Soft Tissue Surgery: Male Reproductive Tract Flashcards
- How does the prostate appear?
- Where does it open into?
- Where is it located before and after puberty?
- Bilobed, tubuloalveolar glands
- Ducts openings into the urethra
- Pelvic position until puberty- partial abdominal position
What are clinical signs of prostatic disease?
Non specific
* Anorexia
* Lethargy
* Weight loss
* Pyrexia
Urinary
* Dysuria
* Haemeaturia
* Urethral discharge
* Urine retention
Defaecatory
* Tenesmus
* Ribbon-like faeces
* Constipation
How can prostatic disease be investigated?
- Rectal palpation
- Abdominal palpation
- Urinalysis and urine bacteriology
- Radiography: plain and contrast/retrograde urethrography
- Abdominal ultrasound
- Prostatic wash: fluid for cytology + bacteriology
- Prostatic biopsy: FNA, catheter suction, trucut, surgical
What are the different diseases of the prostate?
- Benign prostatic hyperplasia
- Prostatitis
- Abscessation
- Cysts
- Neoplasia
- What dogs more commonly have benign prostatic hyperplasia?
- What is the clinical sign?
- What is found on rectal palpation?
- How is it treated?
- Middle aged, entire dogs
- Dyschezia- difficulty defecating
- Symmetrically enlarged and pain-free prostate, homogenous in consistency
- Castration- signs resolve
Anti-androgens
- What cause abscessation of the prostatitis?
- What are the clinical signs?
- What is found on rectal palpation?
- What biochemistry and urinalysis may show?
- How is it diagnosed?
- Ascending infection via urethra, E. coli
- Dyschezia, dysuria, PL stifness, anorexia, lethargy
- Asymmetrical enlarged painful prostate
- Leucocytosis, urine: RBCs, microorganisms
- CS, Imaging, lab findings, cytology
What do these images show?
Prostatitis- abscessation
How is prostate abscessation treated?
- ABs for 4-6 weeks based on sensitivity
- Castration
- Ultrasound-guided drainage of abscess
Surgical
* Drainage and omentilisation
* Partial prostatectomy
What is the difference between paraprostatic cysts and prostatic cysts?
Paraprostatic cysts:
* develop seperate from prostate, don’t communicate with parenchyma but have attachement to the capsule
Prostatic cysts
* Develop within the capsule
How are prostate cysts diagnosed and treated?
Diagnosis
* Caudal abdominal mass
* Abdominal distention
* Urinary incontinence
* Dysuria
* Urine retention
* Rectal palpatoin- not palpable
Treatment
* US guided drainage
* Surgical resectoin and omentalisation
* Castration
- What prostatic neoplasia can occur?
- Why is palliative usually the best option?
- What is found upon rectal palpation?
- Wha are the clinical signs?
- How is it diagnosed?
- Adenocarcinoma, SCC, TCC
- 80% metastatci at presentation
- Painful
- Dysuria, haematuria, urine retention, defecatory tenesmus, weight loss, lethargy
- Imaging- mineralisaton, FNA?, trucut or surgical biopsy
What are the differential diagnoses of prostatic neoplasia?
How is prostatic neoplasia treated?
Benign prostate hyperplasia, Abscess
Palliative treatment
* Cystostomy tube/urethral stenting
* Analgesia
* NSAIDs
* Prostatecetomy
* Radiation therapy
What are the indications for testes?
- Population control
- reduce aggression
- prevention of androgen related diseases
- testicular disease
- scrotal neoplasia
- scrotal urethrostomy
- What is cryptorchidism?
- When is cryptochidism definitive?
- When would the patient be sterile?
- How is it treated?
- One or both testes do not descend into the scrotum
- normally descent by 30-40 days, definite by 6 months of age
- If bilateral
- Castration
Why can cryptorchidism require different surgeries?
Inguinal testicle
* Mobile: advance to prescrotal region
* Non-mobile: incisde over inguinal region
Non-palpable testicle
* Exploratory coeliotomy
* Retroflex bladder, idenfity ductus daferens dorsal to bladder neck
* Follow ductus deferens to testicle
Why can cryptorchidism require different surgeries?
Inguinal testicle
* Mobile: advance to prescrotal region
* Non-mobile: incisde over inguinal region
Non-palpable testicle
* Exploratory coeliotomy
* Retroflex bladder, idenfity ductus daferens dorsal to bladder neck
* Follow ductus deferens to testicle
What are the differential diagnosis of testicular swelling?
- Neoplasia
- Scrotal hernia
- Orchitis
- Trauma
- Torsion
- Scrotal dermatitis
What are the three types of testicular neoplasia?
Interstitial cell tumours (leydig)
Sertoli cell tumours
Seminoma
- What clinical sign may be seen with sertoli cell tumour
- What other clinical signs are found
- Feminization syndrome
- Symmetrical alopecia, prostate enlargment, pendulous prepuce, penile atrophy, gynecomastia, galactorrhea
Metastatsis 2-10%
What are leydig cell tumours associated with?
- Increased testosterone production
- Concurrent perianal adenomas
- Perineal hernias
Which testes tumours are most to least likely to metastasise?
Seminomas- 6-11%
Sertolic cell- 2-10%
Leydig- very rare
What testiculat tumour investigations are indicated?
Haematology to assess oestrogen-related myelotoxicity
* tumour is large
* abdominally retained
* Signs of feminisation
Thoracic radiograhs- metastasis
Evaluate regional lymph nodes
* radiography, US, coelioectomy
How are testicular tumours treated?
- Castration
- Anaemic or thrombocytopenic
- Metiuculous haemostasis
- What is phimosis?
- What can it be secondary too?
- How is it treated?
- Inability to protrude penis from prepuce
- Trauma, neoplasia, infection
- Infectious- inflammatory: conservative
Congenital- reconstructive surgery
- What is paraphimosis?
- What is the aetiology?
- How does it appear?
- How is it treated?
- Inability to retract penis into prepuce
- Mating, trauma, neoplasia, FB, failure of preputial muscles
- Penis congested and discoloured
- Lubricants, hyperosmolar solutions, cold packs
Surgical enlargment/amputation
How should a penile laceration be treated?
- Assess patient fully
- Assess urethra
- Radiogaph: plain and contrast
- Conservative: clean, AB topical, healing by 2nd intention
- Surgical: suture
If urethra not transected- catheterise
If urethra transected: anastomosis and catheterization for upto 10 days
Fracture of os penis- conservative managment
