Reproductive Surgery Flashcards
List the 3 surgical diseases of the ovary.
- ovarian cysts
- ovarian neoplasia
- ovarian remnant syndrome
On routine OHE of an otherwise completely healthy cocker spaniel, you find an ovarian cyst. How should you continue on with this patient?
OHE is curative for nonfunctional ovarian cysts so continue on with the OHE. Submit the ovaries, including the cysts, for histopathology to confirm diagnosis of nonfunctional ovarian cysts.
Functional ovarian cysts are hormone secreting cysts and can be follicular or luteal. A follicular cysts secretes ____________ and a luteal cyst secretes ___________
Follicular cyst: estrogen
Luteal cyst: progesterone
Functional ovarian cysts are hormone secreting cysts. What signalment and clinical signs are typical of a functional ovarian cyst in dogs and cats?
Dogs - <3 years old
Cats - <5 years old
CS: prolonged estrus, vaginal bleeding (dogs), attractiveness to males, and standing heat
Diagnosis of Functional Ovarian Cysts can be made by…
Which of the methods is best?
vaginal cytology (dogs) hormone levels (estrogen: >20pg/ml; progesterone: >2ng/ml) abdominal ultrasound (cysts are 10-50mm in size) - best diagnostic method
Treating a functional ovarian cyst in a breeding animal differs from treatment in a non-breeding animal by…
Breeding animal: spontaneous resolvement, GnRH, HCG, Cyst removal, unilateral ovariectomy
Non-breeding animal: OHE is curative
T/F: Ovarian neoplasia is a common form of neoplasm in small animal patients.
False.
Ovarian neoplasia is approximately 1% of neoplasia in small animal patients >10 years of age.
What is the percent metastasis in ovarian neoplasia in small animal patients?
Ovarian neoplasia typically metastasizes in 20-30% of patients.
50% of ovarian neoplasia is of epithelial origin. What is the malignant and benign form of this neoplasm?
Malignant: Adenocarcinoma
Benign: Adenoma
40% of ovarian neoplasia is of stroll origin. What is the form of this neoplasm and how does it manifest??
Granulose Cell Tumor
Persistent pro-estrus because it is a functional hormone producing tumor that can lead to pyometra.
A small percentage of ovarian neoplasia is of germ cell origin. What is the typical signalment for these neoplasms and what are the 2 types of neoplasms within this tissue of origin?
Patients are <5 years old at presentation.
- Dysgerminoma
- Teratoma
What diagnostics would you implement in order to diagnose ovarian neoplasia?
Radiographs - see a space occupying lesion
Ultrasound - MOST SENSITIVE!
AVOID A FNA!
After diagnosing an Ovarian Adenocarcinoma in a 9 year old female, intact West Highland Terrier, you take full body radiographs and determine there is no detectable metastasis. What treatment of choice do you offer your client?
Ovariectomy
Good prognosis if there is no metastatic disease.
What is the most common surgical condition of the ovary?
Ovarian Remnant Syndrome
What is the definition of Ovarian Remnant Syndrome?
recurrence of estrus following OHE/OVE most likely due to failure of removal of all ovarian tissue - poor technique!
Ovarian remnant syndrome is more common in ______.
cats
Cats require ___________ in order to evaluate their progesterone levels.
lutinization (HCG)
In a cat with suspected ovarian remnant syndrome, diagnostic estrogen levels should read _________ and diagnostic progesterone levels should read _________.
estrogen levels > 15pgm/ml
progesterone levels > 2ng/ml
Clinical signs typical of ovarian remnant syndrome are….
signs of estrus
On vaginal cytology of a DOG with suspected ovarian remnant syndrome, you see….
what mimics a normal heat cycle
Where is ovarian remnant usually located?
At the Caudal Pole of the Kidney
What is the treatment of choice for ovarian remnant syndrome?
surgical removal
When is surgery usually done for patients with ovarian remnant syndrome?
surgery is usually done during estrus - it is often a referral procedure
List the 7 surgical diseases of the uterus.
- cystic endometrial hyperplasia
- pyometra
- metritis
- uterine torsion
- uterine rapture
- dystocia
- uterine neoplasia
Cystic endometrial hyperplasia is associated with….and can lead to ________.
excess and prolonged PROGESTERONE!
Can lead to PYOMETRA!
Clinical signs of cystic endometrial hyperplasia include….
poor fertility
failure to conceive
vaginal discharge
PU/PD
The best/most sensitive diagnostic method for cystic endometrial hyperplasia is ___________ and the recommended treatment is ___________.
ultrasound; OHE
Diestrus results in progesterone secretion which results in endometrial hyperplasia. IF the bitch/queen is pregnant, the endometrial hyperplasia regresses post-parturition. If the bitch/queen is NOT pregnant, the resultant non-gravid uterus causes the endometrium to _____________, causing cystic hyperplasia which is susceptible to __________ and can ultimately lead to ______________.
