Penile, testicular and prostatic disease Flashcards
What can you see on this ultrasound image of a testicule vs normal?
Small focal echogenic areas (fibrous tissue or calcification). Consistent with the consequences of a previous testicular insult - testicular degeneration
What are 2 categories of mating problems in the stud? Give examples for each
Poor Libido
* Frequently results from inexperience or poor breeding management
* No evidence that it is caused by low plasma testosterone
* Do not give androgens! Would create negative feedback and spermatogenesis would slow.
Mating Difficulty
* Inexperienced stud dog
* Psychological problems
* Abnormal prepuce or penis
* (Inexperienced bitch)
* (Incorrect mating time)
* (Abnormal vulval, vagina)
* (Male-female size differences)
What are common testicular/scrotal diseases?
In some sort of order relating to how common:
1. Testicular tumours
1. Abnormal testicular descent
1. Testicular degeneration
1. Torsion of the Spermatic Cord
1. Orchitis
1. Inguinal hernia
What are the 3 common types of testicular tumours? What clinical signs are associated? How are they diagnosed? How are they treated?
- Leydig Cell Tumour
- Sertoli Cell Tumour
- Seminoma
Clinical signs
* Oestrogen production = feminisation: preputial swelling
* male attractiveness
* bilaterally symmetrical non-pruritic alopecia
* non-neoplastic testicle atrophies
* normal testicular tissue within abnormal testicle also atrophies
Diagnosis
* Clinical information, palpation, ultrasonography
* Cornification of preputial epithelial cells
Treatment
Hemi-castration or castration
How can you differentiate between an anorchid and a monorchid dog?
Anorchid
* Absence of both testes - extremely rare
* Most cases are bilateral cryptorchid
* Diagnosis by lack of response of testosterone to intravenous injection of hCG
Monorchid
* A single testicle in the body - extremely rare
* Most cases are unilateral cryptorchid
* Diagnosis by response of testosterone to intravenous injection of hCG
How should you treat cryptochidism?
Medical therapy is not ethical:
* Treatment is by removal of both testes to prevent neoplasia and breeding
* Surgical approach is to look dorsal to bladder for vas deferens then follow these to the testis
What can cause testicular degeneration?
- High temperature / Local inflammation
- Vascular lesions
- Drugs
- Endogenous hormones (tumours)
- Exogenous hormones
- Toxins
- Auto-immune disease
What are common penile/preputial diseases?
In some sort of order relating to how common:
1. Preputial discharge
1. Lymphoid hyperplasia
1. Balanoposthitis
1. Posthitis
1. Phimosis
1. Paraphimosis
1. Priapism
1. Canine herpes virus infection
1. Penile trauma
How should you treat preputial discharge?
- Muco-purulent preputial discharge is normal
- Rarely there is a pre-disposing cause such as foreign body, preputual adhesion, penile abnormality, phimosis
- Careful inspection of the inner surface of the sheath and the penile skin is warranted
Treatment
* May be normal (don’t call it ‘abnormal’ or use antibiotic unless you are sure it is not normal)
* Removal of predisposing causes
* Flushing with saline
* (or antimicrobial or weak antiseptic solutions)
* parenteral drug administration has little value
How does lymphoid hyperplasia present in penile disease?
- Raised nodule-like lesions on at the base of the penis, or preputial lining
- Normally pale in colour and firm (not vesicular)
- May bleed when prepuce is retracted or semen collected or at normal mating
- Requires no treatment
- Must be differentiated from Canine Herpes Virus lesions which are normally vesicular and red in colour or may be ulcerated in the later stage
What is balanoposthitis? How is it managed?
- Inflammation of the penis (balanitis) and prepucial lining (posthitis)
- Usually associated with moist prepuce tip
- Overgrowth of commensal bacteria
- Commonly seen in dogs that frequently lick the prepuce (therefore common in dogs with a ‘normal’ prepuce discharge)
- May require topical cleaning / local antiseptic / topical antibiotic creams / systemic antibiotics
What is balanitis? How is it managed?
- Inflammation of the penis
- (technically balanitis = inflammation the glans penis)
- (technically phallitis = inflammation of all of the penis)
- in dogs we only really see balanitis
- Noted as haemorrhagic spots on the penile skin
- May progress to thickening penile skin
- May be associated with masturbation
What is phimosis? What signs are associated? How is it managed?
Abnormally small preputial orifice
Congenital or the result of trauma or inflammation
Signs
* narrow stream of urine
* urine pooling within prepuce
* may cause balanoposthitis
* unable to copulate
Preputical wedge resection is normally curative
What is paraphimosis? What is it caused by? How is it treated?
Failure of the glans penis to be retracted fully into the prepuce
Causes
* Small preputial orifice
* Inversion of the preputial skin / hair
* Hair ring (tom cat)
* Short prepuce
Penis may become dry and necrotic
Treatment
* Ensure that there is ability to urinate
* According to cause
* Prepucial wedge resection
* Removal of hair
* Preputial advancement
* Penile amputation
What can cause poor semen quality? How can you treat dogs with poor semen quality?
