Surgical Conditions of the Male Repro Tract Flashcards
Define…
1. Anechoic.
2. Balanoposthitis.
3. BPH.
4. Cryptorchid.
5. Dysuria.
6. Echogenicity.
7. Epididymitis.
8. Feminising syndrome.
- Absence of the echo waves / black on ultrasound.
- Inflammation/infection of both glans penis and prepuce.
- Benign prostatic hyperplasia.
- Undescended testicle(s).
- Difficulties urinating.
- How much ultrasound echoes are produced by an organ/tissue.
- Inflammation/infection of the epididymis.
- Associated w/ oestrogen secretion from Sertoli cell tumours of testicles.
Define…
1. Galactorrhoea.
2. Gynaecomastia.
3. Haematuria.
4. Hyperplasia.
5. Hyperechoic.
6. Hypoechoic.
7. Hypospadia.
8. Iatrogenic.
- Inappropriate milk production.
- Mammary gland development in the male.
- Blood in urine.
- Increased number of cells in organ/tissue.
- Higher number of echo waves / light grey on ultrasound.
- Lower number of echo waves / dark grey on ultrasound.
- Congenital failure of urethral closure.
- Caused by a vet.
Define…
1. Idiopathic.
2. Loculations.
3. Omentalisation.
4. Omental release.
5. Orchitis.
6. Paraphimosis.
7. Paraprostatic.
8. Parenchyma.
- Unknown cause.
- Compartmentalisation of a fluid-filled cavity into smaller spaces.
- Filling a cavity w/ omentum.
- Surgical procedure that allows omentum to be placed in more distant places.
- Inflammation/infection of the testicle(s).
- Inability to retract penis into prepuce.
- Next to the prostate.
- The functional tissue of an organ.
Define…
1. Phimosis.
2. Pre-scrotal incision.
3. Priapism.
4. Prostate.
5. Prostatectomy.
6. Prostatic marsupialisation.
7. Prostatomegaly.
8. Prostrate.
- Inability to extrude penis from prepuce.
- Incision cranial to scrotum.
- Persistent erection of the penis.
- Sex gland.
- Removal of prostate.
- Creation of a stoma between prostate and external body wall.
- Enlargement of prostate.
- Lying flat on the ground.
Define…
1. Retention cysts.
2. Scrotal ablation.
3. Scrotal flap.
4. Stranguria.
5. Torsion.
6. Transmissible Venereal Tumour.
- Acquired cyst due to obstruction of gland ductules.
- Removing scrotal skin surgically.
- Using scrotal skin as an axial pattern flap (w/ castration).
- Painful, frequent urination.
- Twisting of testicle around its blood supply.
- Sexually transmitted disease, not in UK.
DAMNIT-V
D = Degenerative / developmental.
A = Auto-immune / anatomical / anomalous.
M = Metabolic.
N = Nutritional / neoplastic.
I = Infectious / inflammatory / idiopathic / immune-mediated / iatrogenic.
T = Toxic / traumatic.
V = Vascular.
Clinical signs of prostatic disease.
- Dysuria / stranguria.
- Urinary incontinence.
- Haematuria.
- Straining to pass faeces.
- Abnormally shaped faeces.
- Abdominal pain.
- Pyrexia.
Prostatic investigation.
CE.
- Rectal exam.
- Size, shape, symmetry and pain.
- Enlargement not always symmetrical.
- Dorsal enlargement may cause rectal compression which will change shape of faeces.
- Very large prostates can weigh down into the abdomen and take the bladder with them.
- Abdominal palpation.
Imaging.
- Radiography (Prostate should not be >1/2 width of pelvic inlet).
- Ultrasound (typically homogenous parenchyma, no pockets of fluid / difference in echogenicity).
Sampling.
- Prostatic wash – catheter tip in location of gland and simultaneous massage of gland.
- FNA under ultrasound guidance.
- Tru-cut biopsy under ultrasound guidance.
Surgical conditions of the prostate.
Benign prostatic hyperplasia.
