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Ross Small Animal Surgery > Reproductive System > Flashcards

Reproductive System Flashcards

1
Q

Describe the three phases of the canine estrus cycle

A
  1. Proestrus:
    Estrogen rises –> vulva enlarges –> serosanguinous vaginal discharge –> attraction of males
  2. Estrus:
    Estrogen declines –> triggers LH surge –> ovulation –> female is receptive (behavioral estrus) –> progesterone begins to rise
  3. Diestrus:
    Progesterone is secreted from corpus luteum –> uterus prepares for implantation
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2
Q

Describe the role of progesterone

A

Produced by ovary after heat (estrus)
o After ovulation, follicle corpus luteum –> makes progesterone (diestrus)
o Required for normal pregnancy

Stimulates endometrial glands (increasing number and secretion) and prepares wall for fertilized ovum

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3
Q

What are the types of ovarian cysts?

A

Non-functional: incidental finding typically discovered when imaging/routine OHE
o Minimal to no clinical signs, may be identified at any age
o Surgical excision is curative, still want to submit for histopathology

Functional: hormone producing, arise from ovarian follicles
o Follicular cysts produce estrogen (most common)
o Luteal cysts produce progesterone (rare in dogs)

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4
Q

What are the clinical signs associated with the most common type of functional ovarian cyst?

A

Follicular cysts

Causes prolonged stage of estrus

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5
Q

What type of ovarian cyst might be associated with pyometra?

A

Progesterone-releasing cysts

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6
Q

What is the signalment associated with ovarian cysts?

A

Young adults (dogs

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7
Q

What is the treatment and prognosis of ovarian cysts?

A

Surgical excision is curative

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8
Q

Why can pyometra be associated with ovarian neoplasia?

A

Chronic release of progesterone as in a functional granulosa cell tumor causes endometrial hyperplasia and immunosuppression of the uterus, making bacterial proliferation more likely

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9
Q

What are the different tissues of origin for ovarian neoplasia and why is tissue-type significant?

A

Tissue of origin dictates effects of tumor

Epithelial: adenoma/adenocarcinoma - space occupying masses only
o Causes vague signs of inappetance, vomiting, lethargy, etc.

Stromal: granulosa cell tumor - functional
o Progesterone –> pyometra
o Estrogen –> persistent proestrus/estrus

Germ cell: dysgerminoma, teratoma, teratocarcinomas (tend to occur in young animals)

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10
Q

What is the general likelihood of metastatic disease with ovarian neoplasia?

A

Uncommon, 20-30%

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11
Q

Is metastatic ovarian disease more common in dogs or cats?

A

Cats

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12
Q

What is the significance of a metastatic, functional ovarian tumor?

A

More complicated than simple excision, but adjunctive treatment may improve survival

Functional tumors (estrogen) can cause irreversible bone marrow suppression

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13
Q

What is the prognosis for a solitary (non-metastatic) ovarian tumor?

A

complete exision is curative

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14
Q

What is the etiology of ovarian remnant syndrome?

A

Surgical error - ovarian tissue left behind at OHE, or tissue dropped into the abdomen that has revascularized

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15
Q

What are the clinical signs of ovarian remnant syndrome?

A

Recurrence of estrus cycle (even 2-3 years later)

Vulval swelling, behavioral estrus

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16
Q

Why is vaginal bleeding not typically seen with ovarian remnant syndrome?

A

The uterus has been removed

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17
Q

How is ovarian remnant syndrome diagnosed in the dog?

A
  1. Vaginal cytology (easiest)
    o Mimics normal heat cycle, must be done in standing heat
    o Inconsistent in cats
  2. Hormone assays
    o Elevated estrogen and progesterone, low LH
    o Cats may require lutenization first
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18
Q

Where should you look for the remnant when treating ovarian remnant syndrome?

A

Caudal pole of right kidney

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19
Q

How does ovariectomy differ from OHE?

A

Removal of ovary alone
o No risk of secondary effects (eg. pyometra) because hormones have been removed

Ligate ovarian vessels as for OHE –> ligate uterine vessels at proper ligament –> excise ovary

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20
Q

Which hormone is necessary for pyometra?