…the resultant non-gravid uterus causes the endometrium to REMAIN HYPERPLASTIC, causing cystic hyperplasia which is susceptible to BACTERIAL CONTAMINATION and can ultimately lead to PYOMETRA.
Bacteria + Cystic Uterine Disease = ___________
PYOMETRA!
The definition of Pyometra is….
infection of the uterus
When does pyometra typically occur?
Pyometra occurs 4-8 weeks after the heat cycle.
Pyometra is more/less common in cats than dogs.
Pyometra is less common in cats than dogs.
Pyometra develops during what part of the heat cycle?
Diestrus
How does estrogen contribute to the development of pyometra?
estrogen increases/sensitizes progesterone receptors
The pathophysiology behind pyometra development begins with….
prolonged/elevated progesterone levels
The most common bacteria in a pyometra is…
Others include…
E. Coli
Pastuerella, Proteus sp., Pseudomonas
The bacterial spread in pyometra is via what 2 methods and which is most common?
Ascending (most common)
Hematogenous
Why is pyometra less common in cats?
Cats are induced ovulates and therefore have a less chance of experiencing/accumulating excess progesterone.
Typical clinical signs of a pet with pyometra include…how many of these clinical signs do most pyometra cases have?
Most pyomtera cases present with 3 or more of the following clinical signs: Lethargy Vomiting PU/PD Vaginal discharge*
*Vaginal discharge may be the only clinical sign if the cervix is open.
What clinical sign may be the ONLY sign of pyometra with an open cervix?
Vaginal Discharge
What is often the most noticeable clinical sign of pyometra and why does it occur?
PU/PD is often the most noticeable clinical sign.
Pathophysiology: Bacterial toxins inhibit the concentrating ability (ADH) and causes glomerular damage.
What physical exam findings are expected in a patient with pyometra?
painful, distended abdomen
tachycardia
tachypnea
FEVER (a subnormal temperature is BAD NEWS!)
What TPR and CBC finding(s) are expected in a patient with SIRS and how often does SIRS occur in pyometra patients?
57% of patients with pyometra develop SIRS
T - >103.5 or <100
P - HR > 160bpm
R - >20 breaths/min.
WBC - >12,000; <4,000; or >10% bands
A chemistry panel in a patient with pyometra typically shows….
Hypoglycemia Azotemia, Proteinuria Anemia Leukocytosis Increased AST and ALP
Why does a patient with pyometra develop anemia?
There are RBCs lost in the vaginal discharge as well as a decrease in erythropoiesis.
Glomerular disease also decreases EPO production meaning you may need to RX: Whole Blood to your patient(s) if they have a low PCV.
On radiographs, a pyometra presents as….
large, fluid filled uterus
Ultrasound is a better diagnostic tool.
When can you rule out pregnancy in a patient with suspected pyometra?
You CANNOT rule out pregnancy until >42 days post ovulation…only then could you see the fetal skeletons.
On ultrasound, a pyometra presents as….
fluid filled uterus
thickened uterine wall
cystic endometrium
you can visualize the bladder (for a UTI) but DO NOT obtain a sample!
What type of antibiotics do you choose when treating a patient with pyometra?
Gram Negatives
Ampicillin or Enrofloxacin
The treatment of choice for patients with pyometra is…..
OHE
List the complications associated with medically treating a patient with pyometra.
abdominal pain emesis tachycardia dyspnea systemic deterioration
It is very important to inform owners that choose to treat their pyometra pets medically….
the bitch/queen must whelp at their next cycle!
The definition of metritis is…
inflammation and/or infection of the uterus
When is an animal susceptible to developing metritis?
Metritis occurs postpartum - between 12 hours to 1 week postpartum.
The typical clinical signs associated with metritis include…
FOUL SMELLING REDDISH BROWN DISCHARGE FEVER Anorexia Lethargy DECREASED MILK PRODUCTION
When an owner complains that “the puppies are crying all of the time”, you should suspect what disease?
metritis of the mom
Causes of metritis include (3)…
Dystocia
Devitalized uterus
Fetal/Placental retention
Treatment of choice for animals with metritis are…
antibiotics for breeding animals
OHE**
T/F - An OHE will prevent a new mother from producing milk to feed her puppies.
FALSE! They still produce milk.
Uterine torsion is defined as….
uterine torsion is the twisting of the uterus along its long axis
Uterine torsion is associated with what 3 conditions?
Uterine torsion is associated with
- dystocia
- pyometra
- cystic endometrial hyperplasia
The typical clinical signs associated with uterine torsion include…
acute abdomen
abdominal distension
shock
T/F - The diagnostic method of choice for uterine torsion is ultrasound.