Prostatitis and prostatic abscesses.
Prostatic neoplasia.
Prostatic and para-prostatic cysts.
Prostatic trauma.
Benign prostatic hyperplasia.
- Hormonally driven by testosterone or by testicular oestrogen.
- Symmetrical prostatomegaly.
- Investigate w/ imaging – plain radiographs or ultrasonography.
– Could consider sampling if anything sinister.
– Some have cystic appearance.
BPH treatment.
Medical
- Delmadinone acetate injection = anti-androgen (“Tardak”).
- Deslorelin implant = GnRH super agonist (“Suprelorin”).
- Osaterone acetate tablets = androgen receptor antagonist (“Ypozane”).
Surgical castration - permanent and curative.
- Prostatitis cause.
- Prostatitis diagnosis.
- Prostatitis treatment.
- How is prostatitis distinguished from BPH?
- Ascending bacterial infection.
- Hx/CE.
Prostatomegaly.
Ultrasound.
Cytology and culture - FNA/prostatic wash. - Treat underlying BPH
ABX. - Pain.
- Prostatic abscess cause.
- Prostatic abscess diagnosis.
- Prostatic abscess treatment.
- Danger of prostatic abscess.
- Progression of prostatitis - untreated more likely than unresolved.
- Unwell, pain.
Doughy feel on palpation.
Loculations w/in parenchyma and hyperechoic / echo-dense fluid. - Surgical drainage.
- Marsupialisation.
- Indwelling surgical drain – high rate of complications.
- Omentalisation. - Can rupture and cause a peritonitis.
Prostatic omentalisation method.
- Dorsal recumbency.
- Urethral catheter.
- Caudal laparotomy.
- Omental release.
- Expose prostate and isolate w/ swabs.
- Stab incision into lateral aspect of prostate.
- Digit exploration of cavities and flush.
- Forceps draw omentum into ventral prostate.
- Wrap omentum around urethra.
- Secure w/ absorbable monofilament sutures.
- Cause of prostatic cysts.
- Diagnosis of prostatic cysts.
- Retention cysts.
Para-prostatic cysts.
Associated w/ BPH / prostatitis / neoplasia. - Hx / CE.
Ultrasound.
Biopsy – rule out neoplasia.
Non-painful, more chronic.
Cysts may contain urine.
Prostatic cyst treatment.
Medical
- Ultrasound-guided drainage – typically refill.
Surgical
- Castration – if parenchymal and small.
- +/- partial or complete resection of cyst.
- Omentalisation for incomplete resection.
How can a para-prostatic cyst be differentiated from the urinary bladder?
Contrast study.
Prostatic cyst resection and omentalisation.
- Dorsal recumbency.
- Urethral catheter.
- Caudal laparotomy.
- Omental release.
- Expose prostatic cyst.
- Isolate w/ moistened lap swabs.
- Resect as much of the cyst and capsule as possible.
- Secure omentum to remaining capsule.
*take samples for culture, cytology and histopathology.
Diagnosis of prostatic neoplasia.
- Hx / CE.
– Uncommon dogs / rare in cats.
– More common in castrated dogs.
– Prostatic signs and cancer signs.
– Asymmetrical prostatomegaly. - Ultrasound.
- Radiographs.
– 70-80% metastatic.
– Sometimes to bone of pelvis / lumbar spine. - Suction biopsy not FNA.
- Almost always adenocarcinoma, sometimes transitional cell carcinoma spread from urethra.
Prostatic neoplasia clinical signs.
- Straining to pass faeces.
- Abnormally shaped faeces.
- Abdominal pain.
- Pyrexia.
- Caudal abdominal mass.
- Weight loss.
Prostatic neoplasia.
Medical.
- NSAIDs via COX-2 inhibition – meloxicam.
Surgical.
- Palliative relief of urethral obstruction.
– Cystostomy tube or urethral stenting increases median survival to 6.9 months.
- Prostatectomy – increases median survival to 9 months.
*both can result in urinary incontinence.
* Prognosis guarded, most euthanised w/in a few months.
