Soft tissue surgery (urogenital) Flashcards
what is the only accessory sex organ of male dogs?
prostate
what are the accessory sex organs of male cats?
prostate
bulbourethral gland
where is the prostate located pre puberty?
pelvic position
where is the prostate located after puberty?
partially pelvic and partially abdominal
what is the function of the prostate?
produce fluid facilitating motility and viability of spermatozoa
what are the clinical signs of prostatic disease?
anorexia, lethargy, weight loss, pyrexia
urinary - dysuria, haematuria, urethral discharge, urine retention
defaecatory - tenesmus, ribbon-like faeces, constipation
what are possible ways to investigate prostatic disease?
rectal palpation
abdominal palpation
urinalysis and urine bacteriology
radiograph/ultrasound
prostatic wash and biopsy
what are the main diseases of the prostate?
benign prostatic hyperplasia
prostatits
abscessation
cysts
neoplasia
what does is benign prostatic hyperplasia see in?
middle aged/old entire dogs
what is the main presenting sign of benign prostatic hyperplasia?
dyschezia
how does benign prostatic hyperplasia feel on a rectal exam?
symmetrically enlarged and pain-free prostate with homogenous consistency
how is benign prostatic hyperplasia treated?
castration - resolves in days
antiandrogen injection
what causes prostatitis?
ascending infection via the urethra (E. coli most common)
what are the clinical signs of prostatitis (abscessation)?
dyschezia, dysuria, pelvic limb stiffness, anorexia, lethargy. pyrexia
how does prostatitis feel on rectal palpation?
painful asymmetrically enlarged prostate
how is prostatitis (abscessation) treated?
long course antimicrobials (4-6 weeks)
castration
ultrasound guided drainage (risk of relapse)
partial prostatectomy
what are the antibiotics used for prostatitis (abscessation)?
fluroquinolones
TMPS (trimethoprim)
what is the difference between a prostatic and paraprostatic cyst?
prostatic cyst develops inside the capsule of the prostate
paraprostatic cysts attach to the capsule of the prostate but don’t communicate with the parenchyma
how are prostatic/paraprostatic cysts treated?
ultrasound guided drainage
surgical resection and omentalisation
castration
what are the clinical signs of prostatic/paraprostatic cysts?
caudal abdominal mass, abdominal distention, urinary incontinence, dysuria, urine retention, dyschezia
what is the most common prostatic neoplasia?
adenocarcinoma
what are the clinical signs of prostatic neoplasia?
dysuria, haematuria, urinary retention, tenesmus, weight loss, lethargy, pain
how can prostatic neoplasia differ from other causes of prostatic enlargement when imaged?
mineralisation may be present with neoplasia
what are som possible treatments for prostatic neoplasia?
usually palliative care
cystotomy tube or urethral stent
analgesia - NSAIDs
radiation therapy
castration
how often do prostatic neoplasms metastasise?
very common - lungs, lymph nodes, bones
what are the indications for castration?
population control
behavioural benefits
prevent androgen related disease
testicular disease - neoplasia, trauma, abscess…
when are testes normally descended in dogs?
by 40 days after birth
how old should a dog be before diagnosing cryptorchidism?
at least 6 months old
how is a cryptorchid testicle found if it isnt palpable?
exploratory coeliotomy - retroflex bladder and identify ductus deferens, following this will lead to the testicle
what are the three types of testicular neoplasia?
interstitial cell (leydig)
Sertoli cell tumours
seminoma
what are the clinical signs of Sertoli cell tumours?
symmetrical alopecia, prostatic enlargment, pendulous prepuce, penile atrophy, gynecomastia, attraction for other males
which testicular neoplasia is rarely metastatic?
leydig cell tumours
what is phimosis?
inability to protrude the penis from the prepuce
what is a common complication of phimosis?
infection/irritation due to urine pooling in the prepuce
what can cause phimosis?
infectious, trauma, neoplasia
congenital
what is paraphimosis?
inability to retract penis into prepuce
how can paraphimosis be treated medically?
lubricant, hyperosmolar solutions, cold packs
what can cause paraphimosis?
mating
trauma
neoplasia
foreign body
congenital
what can cause paraphimosis?
mating
trauma
neoplasia
foreign body
congenital
how can paraphimosis be treated surgically?
enlargement of preputial opening
partial penile amputation
phallopexy (fix penis in prepuce)
what are the indications for ovariohysterectomy?
eliminate unwanted pregnancy
eliminate inconvineunce of oestrus
decreased risk of mammary neoplasia
treat/prevent - pyometra, metritis, neoplasia, prolapse…
what are the advantages of ovariohysterectomy before the first season?
reduce risk of mammary neoplasia
less haemorrhage (smaller vessels)
reduced inconvenience to owner
what are the disadvantages of ovariohysterectomy before the first season?
anaesthesia risk
juvenile behaviour
juvenile hypoplasitc vulva
juvenile disease
obesity
what are some contraindications for ovariohysterectomy before the first season?
juvenile vaginitis
juvenile urethral sphincter mechanism incompetence
when is the best time to perform elective ovariohysterectomy?
between seasons (anaestrus)
>6-8 weeks postpartum
combined with C-section
why should you not perform ovariohysterectomy when a bitch is in season?
increase size of uterine vessels (haemorrhage)
uterine turgidity (more fragile)
what phase of the oestrus cycle does cystic endometrial hyperplasia occur?
luteal
why is cystic endometrial hyperplasia and pyometra seen during the luteal phase?
progesterone stimulates growth/activity of endometrial glands, reduces myometrial activity and suppresses local immune response
what is the most common pathogen associated with pyometra?
