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Y4 SA - Urogenital > Surgery of the male reproductive tract > Flashcards

Surgery of the male reproductive tract Flashcards

1
Q

Name the only accessory sex gland of male dogs

A

Prostate gland

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2
Q

Describe the location of the prostate before puberty

A

Pelvis

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3
Q

Describe the location of the prostate during puberty

A

Partial abdominal position

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4
Q

Describe the location of the prostate after puberty

A

Hyperplastic enlargement (androgen-mediated) > abdominal

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5
Q

Prostatic disease is most commonly seen in which dogs

A

middle age – older entire male dogs

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6
Q

List the general clinical signs of prostatic disease

A

Anorexia, lethargy, weight loss, pyrexia

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7
Q

List the urinary specific clinical signs of prostatic disease

A

Dysuria
Haematuria
Urethral discharge
Urine retention - cysts and neoplasia

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8
Q

List the defecatory specific clinical signs of prostatic disease

A

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

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9
Q

How can prostatic disease be investigated?

A
  • 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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10
Q

List 5 diseases of the prostate

A

Benign prostatic hyperplasia (BPH)
Prostatitis
Abscessation
Cysts
Neoplasia

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11
Q

Benign prostatic hyperplasia is most common in which dogs?

A

Middle aged - old entire dogs

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12
Q

How does benign prostatic hyperplasia feel on rectal exam?

A

Symmetrically enlarged and pain-free prostate, homogeneous in consistency

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13
Q

What is aim of treating benign prostatic hyperplasia?

A

Permanent suppression of secretory activity and resolution of prostatomegaly

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14
Q

How is benign prostatic hyperplasia treated?

A
  1. Medical management considered when patient not surgical candidate or breeding.
  2. Castration – signs resolve in few days
  3. Antiandrogens (Delmadinose acetate, Tardak, Pfizer)
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15
Q

Describe prostatitis - abscessation

A

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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16
Q

What are the clinical signs of prostatitis - abscessation?

A
  • 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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17
Q

Describe the urinalysis findings of prostatitis

A

Leukocytosis, RBCs, microorganisms

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18
Q

Describe the imaging findings of prostatitis

A
  • 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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19
Q

Is FNA indicated for prostatitis diagnostics?

A

No - risk of rupturing abscesses

20
Q

How is prostatitis treated?

A

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

21
Q

What are prostatic paraneoplastic cysts?

A
  • Paraprostatic cysts: develop separate from prostate, don’t communicate with parenchyma but have attachment to the capsule
  • Prostatic cysts: develop within the capsule
22
Q

How do prostatic paraneoplastic cysts present?

A

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

23
Q

How are prostatic paraneoplastic cysts treated?

A

Ultrasound-guided drainage
Surgical resection + omentalisation
Castration

24
Q

Name the most common form of prostatic neoplasia

A

Adenocarcinoma

25
Q

Prostatic neoplasia is most commonly seen in which dogs?

A

Old
Entire and castrated (castration is not protective)

26
Q

How do prostatic neoplasia’s present?

A
  • 80% metastatic at presentation: lungs, regional lymph nodes, skeletal sites
  • Dysuria, haematuria, urinary retention, defecatory tenesmus, weight loss, lethargy, pain
  • Rectal palpation: painful
27
Q

How are prostatic tumours diagnosed?

A

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

28
Q

How are prostatic tumours treated?

A
  • 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
29
Q

List the indications for castration

A
  • Population control
  • Reduces aggression
  • Prevention of androgen related diseases
  • Testicular disease (neoplasia, trauma, torsion)
  • Scrotal neoplasia, trauma, abscess
  • Scrotal urethrostomy
30
Q

Define cryptorchidism

A

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

31
Q

When do testicles normally descend?

A

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

32
Q

What is the main feature of bilateral cryptorchidism

A

Patient is sterile

33
Q

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

A

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

34
Q

List the DDx for testicular swelling

A

Neoplasia
Scrotal hernia
Orchitis
Trauma
Torsion
Scrotal dermatitis

35
Q

Name the 3types of testicular neoplasia

A

Interstitial cell (Leydig) tumours
Sertoli cell tumours
Seminoma

36
Q

Abdominally retained testicless are predisposed to which tumour?

A

Sertoli cell tumour

37
Q

Describe the clinical signs of a Sertoli cell tumour

A

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

38
Q

What are the clinical signs of leydig cell tumours

A

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

39
Q

How can you investigate testicular tumours?

A
  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)
40
Q

How are testicular tumours treated?

A
  • 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
41
Q

Inability to protrude penis from prepuce is termed?

A

Phimosis

42
Q

How is phimosis treated?

A

Infectious – inflammatory disease
- Conservative management
- Antibiotic therapy if there is infection
- Urinary diversion via catheter
- Preputial lavage

Congenital
- Reconstructive surgery of preputial orifice

43
Q

Inability to retract penis into prepuce is termed?

A

Paraphimosis

44
Q

what are the causes of paraphimosis?

A

Mating
Trauma
Neoplasia
Preputial foreign body
Failure of preputial muscles

45
Q

How does paraphimosis present?

A

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

46
Q

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

A
  • 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)

Y4 SA - Urogenital (12 decks)

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