A

Progesterone

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21
Q

What is the most common bacteria found in pyometra?

A

E. coli

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22
Q

What are the typical historical findings of a dog with pyometra?

A 
Recent heat cycle (4-8 weeks ago)
Polyuria/polydipsia 
Systemic illness – variable (anorexia, lethargy, vomiting, fever)
Abdominal pain/guarding
Vaginal discharge – purulent
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23
Q

Why is PU/PD associated with pyometra?

A

PU/PD caused by bacterial toxins that inhibit ADH in PT of kidney

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24
Q

What is the difference between open and closed pyometra, and how does that relate to severity of systemic signs?

A

Open cervix - discharge seen, but less systemically severe

Closed cervix - more severe

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25
Q

How is pyometra diagnosed?

A 
CBC/Chem consistent with sepsis/SIRS
o	Neutrophilia with left shift
o	Mild thrombocytopenia
o	Hypoalbuminemia
o	Mild cholestasis (bilirubin, liver enzymes up)

Radiographs (good), US (ideal) showing large fluid-filled uterus

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26
Q

How should a pyometra case be stabilized?

A

Stabilize with IV fluids +/- colloids

IV antibiotics – empirical therapy for gram negative (usually ampicillin/enrofloxacin)

Treat for SIRS if necessary

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27
Q

List the treatment options for pyometra, which is preferred, and why

A
  1. OHE (preferred – better prognosis, no risk of recurrence)
  2. Medical management
    Prostaglandin F2alpha – smooth muscle, cervix
    Systemic antibiotics
    Close monitoring
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28
Q

What are the indications that would make medical management of pyometra acceptable?

A

NOT systemically ill
OPEN only
Owner highly motivated and aware of risks

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29
Q

Why is medical treatment of closed pyometra contraindicated?

A

Prostaglandin + closed cervix = rupture

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30
Q

What is the likelihood of medical management preserving fertility in a pyometra case?

A

50%

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31
Q

What are the differences between the ‘standard’ OHE and OHE for pyometra?

A

Large incision – xiphoid to pubis
Usually no need to break suspensory ligament
Milk purulent material away from cervix
Ligate prior to clamp placement – friable!
Use noncrushing clamps (Doyen)
Iatrogenic rupture possible!

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32
Q

What is the usual history of a dog with metritis?

A

Post partum (12 hours to 1 week)

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33
Q

What are the clinical signs of a dog with metritis?

A

Systemic illness

Foul-smelling reddish-brown discharge

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34
Q

What is the etiology of metritis?

A

Dystocia
Obstetric manipulation
Retained fetus or placenta
Devitalized uterine tissue

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35
Q

How is metritis diagnosed?

What diagnostic procedure is not helpful?

A

Primarily based on timing following parturition

Vaginal cytology not helpful (degen neutrophils and intracellular bacteria are normal postpartum)

CBC/Chem changes similar to pyometra

Imaging – similar to pyometra

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36
Q

What are the indications for medical treatment of metritis?

A

Valuable breeding animal
Good response to initial therapy
No devitalized tissue/retained placenta or fetus

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37
Q

Is treatment of metritis an emergency?

A

Yes, depending on severity

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38
Q

Which surgical procedure is typically used for metritis?

What is the prognosis?

A

OHE

Good prognosis

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39
Q

What is the impact of OHE on lactation

A

No effect on milk production

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40
Q

What is the pathophysiology of cystic endometrial hyperplasia?

A

Excess progesterone –> glandular tissue becomes cystic –> uterus fills with secretions –> cysts may become hemorrhagic

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41
Q

What history and clinical signs are compatible with cystic endometrial hyperplasia?

A

Failure to conceive

Patients usually bright and alert

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42
Q

How is cystic endometrial hyperplasia diagnosed?

A

US for cysts

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43
Q

Is treatment of cystic endometrial hyperplasia an emergency?

A

Not typically

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44
Q

What are the treatment options with cystic endometrial hyperplasia?
What are the prognoses and which treatment is preferred?

