Prostate Flashcards
According to Del Magno 2021 in Vet Surg, what was the resolution rate for surgical treatment of sterile prostatic cysts? What was the most frequent complication reported.
Resolution rate of 89%.
Temporary or permanent urinary incontinence was the most common complication. Urinary retention and dysuria were also reported.
What percentage of the prostate gland is abdominal by 4 years of age?
50%
Is the prostate peritoneal or retroperitoneal?
The dorsal aspect is peritoneal, the ventral aspect is retroperitoneal.
Is the urethra positioned dorsally or ventrally within the prostate?
Dorsally
What is the vascular supply of the prostate?
Prostatic arteries arise from the internal pudendal vessels, divide into cranial, middle and caudal branches before becoming subcapsular.
The prostatic urethra is supplied by the artery of the bulb of the penis.
Venous drainage is by the prostatic and urethral veins into the internal iliac, and vein of the urethral bulb.
What is the nervous innervation of the prostate?
Hypogastric and pelvic nerves.
What is the histologic make-up of the prostate gland?
Secretory epithelial tissue contained within a stromal capsule of fibrous, elastic, and smooth muscle tissue. The epithelial tissue is divided into lobules (tubuloalveolar glands) that converge with draining ducts that empty into the urethra.
What are the functions of prostatic secretions?
Promote spermatozoa motility and viability, increase uterine perfusion, modulate spermatozoa attachment to the uterine epithelium.
What are prostatic secretions composed of?
Typically thought to contribute to the third fraction of the ejaculate.
It is acidic (pH 6.1-6.5), contains elevated potassium and chloride concentrations, zinc, and proteins (acid phosphatase, canine prostate-specific esterase).
What percentage of dogs are affected by BPH at 2, 5 and 8-9 years of age?
16%, 50%, 70%, respectively.
What are the two types of BPH?
Glandular: more common in young dogs. Symmetric enlargement with maintenance of the normal histologic structure and arrangement of the prostate.
Complex: typically older dogs. Involves the stromal and glandular elements of the prostate, characterized by asymmetric enlargement, areas of atrophy, vascular impairment, and cystic changes.
BPH is thought to be modulated by estrogens which may increase the sensitivity of the prostate to dihydrotestosterone and exert an inhibitor effect on the rate of cell death.
What are some common clinical signs associated with prostatic disease?
Dyschezia, urethral bleeding and pyrexia. May also present with neurologic or orthopedic signs.
How might the position of the prostate on rectal examination vary based on the underlying disease?
Neoplasia: may be fixed in the pelvic canal. Fixation of the gland may also occur with inflammatory conditions.
Cysts: may cause the prostate to migrate cranially out of reach.
Asymmetry of the gland may indicate neoplastic, inflammatory or cystic disease.
What are methods of collection for microbiologic and cytologic prostatic samples?
Ejaculate sampling: non-specific, impractical and may cause discomfort.
Transurethral washing: useful for generalized disease, but may be limited in the detection of localized disease.
Fine needle aspiration: can be collected with ultrasound guidance (prepubic or perineal). Some risk of seeding neoplastic lesions.
Are biopsy samples of the prostate routinely collected?
No, diagnosis is usually achieved by fine needle aspiration. If required, core needle biopsies are preferred over incisional (due to less hemorrhage).
What diagnostic imaging techniques can be used in the work-up of prostatic disease?
- Radiography: allows assessment of size, position, displacement or organs, loss of detail, mineralization (likely carcinoma in neutered dogs). Retrograde contrast studies (air or iodine) can be useful.
- Ultrasound: normal prostate gland is homogenous in appearance. Can be used to identify and drain abscesses and cysts.
CT/MRI/nuclear scintigraphy: often not required due to accuracy of ultrasound.
What is the most common clinical signs associated with BPH?
Dyschezia.
What is the treatment of prostatic cysts?
Ultrasound guided cyst drainage and castration (high rate of resolution).
Definitive treatment involves surgical treatment, options include:
1. Complete resection (if small).
2. Marsupialization (few advantages to this approach).
3. Partial resection and omentalization.
4. Partial prostatectomy.
What surgical technique for management of prostatic abscessation is depicted?
Omentalization. Associated with a low rate of complications and good outcomes. Recurrence may occur if loculations are not broken down completely or if insufficient omentum is packed into the abscess cavity.
