Prostatic cyst:
- Castration may lead to reduction ln size of prostatic cysts
- Surgery If not responding or very large cyst
- Paraprostatic cyst:
- Surgical excision
Treatment of prostatic neoplasia?
Prostatic neoplasia:
- Surgical removal
- +/- Chemotherapy