FALSE - Ultrasound is non-diagnostic for uterine torsion.
Final diagnosis is usually made on exploratory.
Treatment of a uterine torsion includes…
supportive care - fluids and analgesics
OHE - do NOT derotate the tossed uterus; remove any puppies by c-section
The definition of uterine prolapse is…
uterine prolapse is the protrusion of uterine tissue outside of the vulva
Uterine prolapse is rare in both dogs and cats but is LESS RARE in ______.
Uterine prolapse is rare in dogs and cats but is LESS RARE in CATS.
When and why does uterine prolapse typically occur?
Uterine prolapse is a complication of parturition/dystocia and occurs <48 hours postpartum.
Clinical signs of uterine prolapse include…
vaginal discharge
straining
licking of the affected area
visible protruding mass
What are the treatment options for correcting a prolapsed uterus?
- manual reduction - only if there is healthy, undamaged tissue
- OHE
- Ovary removal and uterine harm aputation via ventral celiotomy - when reduction cannot be accomplished
90% of uterine neoplasia in the dog is….
Leiomyoma
the other 10% is Leiomyosarcoma
The uterine neoplasia found more in cats is….
Adenocarcinoma and likely metastatic!
The treatment of choice for uterine neoplasia is…
OHE
What is the prognosis of uterine neoplasia with OHE in the dog and cat?
Dog - good (benign tumors) to fair (malignant tumors)
Cat - guarded (higher metastatic potential)
The definition of dystocia is…
Dystocia is the inability to expel a fetus through the birth canal.
75% of dystocia cases are due to maternal causes. Maternal causes include…
Primary uterine inertia
Secondary uterine inertia
Birth canal obstruction due to a small pelvic canal or a malunion fracture.
25% of dystocia cases are due to fetal causes. Fetal causes include..
malposition
malformation
oversized neonates
secondary uterine inertia
Define primary uterine inertia.
Primary uterine inertia is with parturition fails to proceed - aka no neonates are born - and the birth canal, fetal size, and fetal presentation are all normal.
An oversized litter causes uterine _____________ to the point where it cannot contract, leading to PRIMARY UTERINE INERTIA.
An oversized litter causes uterine STRETCHING to the point where it cannot contract, leading to PRIMARY UTERINE INERTIA.
An undersized litter causes a decrease in uterine ______________, ultimately leading to PRIMARY UTERINE INERTIA.
An undersized litter causes a decrease in uterine STIMULATION, ultimately leading to PRIMARY UTERINE INERTIA.
The gestation period of dogs/cats is…..
63-68 days
Define secondary uterine inertia…
Secondary uterine inertia is a normal delivery of only PART of a litter due to the development of uterine fatigue.
Causes of secondary uterine inertia include…
- fetal obstruction
- pelvic obstruction
- fetal malposition
- fetal size
Clinical signs of secondary uterine inertia include…
prolonged interval between neonates (>4 hours)
weak or absent uterine contractions
One of the most emergent clinical signs of dystocia - when you need to tell the owner to come in immediately - is…..
One of the most emergent clinical signs of dystocia is LOCHIA WITHOUT DELIVERY.
On physical exam, signs of dystocia include…
loch without delivery
obstructed canal on palpation
abnormal fetal presentation
lack of uterine contractions in response to Ferguson’s reflex
How do you diagnose dystocia?
Radiographs
Ultrasound
T/F - Primary uterine inertia can be treated medically.
TRUE!
Secondary uterine inertia can NEVER be treated medically but, primary uterine inertia can be treated medically.
What is the treatment plan for primary uterine inertia?
Admin. oxytocin and repeat in 30 minutes if necessary (make sure the cervix has dilated before administration).
Manually manipulate the fetus(es) in the vaginal vault if they are causing obstruction.
If no result, perform a C-section.
What are the indications for a C-section?
- secondary uterine inertia
- primary uterine inertia refractory to treatment
- systemic signs in the bitch
- fetal distress diagnosed by US
- high risk patients
Where is your incision located for a C-section?
Incise midway between the xiphoid and umbilicus all the way to the cranial pubis.
Where do you clamp the umbilical cord?
Clamp the umbilical cord 2-6 cm from the abdominal wall.
When closing the uterus after a C-section of a breeding animal, what type of suture should you use and what suture pattern(s) are acceptable?
3/0 monofilament, absorbable
single layer or double layer with inversion
*If performing an OHE, there is no need for uterine closure.
What two drugs do you not want to use during neonatal resuscitation?
atropine or doxapram
What artery/arteries do the vagina and vestibule get their blood supply from?
vaginal artery from the internal pudendal artery
What are the surgical conditions of the vagina and vestibule?