A

OHE - good prognosis, preferred
-necessary with hemorrhage (hematometra)

Medical therapy - if valuable breeding animal and no vaginal bleeding

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45
Q

What is uterine torsion?

What causes it?

A

Rotation of uterine horn on long axis

Associated with dystocia, also reported with CEH, pyometra, etc.

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46
Q

Is uterine torsion a surgical emergency?

A

Yes

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47
Q

How is uterine torsion treated?

Should the torsed fetus be derotated?

A

OHE + removal of viable pups by c-section

DO NOT derotate

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48
Q

What are the signalment, cause, and treatment options for uterine prolapse

A

More common in cats
Complication of parturition, up to 48 hours following final fetus

  1. Manual reduction
  2. OHE - prevents recurrence
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49
Q

What is the relative risk of benign vs. malignant uterine neoplasia?

A

Benign: minimal signs, often incidental

Malignant: likely metastatic, prognosis guarded

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50
Q

Is malignant uterine neoplasia more likely in dogs or cats?

A

Cats - variable in origin

In dogs most commonly benign leiomyomas

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51
Q

List the 6 critera for diagnosing dystocia

A
  1. Prolonged gestation (>68 days)
  2. Signs of toxemia during gestation
  3. Stage 1 lasting >24 hours
  4. No puppies >36 hours after temperature drop
  5. Active stage 2 contractions >30 minutes
  6. > 4 hours between puppies
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52
Q

Which breeds are prediposed to dystocia?

A

Brachycephalic

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53
Q

What are the contraindications to medical treatment of dystocia?

A 
Active contractions >30 minutes
Fetal malposition (determined on palpation)
Fetal distress (determined by US – fast or slow HR)
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54
Q

What are the two surgical treatments for dystocia?

How do they differ?

A
  1. C-section (hysterotomy)

2. En-bloc OHE: simultaneous OHE and dystocia treatment

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55
Q

What is the holding layer for closing incisions in the uterus?

A

Submucosa

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56
Q

What suture would you use to close incisions in the uterus?

A 
3-0/4-0 absorbable monofilament
One layer (continuous) or two (+inverting)
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57
Q

What is the prognosis for dogs undergoing surgery for dystocia?

A

99% survival

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58
Q

What is the prognosis for puppies going through dystocia?

A

87% survival 2 hours post-op (lower for brachycephalic breeds)

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59
Q

What are the anatomic indications for an episiotomy approach to the vagina?

A

Anything caudal to the pelvis (vestibular and vaginal lesions)
Access to just cranial of urethral opening (incision limited dorsally by rectum)

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60
Q

What is the proper positioning, incision, and closure for an episiotomy approach?

A

Position as for perineal surgery (leg drop)
Incise on midline from vulvar opening (median raphe)
Expect moderate hemorrhage
Close in 3 layers: mucosa, muscle + SQ, skin

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61
Q

What are the anatomic indications for a ventral approach to the lower reproductive tract?

A

Intrapelvic and abdominal lesions

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62
Q

What is the difference between a caudal abdominal approach and a transpelvic approach to vaginal surgery?

A

Caudal abdominal approach:

  • ventral midline incision
  • limited access to lesions caudal of cervix

Transpelvic:

  • ventral approach through pelvis (osteotomy)
  • very invasive, requires muscle elevation and bone removal
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63
Q

What is the etiology of vestibulovaginal stenosis?

A

Congenital developmental anomaly (no basis for genetic transmission) involving retained embryonic epithelial tissue

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64
Q

What are the 3 forms of vestibulovaginal stenosis?

A
  1. Vertical septum (double vagina)
    - thin band of mucosa oriented dorsoventrally
  2. Annular lesion (imperforage hymen)
    - ring-shaped narrowing
    - includes mucosa and submucosa +/- musularis
  3. Hypoplasia
    - narrowed section of vaginal vault
    - uncommon
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65
Q

What are the clinical signs associated with vestibulovaginal stenosis?

A

Recurrent vaginitis +/- UTI
Difficulty or pain with breeding
Urinary incontinence

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66
Q

How is urinary incontinence related to vestibulovaginal stenosis?
Will repair of the stenosis improve the incontinence?