- Semen contamination
- Abnormalities of:
- Number
- Motility
- Morphology
Treatment
* Often more about establishing prognosis
* May require repeated sampling to establish if values are stable, improving or deteriorating
* Normally done with a gap of 60 days
* Most medical treatments are useless
What is azoospermia? What are possible causes?
- Apparently normal ejaculation but contains no sperm so usually clear fluid
- Possible causes
- Not producing sperm - Gonadal dysfunction (either congenital or acquired)
- Incomplete ejaculation
- Obstructive azoospermia (obstruction of the vas)
What diagnostic techniques are available for the prostate gland? What can you assess with each technique?
-
Rectal palpation
- Gland size
- Pain
- Moveability
- Sublumbar lymph nodes
- Other structures (rectal wall, pelvic wall)
- Ultrasonography
-
Semen evaluation
- Useful for assessment of first and third fractions of the ejaculate
- Colour
- Cellular content
- Bacteriology
-
Radiography
- positive constrast study by filling bladder - highlight where gland is
-
Prostatic massage
- Identification of additional cellular material
-
Urine analysis
- Common sequelae is lower urinary tract infection which needs treatment
-
Prostatic aspiration
- Fine needle aspiration either by palpation or by ultrasound guidance
- Prostatic biopsy
- Haematology
- Blood culture
What are common prostate diseases?
- benign prostatic hyperplasia
- acute bacterial prostatitis
- chronic bacterial prostatitis
- prostatic abscessation
- prostatic cysts
- prostatic neoplasia
What are the causes and consequences of benign prostatic hyperplasia? How is it diagnosed? How is it treated?
Hyperplasia of the prostatic epithelium begins early in life associated with altered androgen/oestrogen ratios
In later life the enlarged gland impinges on the pelvic viscera
* faecal tenesmus
* haematuria
* haemospermia
Diagnosis
* Rectal palpation; symmetrical, freely mobile, non-painful
* Radiography; prostatomegaly, dorsal displacement of colon, cranial displacement of bladder, narrowed prostatic urethra, urinary retention
* Ultrasonography; prostatomegaly, hyperechoic regions, narrowed prostatic urethra, small cystic lesions
* Prostatic massage; poor harvest of cells, normal prostatic epithelial cells (few)
* Semen evaluation; normal except haemospermia
* Prostatic aspiration; normal prostatic epithelial cells
Treatment
* Castration
* Progestogens (e.g. osaterone [Ypozane],
* GnRH depot agonist (deslorelin [Suprelorin]
* Finasteride (human medicinal POM)
* A specific 5-alpha reductase inhibitor which prevents the conversion of testosterone into dihydrotestosterone (marketed as Proscar)
* Can be used under cascade
What causes acute bacterial prostatitis? What clinical signs are associated? How is it diagnosed? How is it treated?
Ascending infection commonly E. coli.
Clinical signs include systemic illness, with vomiting and caudal abdominal pain
Diagnosis
* Rectal palpation; asymmetrical, moveable associated with great pain
* Radiography; normal size or marginally increased, loss of detail in caudal abdomen indicating local peritonitis
* Ultrasonography; large, hypoechochoic / marbled, sub-capsular oedema
* Prostatic massage; painful
* Semen evaluation; usually not capable of producing an ejaculate
* Urinalysis; often many bacteria present
Treatment
* 3-4 week duration antibiotic therapy
* Blood/prostatic fluid barrier not intact therefore good antibiotic penetration
* Urinalysis and examination of prostatic fluid to ensure that does not become chronic infection
* Castration
When does chronic bacterial prostatitis occur?
- Acute lesions may become chronic, and pockets of purrulent exudate form
- Often in the form of micro-abscesses and diffuse inflammation (May later lead to prostatic abscessation)
- Signs are often recurrent cystitis
What causes prostatic abscessation? What clinical signs are associated?
- Chronic prostatitis where purulent exudate accumulates in the parenchyma of the gland
- Clinical signs variable but can be similar to:
- Acute bacterial prostatitis although less fulminating
- Or, progress to exaggerated signs of chronic prostatitis
What are the 2 types of prostatic cysts? How are they treated?
Parenchymal retention cysts
* Start within the parenchyma of the prostate, causing distortion of its outline
* Usually there is an underlying prostatic disease (BPH or metaplasia (Sertoli cell tumour)
Cystic uterus masculinus
- Originate adjacent to the prostate gland but attached by a thin stalk
Treatment
* Castration
* Surgical excision
* + Omentalisation
What is the most common type of prostatic neoplasia? How is it diagnosed? How is it treated?
- Adenocarcinoma are most common
- Tend to metastasise to iliac and sub-lumbar lymph nodes, and to caudal lumbar vertebrae
- Castration not protective
Diagnosis
* Rectal palpation; usually large and painful, may be sub-lumbar swelling
* Radiography; prostatomegaly, sub-lumbar swelling, vertebral involvement
* Filling defect to prostatic urethra
* Reactive changes associated with sub-lumbar lymphadenopathy
* Ultrasonography; disruption of normal architecture, areas of increased echogenicity, areas of fluid accumulation
* May be iliac lymph node involvement
Treatment
* Palliative hormonal treatments
* GnRH Depot Agonist
* Progestogens
* NSAID’s
* (Intra-operative radiation treatment)
* (Prostatectomy)