Congenital Conditions:
vestibulovaginal stenosis
rectovaginal fistula
vaginal hyperplasia
vaginal prolapse
neoplasia
perivulvar dermatitis
What are the surgical procedures of the vagina and vestibule?
episiotomy
episioplasty
vaginectomy
What is an episiotomy?
Episiotomy - an approach to the caudal vagina in order to resect stenotic, hyperplastic or neoplastic lesions.
What is an episioplasty?
Episioplasty - the treatment for perivulvar dermatitis
What is a vaginectomy?
Vaginectomy - the treatment for vaginal hypoplasia, intrapelvic annular stenosis (referral procedure)
Where is your incision located for an episiotomy?
Incise through the perineal body to access the caudal vagina.
How many layers is the closure for an episiotomy?
3 layer closure:
mucosa, muscle and skin
What is a rectovaginal fistula?
Communication between the rectum and vagina.
The only congenital abnormality of the vagina or vestibule that may be simply enough to surgically correct without referral is….
septal stenosis - a derivative of vestibulovaginal stenosis
All other congenital abnormalities of the vagina or vestibule should be referred for correction.
Septal stenosis is characterized by…
a band of tissue oriented dorsoventrally.
AKA - a double vagina
What is the treatment of choice for correcting septal stenosis?
Perform an episiotomy with mucosal resection at the attachments and suture the mucosa OR laser ablation.
In vaginal edema/hyperplasia, what happens to the vaginal tissue?
The vaginal tissue becomes severely edematous and protrudes from the vulva. There may be discharge or hemorrhage from the vulva and the animal may experience breeding difficulties.
What type of condition is vaginal edema/hyperplasia and what type of animals is it commonly seen in?
It is an uncommon, familial condition in large breed dogs <2 years of age in proestrus or estrus.
What are some of the non-specific indications of vulvar disease?
licking
dysuria
perineal enlargement
Medical treatment of vaginal hyperplasia/prolapse includes administration of what drugs and what do these drugs do?
Vaginal hyperplasia/prolapse resolves ar the end of estrus.
Gonadotropin releasing hormone or human chorionic gonadotropin will induce ovulation and shorten estrus.
What surgical procedure prevents recurrence of vaginal hyperplasia/prolapse?
ovariectomy will prevent recurrence
If the vaginal tissue is damaged, what surgical steps are taken to correct the vaginal hyperplasia/prolapse?
resect the prolapsed tissue at the base (via an episiotomy approach) and perform an ovariectomy
Treatment of choice for vaginal prolapse (very rare) is what?
Manual reduction and OHE
80% of vaginal neoplasia is benign and most commonly _______. Other benign vaginal neoplasia(s) are…
Leiomyoma - most common
Fibroma, polyps, and cysts
The most common malignant vaginal neoplasm is…
Others include…
Leiomyosarcoma - most common
TVT, TCC
Treatment of benign vaginal neoplasia is…
local resection via episiotomy and recommend ovariohysterectomy
Treatment of malignant vaginal neoplasia is…
referral procedures!
Aggressive resection with wide borders often requiring vulvovaginectomy and perineal urethrostomy.
What is the treatment of choice for TVT?
Medical treatment!
Vincristine
What type of abnormality is a recessed or hooded vulva?
conformational abnormality where the vulva is engulfed by skin
What is an episioplasty?
Episioplasty is a reconstructive procedure that excises skin folds around the vulva and draws the labia caudally.
What is an episioplasty used to alleviate and what must be under control before surgery?
Episioplasty alleviates perivulvular dermatitis and dermatitis must be controlled before surgery.
Define anorchism.
Anorchism - the absence of both testicles
Define monorchism.
Monorchism - the absence of one testicle
Define Cryptorchism/Cryptorchidism.
Cryptorchism/cryptorchidism - a developmental problem of the gubernaculum; one or both testicles not descended into the scrotum
At what age do the testicles typically descend in a young male? At what age can you diagnose a cryptorchid patient?
Most testicles descent within 30-40 days.
You can diagnose a cryptorchid patient if the testicles have not descended by 6 months of age.
What are the 3 classification categories of cryptorchidism?
Location - abdominal, inguinal, or prescrotal
Side - right or left
Type - unilateral or bilateral
T/F - Bilateral cryptorchidism is common in dogs.
FALSE!
Cryptorchidism is more commonly UNILATERAL in dogs.
Why is a cryptorchid testicle sterile?
The temperature is too high for spermatogenesis in the cryptorchid testicle.
How does cryptorchidism affect the normal testicle?
The normal testicle will have suppressed spermatogenesis.
What does cryptorchidism predispose patients to?
neoplasia
torsion
In the canine cryptorchid patient, you should also check for what other 4 diseases?
- hip dysplasia
- patellar luxation
- penile or preputial defects
- umbilical hernia
In the feline cryptorchid patient, you should also check for what other 4 diseases?