A

Usually due to other urinary abnormalities

Surgery will not improve incontinence

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67
Q

How is contrast vaginourethrogram used to diagnose vestibulovaginal stenosis?
What alternative diagnostic is considered best?

A

Iodinated contrast used to measure the maximum and minimum diameter of the vagina - ratio used to determine severity of stenosis

Vaginoscopy provides direct visualization of stenosis

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68
Q

What are the indications for treatment of vestibulovaginal stenosis?

A

Breeding dogs

Spayed dogs with clinical signs

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69
Q

What general criteria are used to determine treatment of vestibulovaginal stenosis?

A

Lesion type and location

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70
Q

What are the treatment options for a simple septal vestibulovaginal stenosis?

A
  • Digital breakdown ineffective
    1. Episiotomy with mucosal resection at lesion attachments
    2. Endoscopic laser ablation / scissor resection
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71
Q

Why is mucosal resection not an option in anular vestibulovaginal stenosis lesions?
What treatment is preferred?

A

Annular lesions are prone to stricture

  1. Vaginal resection and anastomosis (if caudal to pelvis)
  2. Vaginectomy of cervix to uretheral opening (if intrapelvic)
72
Q

What is the etiology of a recessed vulva?

A

Conformational abnormality (vulva is covered by skin)

73
Q

What is the impact of prepubertal OHE on the incidence of recessed vulvas?

A

NO relationship

74
Q

What is the impact of obesity on the incidence of recessed vulvas?

A

NO relationship

75
Q

What clinical signs are associated with recessed vulvas?

A

Often asymptomatic
Skin fold dermatitis/vaginitis
Urine pooling may cause recurrent UTI or apparent incontinence

76
Q

What procedure is typically recommended for the treatment of recessed vulva?

A

Episioplasty (‘vulvoplasty’)

Resection of extra skin, appose and close tissue

77
Q

What is the prognosis for treatment of recessed vulva?

A

Good

Complications are rare and recurrent signs almost always resolve

78
Q

What history and signalment is compatible with vaginal edema?

A

Young dogs in the first few proestrus/estrus cycles

79
Q

What is the etiology of vaginal edema?

A

Mucosa becomes edematous –> protrudes from vulva –> tissue subject to drying/trauma

80
Q

How is vaginal edema typically treated

A

Edema resolves with end of cycle (though will recur), lubricate and reduce until then

OHE/OVE resolves and prevents recurrence

Resection of tissue is alternative for breeding animals

81
Q

How is vaginal prolapse differentiated from vaginal edema and neoplasia?

A

Entire circumference of vagina prolapses, creating a ‘donut-shape’

82
Q

What are the etiologies of vaginal prolapse?

A

Secondary to dystocia, constipation, forced separation

83
Q

How is vaginal prolapse typically treated?

A

Manual reduction and OHE

84
Q

What is the typical signalment associated with reproductive neoplasia?

A

Older (>10), intact female dogs

85
Q

What is the relative likelihood of benign vs. malignant vaginal neoplasia?

A

80% benign (leiomyoma most common)

86
Q

What is involved in the staging workup of vaginal neoplasia?

A

CBC/Chem/UA
thoracic rads
abdominal US
Biopsy required to determine malignancy

87
Q

How is benign vaginal neoplasia typically treated?

A

Full-thickness resection of vaginal wall at base of mass

88
Q

What is the most common type of vaginal malignant neoplasia?

What are the characteristics of that malignancy?

A

Leimyosarcoma

Relatively low risk of metastasis
Locally invasive
Survival good with local control of tumor

89
Q

What is involved in surgical treatment of malignant vaginal tumors?

A

Aggressive resection (2-3 cm) via vulvovaginectomy

90
Q

What breed may be predisposed to malignant mammary tumors?

A

German Shepherds

91
Q

What is the relative likelihood of malignant mammary tumors in dogs, male vs female?

A

Most common neoplasm in female intact dogs, 50% are malignant

Extremely rare in males, more likely benign

92
Q

Is it more common to have single or multiple mammary tumors?

