43 / 44 - Urethra / Prostate

Question 1

Name the different portions of the urethra in the male dog

Answer 1

A: Prostatic

B: Membranous

(A+B = intrapelvic portion)

C: Penile (cavernous)

Question 2

Where is the feline prostate located?

Answer 2

Dorsolaterally

Question 3

What volume of contrast is advised for retrograde urethrography?

Answer 3

5-20ml

(5-10ml in female dogs)

Question 4

What volume of contrast is recommended for canine vaginocystourethrography?

Answer 4

1ml/kg

AVOID HIGH PRESSURE, make sure balloon is inflated in vestibule

Question 5

What are the two most signficant complications of retrograde urethrography?

Answer 5

Urinary tract rupture,

UTI

Question 6

What are the two most common locations of urinary calculus obstruction in male dogs?

Answer 6

Ischia arch,

Base of os penis

Question 7

Name 3 normal anatomical variants that may be confused with urethroliths

Answer 7

Feline os penis

Seperate ossification centre of canine Os penis (cranial location makes unlikely to be urethrolith)

Nipple!

Question 8

Granulomatous urethritis is associated with which signalment?

Answer 8

Female dogs

Question 9

List three reported causes of urethral masses

Answer 9

TCC (urethral vs extension of bladder)

Prostatic carcinoma

Fibroepithelial polyps

Question 10

List possible features of urethral stricture expected radiographically (contrast)

Answer 10

Consistently visible narrowing

Irregular urethral surface

Proximal dilation of urethra

Question 11

What is the normal size and location of the feline prostate?

Answer 11

Dorsolateral, pelvic location

Approx 10mm

Question 12

What is the pathophysiology of BPH?

Answer 12

Increased volume of intercellular and ductal spaces (NOT intracellular or cell no.)

=> Solid hypertrophy -> cystic hypertrophy (later stage)

Question 13

Name the 2 most common prostatic diseases

Answer 13

BPH

Prostatitis

Question 14

Describe features of chronic prostatits

Answer 14

May be SMALL gland (fibrotic), can cause urethral stricture

Question 15

ACCORDING TO THRALL, how does incidence of prostatic adenocarcinoma compare between intact and neutered male dogs?

Answer 15

Similar incidence!

Question 16

List 5 features of prostatomegaly on radiography

Answer 16

Displacement of bladder, colon

Narrowing of colon /rectum lumen

Constipation

Presence of ventral fat triangle highlighting vesicoprostatic junction

Size >90% from pubis -> sacral promontory = SUGGESTIVE OF MASS

Question 17

How large can prostate glands enlarge in BPH? ANnd with cysts / abscesses?

Answer 17

Up to 10x normal

Up to 20x with cysts / abscesses

NB: Acute prostatitis and neoplasia do not usually cause marked enlargement. Chronic prostatitis may make gland small

Question 18

What may prostatic mineralisation indicate?

Answer 18

Chronic prostatitis or neoplasia

=> wispy or indistinct calcification has strong PPV for neoplasia, partiularly if neutered

Question 19

What pathological process may result in gas within the prostate?

Answer 19

Gas-forming bacterial prostatitis (coliform or clostridial reported -> severe haemorrhagic / necrotic prostatitis, shock, sepsis)

May result in scarring -> urine retention, loss of sphincter mechanism, sterility

RULE OUT iatrogenic causes. May fill DUCTS during negative contrast studies etc, but not parenchyma.

Question 20

Where do prostatic neoplasms metastasise to?

Answer 20

MILN

Lumbar vertebrae

Pelvis

Question 21

GIve three examples of masses that may be confused with the urinary bladder (retrograde can help to clarify)

Answer 21

Paraprostatic cyst,

Omental tumour,

Retained testicular tumour

Question 22

What two features of the prostatic urethra should be highly suggestive of neoplasia?

Answer 22

Ulceration,

Stricture

Question 23

Which structures of the prostate MAY normally may fill with contrast?

What features of contrast accumulation are considered abnormal?

Answer 23

Normal:

Ducts!

Or no filling (but can still be abnormal prostate and no filling)

Abnormal:

Pooling of contrast,

Irregular shaped cavities with rough walls communicating with urethra (suggestive of neoplasia),

Cavitary smooth walled lesions containing intraluminal masses (suggestive of neoplasia).

Question 24

What 4 features may effect the size of the prostatic urethra on retrograde?

Answer 24

Injection pressure,

Size of prostate,

Pathology present,

Bladder distension,

Question 25

What structure is identified in this picture?

(Small, smooth filling defect in dorsal wall of urethra near centre of prostate gland?)

Answer 25

Colliculus seminalis

=> Landmark distal to seminal orifices, bordering prostatic utricle and openings of prostatic ducts.

Question 26

US features of BPH

Answer 26

Uniformly enlarged,

Hyperechoic

Can be Dorsal > ventral or vice versa, BUT SYMMETRIC right to left

-> lost as cysts devlop

(Sold vs cystic forms can be distinguished)

Question 27

US features prostatitis

Answer 27

Varying enlargement,

Hyper (chronic), or hypo (acute),

Normal (or distorted, particularly if abscess)

Hypo band of oedema,

Periprostatic steatitis

Question 28

How should prostatic mineralisation be interpreted?

Answer 28

Generally, concern for neoplasia particularly if linear or irregular.

May be seen in chronic prostatitis

=> indication for further evaluation (cyto or histo)

Question 29

US features of prostatic neoplasia

Answer 29

Mineralisation (although can be inflammatory)

Irregular enlargement,

Mixed echo

Question 30

CEUS features of the prostate

Answer 30

Typically, 30secs post injection for peak enhancement,

Benign diseases (BPH and prostatitis) -> similar

Malignancy -> Sig shorter time to peak and GREATER enhancement than normal and bening dogs