- patellar luxation
- shortened or kinked tail
- tarsal deformities
- eyelid agenesis
When performing a castration on a patient who has an abdominal cryptorchid testicle, what approach should you take?
Confirm the cryptorchid testes’ location via US and then take a caudal paramedian abdominal approach OR move back to the ventral midline - between the umbilicus and cranial to the end of the prepuce (especially if you cannot locate the non-descended testicle on US).
During a castration on a patient who has an abdominal cryptorchid testicle, what anatomic structure should you follow in order to locate the cryptorchid testicle?
follow the testicular artery OR the vas deferens
Typically in an abdominal cryptorchid, the testicle can be located anywhere between what 2 anatomic structures?
the non-descended testicle can be anywhere between the caudal pole of the kidney and the inguinal ring
What clinical signs are typically indicative of testicular torsion?
anorexia, lethargy AKA the patient is ADR on presentation….
more specifically = acute abdomen, shock and death
What are the 2 diagnostic methods for diagnosing a patient with suspected testicular torsion?
Ultrasound - Dopple blood flow is absent
Exploratory
What is the incidence of testicular neoplasia in small animal patients?
1-16%
Rare in cats.
What are the 3 types of testicular neoplasia in small animal patients?
Interstitial Cell
Sertoli Cell
Seminoma
40% of the time, a testicular neoplasia is _______(unilateral/bilateral) and _____________ (of one origin/mixed).
40% of the time, a testicular neoplasia is bilateral and mixed.
T/F - A cryptorchid patient is at an increased risk for developing testicular neoplasia.
True!
Sertoli cell tumors produce what hormone?
estrogen
What are the clinical signs associated with a sertoli cell tumor?
feminization (40%) bilateral symmetrical alopecia gynecomastia penile atrophy squamous metaplasia of the prostate/prostatic cysts
What chemistry abnormalities do you expect to see in a patient with suspected sertoli cell tumor?
anemia and leukopenia
this is BAD - it is not always a reversible finding
T/F - Sertoli Cell tumors have a high metastatic rate.
False!
Sertoli cell tumors have a low metastatic rate.
Interstitial cell tumors produce what hormone?
testosterone
What does an interstitial cell tumor predispose the patient to?
perineal hernia
perianal adenoma
anal gland adenocarcinoma
The treatment of choice for testicular neoplasia is…
castration/scrotal ablation - can be curative if there is no metastasis
What are the surgical diseases of the scrotum?
- trauma
- ulcerative dermatitis
- sunburn
- frostbite
- infection/abscess
- complications from orchiectomy
- neoplasia - MST, melanoma, SCC
The treatment of choice for scrotal diseases that are nor amenable to medical management is….
SCROTAL ABLATION
When is a scrotal ablation indicated?
neoplasia
infection
trauma
castration of older, large breed dogs
How many layers of closure is involved in a scrotal ablation?
3 layer closure
What are the surgical conditions of the penis and prepuce?
- hypospadias
- trauma/fractures
- paraphymosis
- phimosis
- neoplasia
What are the surgical procedures of the penis and prepuce?
- penile amputation
- preputial advancement
- phallopexy
Trauma or strangulation of the penis can be managed by…
- conservative management
- catheterize if there is urethral trauma
- penile amputation if the penis is necrotic
If there is a fracture of the os penis, you should manage it by..
- conservative management possibly including urethral catheterization
- wire or finger plate if there is a comminuted fracture
When is a penile amputation indicated?
- gangrenous penis
2. severe urethral trauma
What are the tumors you may see of the penis/prepuce?
Papilloma SCC Osteosarcoma MCT TVT
What penile/preputial neoplasia should not be managed surgically?
TVT
For most penile/preputial tumors, the treatment of choice is….
surgical resection or partial penile amputation
Define paraphimosis.
Paraphimosis - inability to retract the penis into the prepuce.
Paraphimosis can lead to…
congestion, discoloration and necrosis
In a patient with paraphimosis, if the tissue is viable, how would you manage it?
Lubricants and hyperosmolar agents as well as reducing the edema with hyperosmotic agents or cold H20.
In a patient with paraphimosis, if the tissue is non-reducable due to 1. a narrow orifice or 2. a short prepuce, how would you manage it?
If the cause is a narrow orifice - preputiotomy
If the cause is a short prepuce - preputial advancement
In a patient with recurrent or persistent paraphimosis, how would you manage it?
Phallopexy
In a patient with necrotic or gangrenous tissue due to persistent paraphimosis, how would you manage it?
penile amputation
Define Phimosis.
Phimosis - the inability to protrude the penis beyond the preputial orifice
Clinical signs of phimosis include…
unusual urine streams
Balanoposthitis from retention of urine
extremely fowl odor
Congenital phimosis is due to…
a distended prepuce
Acquired phimosis is due to…
preputial trauma or neoplasia
What are the appropriate treatment options for phimosis?
fish mouth - enlarging the preputial orifice
OR
surgically shortening the prepuce
What are the surgical diseases of the prostate?