A

Multiple

93
Q

Why is it important to remove all mammary tumors, and to test each one histopathologically?

A

Malignant transformation is possible

May see different histologic subtypes within the same dog

94
Q

What is the difference between canine mammary hyperplasia and neoplasia?

A

Hyperplasia occurs after heat cycle and will regress

Typically multiple masses only a few mm in diameter

95
Q

What tests are recommended in the workup of canine mammary neoplasia and why?

A
  1. Minimum database
  2. Three-view thoracic radiographs - 25-50% of malignancies have mets at initial diagnosis
  3. Abdominal US/CT/MRI - especially for caudal mammary masses d/t drainage to iliac LNs
96
Q

What is the value of cytology (FNA) in the workup of mammary tumors?

A

Questionable value - cannot definitively r/o malignancy and treatment is the same whether benign/malignant

Can differente mammary tumor from other masses

97
Q

List the 5 criteria of malignancy in mammary tumors

A
  1. Rapid growth
  2. Size (>1cm diameter)
  3. Fixed to skin/underlying tissues
  4. Poorly circumscribed
  5. Ulceration or inflammation
98
Q

What are the appropriate margins for wide excision of a potentially malignant mammary tumor?

A

2-3 cm circumference, fascia and muscle plane deep

99
Q

What are the differences between the 4 excision procedures for mammary tumors?
What are the indications for each?

A
  1. Lumpectomy
    - removal of solitary, small mass located between glands or at periphery
    - contraindicated with any COM
  2. Simple mastectomy
    - indicated for solitary masses, 1-2cm, within gland
  3. Regional mastectomy
    - indicated for multiple tumors in adjacent glands
    - remove 1-3 or 3-5
    - rarely used since likelihood of metastasis is great
  4. Chain (radical) mastectomy
    - indicated for mulitple masses throught chain, tumors in gland 3 with any COM, or solitary masses anywhere with multiple COM
100
Q

Which mastectomies are typically staged, and why?

A

Bilateral chain mastectomies

Risk of dehiscence is too high if done at the same time, stage 4-6 weeks apart

101
Q

What is the prognosis for a benign mammary mass removal?

A

Good with complete resection

102
Q

Describe the three stages of labor, including the events preceding and following it

A

• Temperature drop (

103
Q

What size mammary masses are most likely to be benign in dogs?

A
104
Q

What is the median survival time of malignant mammary disease?

A

1-2 years if no metastasis

105
Q

What main factor of malignant mammary tumors is associated with longer survival?

A

Size (smaller tumors = longer survival)

106
Q

What is the prognosis for dogs with metastatic mammary disease?

A

Poor.
80% recurrence with LN mets
MST 5 months

107
Q

What is the influence of OHE/OE on the risk of developing mammary tumors in dogs?

A

OHE prior to 1st estrus –> 0.5% risk
OHE before 2 years reduces risk
OHE after 2 years, no effect

108
Q

What other procedure is typically recommended at the time of mastectomy?
Which procedure is performed first?

A

OHE

OHE performed first to avoid seeding tumor into abdomen

109
Q

How is an inflammatory carcinoma differentiated form a standard mammary tumor?

A

Multiple glands affected in both chains with edema, erythema, and pain of affected glands

110
Q

Is inflammatory carcinoma likely to be metastatic?

A

Highly likely

111
Q

What is the prognosis of inflammatory carcinoma?

A

Poor, MST

112
Q

Is surgical treatment usually recommended with inflammatory carcinomas?

A

No

113
Q

What is the relative likelihood of malignant mammary tumors in cats?

A

90% malignant (adenocarcinoma)

Male and female rates similar

114
Q

How does OHE affect the development of mammary tumors in cats?

A

Prior to 6 months = 10% risk

Prior ot 1 year = 15% risk

115
Q

When is surgery of feline mammary tumors indicated?

Which procedure is typically selected?

A

Recommended if no metastasis

Chain mastectomy
No evidence that simultaneous OHE increases survival

116
Q

When is adjunctive therapy recommended for feline mammary tumors?