E. coli (Pasteurella, Pseudomonas, Klebsiella…)
what are the clinical signs of pyometra?
PUPD, lethargy, inappetence, vomiting, pyrexia, dehydration, abdominal pain, vaginal discharge, gait abnormalities
what are some possible changes on haematology of a dog with pyometra?
anaemia
left shift
banded neutrophilia
low platelet numbers
what is the first thing to do when presented with a pyometra?
stabilise and give antimicrobials
what is the only time medical management would be considered for pyometra treatment?
if bitch is of high breeding value (high risk of reoccurrence)
how can pyometra be managed medically?
uterine emptying - prostaglandins, progesterone receptor antagonists
antimicrobials
what progesterone receptor antagonist can be used to treat pyometra medically?
aglepristone
what must be present for a uterine stump pyometra to occur?
progesterone source
what is the main clinical sign of ovarian remnant syndrome?
signs of recurrent oestrus
what are the risk factors that predispose to uterine stump granuloma?
poor aseptic technique
use of non-absorbable suture material
if excessive uterine body is left in situ
what is the main clinical sign of a fistulae associated with using inappropriate suture material for an ovariohysterectomy?
draining tracts on flank, inguinal region or medial thigh
what causes vaginal hyperplasia?
oedematous enlargement of vagina during proestrus/oestrus under the influence of oestrogen
where does oedema of vaginal hyperplasia usually arise from?
ventral floor of vagina
how is a vaginal prolapse treated?
prevent self trauma
apply lubricant
reduce and apply purse string suture
what is an episiotomy?
incision between vulva and anus
what are the indications of an episiotomy?
surgical exploration of vagina
excise vaginal mass
repair vaginal lacerations
treat strictures/congenital defects
facilitate manual foetal extraction
what should always be placed before performing an episiotomy?
urinary catheter (can visualise the urethral opening and stay away from it)
what is episioplasty?
reconstructive procedure to remove excess skin folds around the vulva
what are some possible ovarian neoplasms seen in dogs?
germ cell - teratoma, teratocarcinoma
epithelial - adenoma, adenocarcinoma
sex cord stromal - granulosa cell tumours
what are some possible uterine neoplasm seen in dogs?
leiomyomas
leiomyosarcomas
what are the most common neoplasms seen in entire female dogs?
mammary tumours
how many pairs of mammary gland do dogs have?
5
which lymph nodes drain the mammary glands?
inguinal, sublumbar, axillary, prescapular, thoracic
what supplies blood to the mammary glands?
cranial/caudal epigastric
what are the possible surgical treatments for mammary neoplasia?
lumpectomy
simple mastectomy
regional mastectomy
chain mastectomy
what is the surgical treatment used for mammary neoplasia in cats?
chain mastectomy (aggressive and metastatic in cats)
what nerve mainly controls the bladder filling/storage phase?
hypogastric
what receptors are triggered to cause the detrusor muscle to relax?
beta-adrenoreceptors
what receptors are triggered to cause the urethral smooth muscle and trigone to contract?
alpha-adrenoreceptors
what nerve allows for somatic (voluntary control) of the bladder filling/storage phase?
pudendal
what nerve controls the bladder emptying phase?
pelvic nerve (parasympathetic system)
what are typical findings of an abnormality associated with the bladder filling phase?
patients can urinate normally
patients can empty bladder normally
patients dribble urine between urinations
patients have reduced bladder capacity
what are the differential diagnoses for abnormalities associated with the filling phase of the bladder?
ectopic ureter
reduced pressure at the bladder neck
involuntary contractions
what can cause reduced pressure at the neck of the bladder leading to urinary incontinence?
congenital/acquired urinary sphincter mechanism incontinence
intrapelvic/hypoplastic bladder
bladder neck mass
what can cause involuntary contractions of the bladder?
bacterial infection
cystic calculus
drugs
FeLV
bladder neck neoplasm
what are the typical signs of an abnormality associated with the emptying phase of the bladder?
distended bladder
constant urine dribble
no normal urination
what are some differentials for abnormalities of the bladder emptying phase?
partial/complete urethral obstruction
chronic bladder distention
dyssynergia (muscular disturbance)
when does incontinence usually occur with urethral sphincter mechanism incontinence?
when bitch is relaxed (sleeping…)
what are some causes of urethral sphincter mechanism incontinence?
low urethral tone
spayed prior to first season (hormonal)
obesity
intrapelvic bladder
what animals is congenital urethral sphincter mechanism incontinence seen in?
juvenile bitches prior to their first season
how is congenital urethral sphincter mechanism incontinence treated?
wait until first season - most resolve after this
what can be done to medically treat urethral sphincter mechanism incontinence?
increase muscle tone - phenylprpanolamine, ephedrine, estriol
reduce contributing factors - obesity, UTI
what are possible options for surgical treatment of urethral sphincter mechanism incontinence?
colposuspension (relocate bladder neck cranially)
urethropexy
artificial urethral sphincter
submucosal urethral injections of blocking agents
what are ectopic ureters?
congentital abnormality when ureter bypasses the bladder to empty into urethra, vagina or rectum
how are surgical ureters treated?
treat associated UTI
surgery before irreversible secondary changes occur