- Cause of prostatic trauma.
- Cryptorchidectomy.
Conditions of the scrotum and testicles.
- Anorchism / monorchism.
- Testicular hypoplasia.
- Cryptorchidism.
- Clinical exam of scrotal and testicular neoplasia.
- Staging of scrotal and testicular cancer.
- Treatment of scrotal and testicular cancer.
- Asymmetrical enlargement / difference in architecture or texture.
+/- male feminising syndrome.
Cryptorchid - ~10X risk for neoplasia. - Abdominal imaging.
Met check = metastasise late. - Closed castration aiming for good margin of healthy cord +/- scrotal ablation.
Chemotherapy for the few cases w/ metastasis.
Sertoli cell tumours.
- Arise from Sertoli cells in seminiferous tubules.
- Typically slow growing, non-invasive.
– ~10% metastasis. - 16-39% feminising syndrome due to oestrogen secretion (Alopecia, gynaecomastia, galactorrhoea, pendulous prepuce, attractive to males).
- Bone marrow hypoplasia and pancytopenia can occur –> bad.
Interstitial cell tumours.
- Derived from Leydig cells.
- Small and non-palpable – 43% bilateral.
- Incidental finding, always benign.
Seminomas
- Arise from spermatogenic cells of seminiferous tubules.
- Although normally benign, can metastasise.
- Androgen secretion more common.
- Infectious / inflammatory conditions of the scrotum and testicles.
- Traumatic conditions of the scrotum and testicles.
- Vascular condition of the scrotum and testicles.
- Orchitis / epididymitis.
- Fighting rabbits.
- Jumping dogs.
- Fighting rabbits.
- Torsion.
Orchitis / epididymitis.
- Usually ascending infection (prostatitis, UTI), but can also be secondary to bites and/or via haematogenous spread.
- Bacterial – E. coli, staphylococcus, streptococcus, mycoplasma, brucella canis.
- Also possible but v rare = Distemper, Ehrlichiosis.
- Acute pain and swelling.
- Can result in abscess (testes/scrotum).
- Medical stabilisation and castration for treatment.
Treatment of trauma to testicles and/or scrotum.
- Typically debride to remove damaged / necrotic tissue.
- Castration if testicle exposed.
- Convert a ‘messy’ wound to a surgical wound for closure.
Torsion.
- Associated w/ enlarged, neoplastic, abdominal testicles.
- Can also be scrotal.
- Wound classification for scrotal surgical wound.
- Surgical options for the scrotum.
- Clean / contaminated.
- Pre-scrotal incision for castration.
- Scrotal incision for castration.
- Scrotal ablation.
- Scrotal flap – for reconstruction of inguinal/perineal skin defects in uncastrated dog (when combined w/ castration!)
- Pre-scrotal incision for castration.
Congenital abnormalities of the penis and prepuce.
- Intersex – anatomical elements of both genders (Yorkies and cockers).
- Hypospadia.
- Persistent penile frenulum.
- Congenital phimosis.
- Congenital paraphimosis.
- Preputial agenesis.
- Neoplasia of the prepuce and penis.
- Infection / inflammation of the prepuce and penis.
- Trauma of the penis and prepuce.
- Ischaemic necrosis of the penis and prepuce.
- Skin.
- Mucosa.
- Os penis.
- Skin.
- Balanoposthitis.
- Acquired phimosis.
- Acquired paraphimosis.
- Balanoposthitis.
- Self-inflicted or non self-inflicted.
- RTA, bites, malicious behaviour, hypersexuality.
- Gives rise to secondary issues:
– vascular compromise of the penis itself.
– urethral prolapse.
– phimosis.
– paraphimosis. - Drug-related thrombosis.
Hypospadia.
- congenital.
- failure of the urogenital folds to fuse and incomplete formation of penile urethra.
- abnormal termination of urethra.
- UTI, urine scalding, incontinence.
- Treatment only if clinical.
- Malignant penile and preputial neoplasia.
- Benign penile and preputial neoplasia.