A

Always

117
Q

What 3 factors predict a good prognosis for feline mammary neoplasia?

A
  1. Size:
    3 years
    >3cm = MST ~6 months
  2. Surgery
    More aggressive = better survival
  3. Histologic grade
118
Q

How is fibroadenomatous hyperplasia differentiated from feline mammary neoplasia

A

Characteristic appearance (cat boobs), definitive dx on histopath if needed

119
Q

What signalment is associated with fibroadenomatous hyperplasia in cats?

A

Young (

120
Q

Which hormone induces fibroadenomatous hyperlasia in cats?

What conditions is it associated with?

A

Progesterone-dependent

Complicated by trauma, infection, necrosis

121
Q

Which surgical procedure is used to treat fibroadenomatous hyperplasia and why?
Which approach is preferred?

A

OE/OHE (remove the hormones)

Flank approach

122
Q

Define: cryptorchidism

A

failure of either testicle to descend into the scrotum

123
Q

At what age can cryptorchidism be diagnosed definitively?

A

6 months

124
Q

How is cryptorchidism transmitted?

A

Genetically, with small breeds predisposed

125
Q

What are the potential sequelae of cryptorchidism?

A

Sterility in affected testicle (always)
Suppression of spermatogenesis in normal testicle
Highly prone to neoplastic transformation
Prone to torsion
Often atrophied

126
Q

Where can prescrotal testicles usually be palpated?

A

in SQ between inguinal ring and scrotum

127
Q

How can testicles in the abdomen or inguinal region be located?

A

Abdominal US
Exploratory laparotomy
*recall origin is at caudal pole of kidney

128
Q

What procedures are used when performing castration of a cryptorchid dog?

A

Remove abnormal testicle first
Prescrotal - incise directly over testicle
Abdominal - caudal celiotomy incision (skin adjacent to prepuce) –> divide preputial muscle and vessels –> midline linea incision –> follow testicular artery or vas deferens

129
Q

In which patients is testicular torsion more common?

A

Abdominal cryptorchids

130
Q

What are the clinical signs associated with testicular torsion?

A

May be mild (anorexia lethargy) to acute abdomen (marked pain, shock)

131
Q

How is testicular torsion diagnosed?

A

Ultrasound, palpation

132
Q

Is testicular torsion a surgical emergency?

A

Yes

133
Q

What is the prognosis for testicular torsion with or without surgery?

A

Good with surgery

Fatal without

134
Q

In cases of testicular torsion, should the testicle be derotated before it is ligated

A

no

135
Q

Which condition predisposes to testicular neoplastic transformation?

A

Cryptorchidism

136
Q

Can neoplastic testicles be functional?

A

Yes, functionality is common

137
Q

How are functional testicular tumors associated with other secondary characteristics?

A

Feminism syndrome

  • Sertoli cell tumors (estrogen)
  • alopecia, prostate disease, gynecomastia, bone marrow suppression

Testosterone

  • interstitial cell tumors
  • perineal hernias
138
Q

What is the likelihood of metastatic disease with testicular tumors?

A

Rare,

139
Q

Which surgical procedure is recommended for the treatment of un-metastasized testicular neoplasia?
What is the prognosis?

A

Bilateral castration with scrotal ablation

Surgery may be curative

140
Q

What is scrotal ablation?

A

Removal of the scrotum along with castration

141
Q

When is scrotal ablation indicated?

A

Neoplasia
Torsion
Castration of older, large-breed dogs

142
Q

What is ligated and divided during vasectomy?

A

Vas deferens

143
Q

Why does vasectomy have no effect on testosterone-related disease?

A

Testicles still intact

144
Q

What is hypospadias?

A

incomplete formation of the penile urethra

145
Q

What is the breed predilection for hypospadias?

A

Boston Terriers

146
Q

How is hypospadias treated?

A

Urethrostomy proximal to abnormality

Excision of exposed mucosa and penile remnants

147
Q

What is paraphymosis?

A

Inability to retract penis into prepuce

148
Q

What causes paraphymosis?

