Surgery of the male reproductive tract Flashcards
Name the only accessory sex gland of male dogs
Prostate gland
Describe the location of the prostate before puberty
Pelvis
Describe the location of the prostate during puberty
Partial abdominal position
Describe the location of the prostate after puberty
Hyperplastic enlargement (androgen-mediated) > abdominal
Prostatic disease is most commonly seen in which dogs
middle age – older entire male dogs
List the general clinical signs of prostatic disease
Anorexia, lethargy, weight loss, pyrexia
List the urinary specific clinical signs of prostatic disease
Dysuria
Haematuria
Urethral discharge
Urine retention - cysts and neoplasia
List the defecatory specific clinical signs of prostatic disease
Tenesmus - BPH, cysts, abscess, prostatitis
Ribbon-like faeces
Constipation
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)
List 5 diseases of the prostate
Benign prostatic hyperplasia (BPH)
Prostatitis
Abscessation
Cysts
Neoplasia
Benign prostatic hyperplasia is most common in which dogs?
Middle aged - old entire dogs
How does benign prostatic hyperplasia feel on rectal exam?
Symmetrically enlarged and pain-free prostate, homogeneous in consistency
What is aim of treating benign prostatic hyperplasia?
Permanent suppression of secretory activity and resolution of prostatomegaly
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)
Describe prostatitis - abscessation
Ascending infection via the urethra
Any age, more common middle-aged to older dogs
E. coli
Prostatitis can progress to abscess
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
Describe the urinalysis findings of prostatitis
Leukocytosis, RBCs, microorganisms
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
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?
- Haematology to assess oestrogen-related myelotoxicity, especially if:
- Tumour is large
- Abdominally retained testicle
- Signs of feminization - 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)
