Surgery of the male reproductive tract Flashcards by Sophie Robinson

Name the only accessory sex gland of male dogs

Prostate gland

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Describe the location of the prostate before puberty

Pelvis

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Describe the location of the prostate during puberty

Partial abdominal position

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Describe the location of the prostate after puberty

Hyperplastic enlargement (androgen-mediated) > abdominal

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Prostatic disease is most commonly seen in which dogs

middle age – older entire male dogs

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List the general clinical signs of prostatic disease

Anorexia, lethargy, weight loss, pyrexia

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List the urinary specific clinical signs of prostatic disease

Dysuria
Haematuria
Urethral discharge
Urine retention - cysts and neoplasia

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List the defecatory specific clinical signs of prostatic disease

Tenesmus - BPH, cysts, abscess, prostatitis
Ribbon-like faeces
Constipation

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How can prostatic disease be investigated?

Rectal palpation
Abdominal palpation
Urinalysis and urine bacteriology
Radiography: plain and contrast / retrograde urethrography
Staging if neoplasia: thoracic imaging
Abdominal ultrasound
Prostatic wash: fluid for cytology + bacteriology
Prostatic biopsy: FNA, catheter suction, Trucut, surgical (last)

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List 5 diseases of the prostate

Benign prostatic hyperplasia (BPH)
Prostatitis
Abscessation
Cysts
Neoplasia

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Benign prostatic hyperplasia is most common in which dogs?

Middle aged - old entire dogs

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How does benign prostatic hyperplasia feel on rectal exam?

Symmetrically enlarged and pain-free prostate, homogeneous in consistency

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What is aim of treating benign prostatic hyperplasia?

Permanent suppression of secretory activity and resolution of prostatomegaly

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How is benign prostatic hyperplasia treated?

Medical management considered when patient not surgical candidate or breeding.
Castration – signs resolve in few days
Antiandrogens (Delmadinose acetate, Tardak, Pfizer)

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Describe prostatitis - abscessation

Ascending infection via the urethra
Any age, more common middle-aged to older dogs
E. coli
Prostatitis can progress to abscess

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What are the clinical signs of prostatitis - abscessation?

Dyschezia, dysuria, PL stiffness, anorexia, lethargy, pyrexia, oedema on PLs
Risk of septic peritonitis
Rectal palpation: asymmetric enlarged painful prostate
Painful abdominal palpation

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Describe the urinalysis findings of prostatitis

Leukocytosis, RBCs, microorganisms

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Describe the imaging findings of prostatitis

Free peritoneal fluid in caudal abdomen
U/s: heterogeneous changes with focal areas of echodensity surrounding pockets of echolucency
Abscesses: multilobulated appearance of capsular tissue surrounding material with a flocculent fluid signal

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Is FNA indicated for prostatitis diagnostics?

No - risk of rupturing abscesses

How is prostatitis treated?

Antimicrobials for 4-6 weeks based on sensitivity
Castration
Ultrasound-guided drainage of abscess
Surgical treatment

What are prostatic paraneoplastic cysts?

Paraprostatic cysts: develop separate from prostate, don’t communicate with parenchyma but have attachment to the capsule
Prostatic cysts: develop within the capsule

How do prostatic paraneoplastic cysts present?

Caudal abdominal mass, abdominal distention, urinary incontinence, dysuria, urine retention, dyschezia
Rectal palpation: prostate not palpable

How are prostatic paraneoplastic cysts treated?

Ultrasound-guided drainage
Surgical resection + omentalisation
Castration

Name the most common form of prostatic neoplasia

Adenocarcinoma

Prostatic neoplasia is most commonly seen in which dogs?

Old Entire and castrated (castration is not protective)

How do prostatic neoplasia's present?

- 80% metastatic at presentation: lungs, regional lymph nodes, skeletal sites - Dysuria, haematuria, urinary retention, defecatory tenesmus, weight loss, lethargy, pain - Rectal palpation: painful

How are prostatic tumours diagnosed?

Imaging (mineralization?) + staging! FNA – seeding? Catheter suction: tumours may not exfoliate Trucut or surgical biopsy

How are prostatic tumours treated?

- Palliative treatment - Cystostomy tube or urethral stenting - Analgesia - COX-2 inhibitors (NSAID) - Prostatectomy (..incontinence) ? - Castration ? (cancer cells are androgen-receptor negative> androgens not related with aetiopathogenesis) - Radiation therapy

List the indications for castration

- Population control - Reduces aggression - Prevention of androgen related diseases - Testicular disease (neoplasia, trauma, torsion) - Scrotal neoplasia, trauma, abscess - Scrotal urethrostomy

Define cryptorchidism

One or both testicles do not descend in the scrotum, unilateral more common

When do testicles normally descend?

30-40 days after birth Definitive diagnosis: if not descended by 6 months of age

What is the main feature of bilateral cryptorchidism

Patient is sterile

Describe the two types of inguinal testicle - and how to approach them surgically for castration

Mobile: advance to prescrotal region Non-mobile: incise over inguinal region

List the DDx for testicular swelling

Neoplasia Scrotal hernia Orchitis Trauma Torsion Scrotal dermatitis

Name the 3types of testicular neoplasia

Interstitial cell (Leydig) tumours Sertoli cell tumours Seminoma

Abdominally retained testicless are predisposed to which tumour?

Sertoli cell tumour

Describe the clinical signs of a Sertoli cell tumour

Symmetrical alopecia, prostatic enlargement, pendulous prepuce, penile atrophy, gynecomastia, galactorrhoea, attraction for other males

What are the clinical signs of leydig cell tumours

Increased testosterone production > concurrent perianal adenomas, perineal hernias, perianal gland adenocarcinomas

How can you investigate testicular tumours?

1. Haematology to assess oestrogen-related myelotoxicity, especially if: - Tumour is large - Abdominally retained testicle - Signs of feminization 2. Evaluate regional lymph nodes: - Radiography - Ultrasound - At coeliotomy (for abdominally retained testicles)

How are testicular tumours treated?

- Castration - Anaemic or thrombocytopenic patients: transfusion! - Meticulous haemostasis - Prognosis is excellent if no metastasis / myelotoxicity - Myelotoxicity may be fatal despite aggressive supportive care - Hematological parameters may take months to improve

Inability to protrude penis from prepuce is termed?

Phimosis

How is phimosis treated?

Infectious – inflammatory disease - Conservative management - Antibiotic therapy if there is infection - Urinary diversion via catheter - Preputial lavage Congenital - Reconstructive surgery of preputial orifice

Inability to retract penis into prepuce is termed?

Paraphimosis

what are the causes of paraphimosis?

Mating Trauma Neoplasia Preputial foreign body Failure of preputial muscles

How does paraphimosis present?

Penis congested and discoloured, dog licking penis exacerbating inflammation > penile necrosis, urethral obstruction

How are preputial/penile wounds/lacerations managed/treated?

- Assess patient fully - Assess urethra - Radiography: plain and contrast - Conservative management: clean, antibiotic ointment, healing by 2nd intention, control bleeding - Surgical management: suture penile mucosa (absorbable material)