Exam 4 - Prostatic Disease Flashcards
is prostatic disease more common in dogs or cats?
dogs
does bacterial prostatitis affect neutered male dogs?
nope, just intact
what dogs are affected by prostatic neoplasia?
older, neutered male dogs
what breed of dog has a prostate that is 4 times larger than other dogs of similar size?
scottish terriers
T/F: prostatic neoplasia can cause signs of lower urinary tract inflammation & obstruction
true
what is important to think about for all intact male dogs older than 5?
BPH reliably occurs in these guys!!! can be asymptomatic or cause dripping of blood from the urethra
what signs may be seen with acute bacterial prostatitis?
severe systemic illness
signs of lower urinary tract inflammation
tenesmus
bloody or purulent penile discharge
how is rectal palpation done to evaluate the prostate?
one hand is used to push the caudal abdomen & prostate dorsocaudally & the other is used to palpate the prostate at the cranial edge of the pubis - evaluate the size, shape, symmetry, & presence of pain
what would you expect to feel on rectal palpation of dog with bph?
symmetric prostate enlargement & non-painful prostate!
if a male dog presents for prostate pain or obstruction of urine flow, what do you need to promptly do?
evaluate for prostatitis, neoplasia, or both
what would you expect to feel on rectal palpation of dog with acute bacterial prostatitis?
may be febrile & painful on abdominal palpation
prostate may be enlarged, symmetrical/asymmetrical, & painful
what does a normal prostate look like on ultrasound?
round & smooth
what are some changes seen on ultrasound that are suggestive of neoplasia?
mineralization & complex parenchymal changes
what is the purpose of doing an abdominal ultrasound for a dog with an enlarged prostate?
evaluate prostate size, symmetry, assess for cysts & abscesses, & look for evidence of neoplasia
what are some ultrasound findings seen with chronic bacterial prostatitis?
non-specific & may mimic neoplasia!!!! mixed echotexture with hyperechoic areas of fibrosis
what does a normal prostate look like on abdominal radiographs? are radiographs helpful?
normal prostate is round & smooth, <50% of the width of the pelvic inlet on the v/d view or <70% of the distance from the sacral promontory & cranial aspect of the pubis on the lateral view
not really, they have a limited diagnostic value in assessing the prostate, but can help evaluate for metastasis
what is the purpose of doing a retrograde contrast cystourethrogram for a dog with an enlarged prostate?
used to clearly differentiate the bladder from prostate, determine whether a cystic structure is located with the prostate or is paraprostatic, & to assess urethral patency
when would you do a prostatic wash?
used when semen can’t be collected & when neoplasia is invading the prostatic urethra is suspected
submit for cytology & culture
what is bph? why does it occur?
hypertrophy (increase in cell size) & hyperplasia (increase in cell number) of the secretory & connective tissues of the prostate & increased vascularity
due to the effects of dihydroxytestosterone (DHT) on prostatic parenchyma - results in symmetric, eccentric prostatic parenchyma that may contain cysts, so symmetrically enlarged prostate that is non-painful & often asymptomatic
what is the most common sign of BPH? what are some others?
blood dripping from the urethra that is not associated with urination
often asymptomatic, but:
may have tenesmus, hemospermia, hematuria, ribbon-shaped stool
is urethral compression a consequence of bph?
nope!
why are dogs not dysuric with bph?
there is little smooth muscle within the canine prostate
does bph affect fertility?
no but may compromise cryopreservation (hemoglobin increases sperm cell membrane fragility during the freeze/thaw process)
T/F: BPH in dogs is NOT pre-neoplastic but DOES predispose them to bacterial prostatitis
true
what is the classic ultrasound appearance of bph?
symmetric prostatic enlargement with homogenous echogenicity - may contain very small cysts
how is bph diagnosed?
often presumptive
confirmed with cytology & biopsy
how is bph treated?
castration is curative - clinical signs resolve within 4 weeks
finasteride (a-5-alpha-reductase inhibitor) can be considered if a dog can’t be neutered to reduce prostate size & cysts after treating for 16 weeks
do you need to treat an asymptomatic dog for bph?
nope
what should you suspect if you have an intact male dog with a UTI?
bacterial prostatitis
what is the most common cause of bacterial prostatitis in dogs?
usually due to ascending UTI
can be hematogenous
what are the most commonly isolated bacteria in bacterial prostatitis?
e. coli, staphylococcus spp., streptococcus spp., & mycoplasma
what clinical signs are associated with acute bacterial prostatitis?
systemic illness - fever, lethargy, depression, vomiting
purulent/hemorrhagic penile discharge, tenesmus, may be painful on abdominal palpation, cbc may be inflammatory, & prostate is painful on palpation
what clinical signs are associated with chronic bacterial prostatitis?
prostate can be symmetrical, firm, & painful or non-painful
may manifest as recurrent urinary tract infections
what is the pathogenesis of prostatic abscesses?
accumulation of purulent fluid within a cystic space in a persistently infected prostate - can occur after acute or chronic bacterial prostatitis
can rupture & cause life-threatening periotonitis
how do you diagnosis prostatic abscesses?
typically have concurrent bacterial cystitis so urine culture is often sufficient for diagnosis - consider culture of prostate if urine culture is negative or patient doesn’t respond to abx therapy selected from C&S
ultrasound findings are non-specific & may mimic neoplasia (mixed echotexture with hyperechoic areas of fibrosis) used to assess for abscesses
what treatment is used for acute bacterial prostatitis?
enrofloxacin is first line choice
other choices are TMS & chloramphenicol
castration as soon as patient is stable!
where are paraprostatic cysts most commonly located? do they connect to prostatic parenchyma?
craniolateral or caudal to the prostate
nope
what clinical signs are seen with paraprostatic cysts?
clinical signs are related to impingement on adjacent structures - tenesmus, stranguria, & lethargy
how are paraprostatic cysts diagnosed?
ultrasound is the test of choice - appear as large anechoic structures that may be septate
how are paraprostatic cysts treated?
may be amendable to ultrasound guided drainage but may need to be repeated several times & more effective for smaller cysts
may require surgical excision
what is the mean age of diagnosis for prostatic neoplasia?
older dogs - mean age 10 years old, affects neutered dogs more than intact dogs
T/F: a castrated dog with prostatomegaly should be considered to have prostatic neoplasia until proven otherwise
true
what is the most common prostatic neoplasia seen in dogs?
UCC from urothelial cells that line the prostatic ducts
others - adenocarcinoma, leiomyosarcoma
what clinical signs are associated with prostatic neoplasia?
signs related to prostatic enlargement - lower urinary tract signs, urinary obstruction, tenesmus, ribbon shaped stool
what are ultrasound changes suggestive of prostatic neoplasia?
mineralization, focal to diffuse hyperechoic areas & loss of normal contour
mineralization of the prostate can occur with neoplasia or chronic, severe inflammation (consider the dog’s age when castrated)