- benign prostatic hyperplasia
- prostatic abscess
- prostatic neoplasia
What are the surgical procedures of the prostate?
castration (part of the treatment for ALL prostatic diseases EXCEPT neoplasia)
drainage procedures
partial prostatectomy
total prostatectomy
Where is the nerve and blood supply of the prostate located?
on the dorsal aspect
The prostate encircles what anatomic structure?
the urethra
Prostatomegaly is a clinical sign of what prostatic disease(s)?
Prostatic hyperplasia
Prostatic abscess
prostatic cyst
prostatic neoplasia
T/F - A painful prostatic palpation is indicative of prostatic hyperplasia and/or prostatic cysts.
False.
There will NOT be pain of palpation.
On prostatic cytology, hemorrhage is a sign of what 3 prostatic disease?
prostatic hyperplasia, prostatic cysts, and prostatic abscess*
*cytology of a prostatic abscess will also reveal inflammation and bacteria
Pyuria is a potential clinical sign of what 2 prostatic diseases?
prostatic abscess and prostatic neoplasia
What canine breed typically has really large prostates on physical exam?
Scottish Terriers
Benign Prostatic Hyperplasia is not neoplastic but can predispose the patient to….
prostatic cysts
T/F - Benign Prostatic Hyperplasia is an abnormal aging change.
False.
Benign prostatic hyperplasia is a NORMAL aging chance.
The cause of benign prostatic hyperplasia is due to…
an increased number and sensitivity of testosterone receptors
Clinical signs of benign prostatic hyperplasia include…
could be asymptomatic
dyschezia
ribbon-like feces
*it is unusual for this condition to cause urinary problems
On prostatic palpation on a patient with suspected benign prostatic hyperplasia, what would you expect?
Symmetrical enlargement, PAIN FREE
What is the treatment of choice for benign prostatic hyperplasia?
Castration - curative!
When an older castrated dog is presented with prostatic disease, what is the most common cause (with or without a prostatic abscess)?
NEOPLASIA
Clinical signs of prostatitis/prostatic abscess include…
dyschezia PAINFUL URINATION purulent discharge FEVER PAINFUL ASYMMETRICAL prostate anorexia/lethargy cardiac arrhythmias sepsis, depression, death
In a patient with suspected prostatic abscess, bloodwork will show…
leukocytosis
increased globulins
In mild cases of prostatic abscess, treatment options include…
castration
systemic antibiotics - enrofloxacin or TMS
In severe cases of prostatic abscess, treatment options include…
supportive cafre
systemic antibiotics - enrofloxacin or TMS
prostatic drainage
castration
The proper prostatic drainage procedure is…why?
omentalization - it eliminates problems with other procedures by shortening hospitalization, no ascending infections, no peristomal dermatitis, LESS REOCCURRENCE, more appropriate drainage of all sites and BETTER SUCCESS
Define prostatic cysts.
Prostatic cysts - accumulation of glandular secretions within the prostate
What is the typical signalment of a patient with a prostatic cyst?
Older, IN TACT males
What are prostatic cysts associated with?
prostatic cysts are associated with benign prostatic hyperplasia and hormone imbalances
clinical signs of a prostatic cysts include…
caudal abdominal mass may be asymptomatic AFEBRILE abdominal dissension urinary incontinence and dysuria (unlike other prostatic disease)
T/F - Parenchymal prostatic cysts are uncommon.
False.
Parenchymal prostatic cysts are COMMON.
T/F - Periprostatic cysts are uncommon.
TRUE!
Describe periprostatic cysts
periprostatic cysts are often large, adjacent to the prostate, and have the clinical effects of a mass lesion.
What signs are diagnostic for prostatic cysts?
elongated urethra on contrast rads.
“double bladder” sign on ultrasound
brown, watery fluid with NO microorganisms on FNA
Treatment options for small prostatic cysts include…
surgical resection
castration
Treatment options for large cysts or cysts with capsular/urethral communication include…
partial resection
drainage
omentalization
castration
The most common prostatic disease in dogs who were castrated young is…
prostatic neoplasia
What is the most common prostatic neoplasia?
adenocarcinoma
Other than adenocarcinoma, what other neoplasia(s) affect the prostate?
TCC
SCC
Clinical signs of prostatic neoplasia include…
dysuria hematuria STRAINING TO DEFECATE ribbon-like feces lameness (due to metastasis) LARGE, ASYMMETRICAL PROSTATE
Treatment options for prostatic neoplasia include…
Treatment is often NOT pursued due to advanced disease.