- Haemangiosarcoma.
MCT.
Osteosarcoma of the os penis.
Chondrosarcoma of the os penis.
Squamous cell carcinoma.
Transitional cell carcinoma (urethral).
Transmissible venereal tumours. - Fibroma.
Lymphoma.
Osteoma of the os penis.
Papilloma.
- Clinical signs of penile neoplasia.
- Staging of penile neoplasia.
- Treatment of penile neoplasia.
- Swelling / mass.
- Discharge.
- Prolapse.
- Haematuria / dysuria.
- Swelling / mass.
- Biopsy
LN check
Distant met check. - Amputation (partial/complete).
- Adjunctive therapies.
- Amputation (partial/complete).
- Most common form of preputial neoplasia.
- Why is surgical treatment of preputial neoplasia so difficult?
- MCT.
- Need to be able to reconstruct the skin and preputial mucosa.
- Clinical signs of penile laceration.
- Treatment of penile laceration.
- Haemorrhage.
May have dysuria. - Minor lacerations heal by second intention.
Minor wounds in penile urethra managed w/ catheter (7-10 days) while heals.
More major trauma requires:
- primary reconstruction.
- partial or total penile amputation.
- Signalment for urethral prolapse.
- Aetiology of urethral prolapse.
- Clinical signs of urethral prolapse.
- Treatment of urethral prolapse.
- Brachycephalic.
- Sexual excitement.
- UTI.
- Sexual excitement.
- Can be intermittent or permanent.
- Urethral mucosa protrudes from tip of penis.
- Haemorrhage.
- May have dysuria.
- Can be intermittent or permanent.
- Treat underlying cause and perform urethropexy.
- What is phimosis.
- Aetiology of phimosis.
- Clinical signs of phimosis.
- Treatment of phimosis.
- Inability to extrude penis from prepuce.
- Preputial orifice too small.
- Congenital or
- acquired (secondary to inflammation, infection, trauma, scarring. - Inability to urinate normally.
Impedes mating. - Surgical correction to enlarge orifice (fairly simple).
- What is paraphimosis?
- Aetiology of paraphimosis.
- Inability to retract the penis into the prepuce.
- Congenital – narrowed preputial orifice and an abnormally short prepuce.
- Acquired – Trauma, balanoposthitis (inflammation of glans penis and prepuce), neoplasia, often following sexual activity, can be caused by hair entrapment post penile extrusion.
- Congenital – narrowed preputial orifice and an abnormally short prepuce.
- Clinical signs of paraphimosis.
- Treatment of paraphimosis.
- Pain.
- Avoid and/or treat urethral obstruction / ischaemic necrosis.
Paraphimosis medical management.
Reduce size of penis and protect from trauma.
- Sedatives.
- Flush penis – sugar, mannitol, cold saline.
- Lubricate – KY.
Replace penis.
- Remove any foreign bodies.
- Draw prepuce forward.
Prevent recurrence w/ temporary purse string while swelling resolves.
Surgical management of paraphimosis.
Narrowing of preputial orifice (temp. or permanent).
Enlargement of preputial orifice.
Preputial lengthening (preputioplasty).
Phallopexy.
Penile amputation.
- What is priapism?
- Aetiology of priapism.
- Treatment of priapism.
- Persistent erection of the penis (not associated w/ sexual excitement).
- Parasympathetic stimulation via pelvic nerve.
Typically secondary to spinal cord injury / thromboembolic occlusion / mass lesion. - Treat underlying cause.
Not surgery unless become necrotic, in which case - amputate.
Penile surgical options.
Urethropexy - for prolapsed urethra, stitch urethra back into penis.
Phallopexy - for paraphimosis, permanently sutures penis to prepuce.
Penile amputation - partial or complete.
Vasectomy (ferrets!)
Preputial surgery options.
Preputial neoplasia excision and reconstruction.
Preputial orifice:
- narrowing – for paraphimosis (purse string or skin reconstruction).
- widening – for phimosis.
Preputioplasty (lengthening for paraphimosis).