A

Congenital - narrowed orifice, shortened prepuce

Acquired - trauma, infection, priapism (persistent erection)

149
Q

What are the medical treatments for paraphymosis?

A 
Reduce edema/swelling
-hyperosmolar solutions
-cold/heat
Reduce paraphimosis
-lube
150
Q

What are the indications for surgical treatment of paraphymosis?

A

Recurrent condition
Small diameter preputial opening
Necrosis

151
Q

Why is castration indicated for acquired paraphimosis?

A

In cases of priapism it will resolve the problem

152
Q

When is penile amputation indicated in paraphimosis?

A

Necrosis

153
Q

What is phallopexy?

A

Attaching of penis to prepuce

154
Q

What procedure is indicated for tumors of the penis and prepuce?

A

Penis - penile amputation

Prepuce - preputial reconstruction

155
Q

What are the common tumor types arising from the penis and prepuce?

A

Penis:
TVT, papilloma, squamous cell, mast cell
Prepuce:
mast cell, TVT, melanoma

156
Q

Which penile tumor is not treated surgically?

A

TVT - tx with vincristine

157
Q

What is important about mast cell tumors of the prepuce?

A

More malignant than other sites

158
Q

What two components are necessary for reconstruction of the prepuce?

A 
Epithelial surface (local, haired skin)
Mucosal surface (oral cavity)
159
Q

What are the CS and PE findings with benign prostatic hyperplasia?

A

CS: dyschezia, dysuria
PE: palpation of symmetrically enlarged, pain-free prostate

160
Q

How is benign prostatic hyperplasia differentiated from other prostatic disease?

A

US shows characteristic homogenous enlargement of prostate

161
Q

How is benign prostatic hyperplasia treated?

A

Castration

162
Q

What are the two components of the etiology of prostatitis?

A

Ascending infection from the urethra (E. coli most common)

Pre-existing BPH

163
Q

What are the clinical signs of prostatitis?

A

Dyschezia, dysuria, pain on urination/defecation, +/- purulent penile discharge

164
Q

How is prostatitis differentiated from other prostatic disease?

A

Palpation - bilobed, symmetrical, painful!

US - heterogenous prostate with pathognomonic flocculent fluid

165
Q

What are the ramifications of severe cases of prostatitis?

A

Rupture –> septic shock, peritonitis

166
Q

What is the sx treatment for mild vs. severe cases of prostatitis?

A

Mild - castration

Severe - exploratory laparotomy and omentalizaiton + castration

167
Q

What is omentalization of the prostate?

A

Bringing omentum into or through abscess cavity to improve drainage

168
Q

What is the typical signalment of a dog with prostatic cysts?

A

Older, intact males

169
Q

What are the clinical signs associated with prostatic cysts, and how is it differentiated from other prostatic disease?

A

Large, discrete mass in caudal abdomen
May be asymptomatic
‘Double bladder’ on US
Fluid aspiration is brown/watery

170
Q

Which surgical procedure is indicated based on the structure of a prostatic cyst?

A

All cysts - castration
Small with limited attachment - surgical resection
Large or capsular/urethral communication - partial resection and omentalization

171
Q

What is the prognosis for treatment of prostatic cysts

A

Good with sx

172
Q

How is urinary incontinence related to prostatic cysts?

A

Resultant of anatomical changes in urethra by cyst, not the surgery

173
Q

What is the most common type of prostatic neoplasia?

A

Adenocarcinoma

174
Q

How common is prostatic metastatic disease?

A

80% at the time of diagnosis

175
Q

What is the effect of castration on the incidence of and prognosis for prostatic neoplasia?

A

Castration –> increased incidence and risk of metastasis

176
Q

What clinical signs are compatible with prostatic neoplasia?

A

dysuria, hematuris, urinary retention, dyschezia
lameness d/t bone mets
large, asymmetrical prostate on palpation

177
Q

What treatment is recommended for prostatic neoplasia?

A

Palliative:

  • tube cystotomy
  • urethral stent

Sx treatment not typically pursued d/t guarded prognosis

Ross Small Animal Surgery (3 decks)

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