Palliative Txt: tube cystotomy or urethral stent
If it is early detection or a small lesion: partial prostatectomy, complete prostatectomy +/- radiation therapy.
When is a subtotal prostatectomy indicated?
multilocular abscesses
recurrent abscesses
neoplasia (rarely)
When is a total prostatectomy indicated?
ONLY indicated for EARLY NEOPLASIA
What is the percentage of patients who end up incontinent following a total prostatectomy?
80% incontinence
What are the 5 paired mammary glands in the canine?
Cranial/Caudal thoracic
Cranial/Caudal abdominal
Inguinal
Where do the 3 cranial mammary glands of the canine get their blood supply from?
lateral thoracic
Cranial superficial epigastric
Where do the 2 caudal mammary glands of the canine get their blood supply from?
caudal superficial perigastric
Lymph drainage in the canine for mammary glands 1 and 2 is via…
the axillary lymph nodes
Lymph drainage in the canine for mammary glands 4 and 5 is via…
the inguinal lymph nodes
Lymph drainage in the canine for mammary gland 3 is via…
the axillary lymph node
The 4 paired mammary glands of the feline are…
thoracic
cranial/caudal abdominal
inguinal
Lymph drainage in the feline for the thoracic and cranial abdominal* mammary glands is via…
the axillary lymph node
*cranial abdominal can also drain into the inguinal
Lymph drainage in the feline for the caudal abdominal* and inguinal mammary glands is via…
the inguinal lymph node
*caudal abdominal can also drain into the axillary
In the canine, the most common site for a mammary tumor is…
the 4th and 5th mammary glands
In the feline, 1/3 of all tumors are in the ________.
mammary glands
The type of mammary tumor in the feline patient is….
adenocarcinoma
What is the percent malignancy of mammary tumors in the dog? In the cat?
Dog - 35-50%
Cat - >90%
To prevent mammary tumor development in both the canine and feline, what is recommended?
Early ovariectomy or ovariohysterectomy.
Surgical procedures for mammary tumor(s) in the canine patient include…
lumpectomy
mastectomy
regional mastectomy
full chain mastectomy
Surgical procedures for mammary tumor(s) in the feline patient include…
FULL CHAIN MASTECTOMY
Prognosis for mammary tumor(s) in the canine patient is….in the feline patient?
Canine - excellent to poor
feline - guarded to poor
T/F - The most common sire of neoplasia in the female dog is the mammary gland.
TRUE!
42-70% of all tumors in the female dog are mammary gland tumors
If a dog undergoes an OHE before its 1st estrus, it’s risk of developing mammary tumors is _____.
0.5%
If a dog undergoes an OHE before its 2nd estrus, it’s risk of developing mammary tumors is ____.
8%
If a dog undergoes an OHE <2 years of age, it’s risk of developing mammary tumors is _____.
26%
If a dog undergoes an OHE >2 years of age, it’s risk of developing mammary tumors is _____.
there is no effect on the development of malignant tumors
Aside from the time a female dog undergoes an OHE, what other risk factors are there for the development of mammary tumors?
Obesity at <1 year old
administration of progestins
presence of benign tumors
50% of canine mammary tumors are benign and the types are….
mixed mammary tumor (fibroadenomas)
adenoma
benign mesenchymal tumors
50% of canine mammary tumors are malignant and the types are…
carcinoma/adenocarcinoma - the most common malignant tumor
sarcoma (<5%)
Carcinosarcoma - malignant mixed mammary tumor
inflammatory carcinoma
T/F - In the canine patient with a suspect mammary tumor, it is uncommon for multiple tumors to be present.
False.
It is COMMON for multiple tumors to be present in the canine.
What pair of glands have a higher incidence of developing mammary tumors in the canine?
The caudal (4th or 5th) glands.
What is the percentage of thoracic metastasis at the time of diagnosis in the canine patient with mammary tumors?
25-50% of dogs with malignant tumors
Benign tumors of the canine mammary glands express ____% of estrogen receptors.
Benign tumors of the canine mammary glands express 96% of estrogen receptors.
Malignant tumors of the canine mammary glands express ____% of estrogen receptors.
Malignant tumors of the canine mammary glands express 51% of estrogen receptors.
Benign tumors of the canine mammary glands express ____% of progesterone receptors.
Benign tumors of the canine mammary glands express 100% of progesterone receptors.
Malignant tumors of the canine mammary glands express ____% of progesterone receptors.
Malignant tumors of the canine mammary glands express 72% of progesterone receptors.
In dogs, the standard of practice in diagnosing mammary tumors in via __________.
Excision biopsy
In cats, diagnosing mammary tumors is via _____.
FNA
Treatment of choice for all mammary tumors is ____________ UNLESS:
Treatment of choice for all mammary tumors is SURGICAL RESECTION UNLESS:
- inflammatory carcinoma
- presence of distant metastasis
What are the benefits of an adjunct OHE with surgical resection in patients with mammary tumors?
OHE decreases the incidence of new BENIGN tumor formation (NOT MALIGNANT TUMORS).
Regression of normal mammary tissue - making tissue development easier to find.
When should you perform your OHE/Surgical resection in a patient with mammary tumors? Why?
Perform the OHE BEFORE surgically resecting the mammary tumors.
This avoids tumor seeding and decreases anesthesia time.
Define lumpectomy.
Lumpectomy - excision biopsy - removal of the tumor ONLY
Define simple or local mastectomy.
Simple of Local Mastectomy - removal of the tumor and its gland of origin.
Define regional mastectomy.
Regional mastectomy - removal of 2 or more glands with their associated lymphatic structures.
Ex: 4th and 5th glands of the canine
Define Full Chain/Radical Mastectomy.
Full Chain/Radical Mastectomy - removal of the entire chain and associated lymphatic structures.
When would you perform a Unilateral Mastectomy?
If the tumor(s) is confined to one mammary chain.
How would you perform a staged bilateral mastectomy?
With 6 week interval(s) between surgeries.
Ovariohysterectomy at the time of diagnosis of mammary tumors WILL….
eliminate hormonal influence on existing tumors and will prevent uterine disease.
Ovariohysterectomy at the time of diagnosis of mammary tumors WILL NOT…
prevent development of additional malignant mammary tumors.
If a patient presents with a mammary tumor of the 3rd gland, you should perform a….why?
FULL CHAIN MASTECTOMY
The 3rd gland ALWAYS drains cranially and sometimes drains caudally.
If you have a small, freely moveable mass on the periphery of the gland, you should perform a…
lumpectomy.
If you have a mass that is central in the gland, you should perform a…
simple mastectomy.
If you have masses in both inguinal glands on one side of the patient, you should perform a…
regional mastectomy.
If you have masses in the cranial and caudal mammary glands, you should perform….
multiple simply mastectomy procedures
OR
chain mastectomy
Indications for a lumpectomy are…
small tumors <5cm
tumor is know to be benign
mass is between glands or near the edge
Contraindications for a lumpectomy are…
any COM
a mass in the middle of a gland
Indications for a simple mastectomy are…
larger fixed solitary tumors 1-2cm
centrally located tumors
Contraindications for a simple mastectomy are…
there is more than 1 COM
a mass >2cm
Indications for a regional mastectomy…
multiple tumors
larger tumors
If you have tumors in glands 1 and 2, you should remove…
glands 1, 2 and 3
If you have tumors in glands 4 and 5, you should remove…
glands 3, 4, and 5
If you have tumors in gland 3, you should remove…
you perform a CHAIN MASTECTOMY
What percentage of tumors in the feline are mammary tumors?
17% if all feline tumors are mammary tumors
What percentage of mammary tumors in the feline are malignant?
80% of feline mammary tumors are malignant (adenocarcinomas)
What percentage of mammary tumors in the feline have metastasis at presentation?
80% of feline mammary tumors have metastasis on presentation
What percentage of feline mammary tumors are multiple?
> 50% of feline mammary tumors are multiple
If a cat undergoes an OHE at <6 months of age, it’s risk of developing mammary tumors is _____.
10%
If a cat undergoes an OHE at <1 year of age, it’s risk of developing mammary tumors is _____.
15%
T/F - In the feline patient, all 4 pairs of mammary glands are at equal risk for developing mammary tumors.
True
T/F - Feline mammary tumors are often firm and ulcerated.
True
What may be associated with development of malignant mammary tumors in cats?
Exogenous progesterone
In the feline patient with mammary tumor(s), treatment of choice is…
Chain Mastectomy regardless of the tumor.
T/F - In the feline patient, full chain mastectomy decreases risk of local recurrence of mammary tumors.
True
Define canine mammary hyperplasia.
Canine mammary hyperplasia - rapid development of small multiple masses after a heat cycle (progesterone)
T/F - Canine mammary hyperplasia is commonly symmetrical, painful, affects most glands and typically does not resolve with OHE.
False!
Canine mammary hyperplasia is commonly symmetrical, NON-PAINFUL, affects most glands and usually RESOLVES within weeks after OHE.
Fibroadenomatous hyperplasia is benign or malignant lesion in cats at what age?
Benign
<2 years old
Fibroadenomatous hyperplasia is estrogen or progesterone dependent?
progesterone dependent
When is fibroadenomatous hyperplasia first seen?
after the first estrus
after progestin treatment
after pregnancy
define fibroadenomatous hyperplasia
fibroadenomatous hyperplasia - rapid proliferation and mammary gland enlargement
What is the treatment for fibroadenomatous hyperplasia?
OHE/OVE
Consider a flank approach
Resolves in weeks.
