Surgical diseases of the male reproductive system Flashcards
1
Q
What are diseases of the prostate gland?
A
- Benign prostatic hyperplasia (BPH)
- Prostatitis +/- abscessation
- Intraprostatic
- Paraprostatic cysts
- Neoplasia
2
Q
What are possible CS of prostatic disease?
A
- General
-Anorexia, lethargy, weight loss +/- pyrexia, Defaecatory
-Tenesmus, constipation
-Flattened, ribbon-like faeces
-Constipation - Urinary
-Dysuria
-Haematuria
-Urethral discharge
-Urine retention - Orthopaedic
-Pelvic limb stiffness, straddling gait
3
Q
How would you investigate prostate disease?
A
- Clinical examination =
-Rectal palpation
-Abdominal palpation - Urinalysis and urine bacteriology
- Imaging
-Radiography: plain and contrast / retrograde urethrography
-Abdominal ultrasound (prostate, bladder, sublumbar lymph nodes, remainder of abdomen)
-CT of pelvis, abdomen (+ thorax) - Sampling of prostate gland
-Prostatic wash: fluid for cytology + bacteriology
-FNA (ideally under ultrasound guidance)
-Biopsy: catheter suction, Trucut (only under ultrasound guidance), surgical: last option - Sampling of abnormal sublumbar lymph nodes
-FNA under ultrasound guidance
4
Q
What animals is benign prostatic hyperplasia seen in?
CS? Dx? Tx?
A
- Middle-aged, older entire male dogs
- CS = dyschezia, flattened faeces, dysuria, haemorrhagic discharge from peins
- Dx = rectal palp, US
- Tx = castration / antiandrogens
5
Q
What animals get prostatitis? CS? Dx?
A
- Middle-aged to older dogs, dogs w BPH
-E.coli common - can form abscess + rupture = septic peritonitis - CS = dyschezia, dysuria, hindlimb stiffness +/- oedema, anorexia, lethargy, septic peritonitis (if rupture)
- Dx = CS, US + lab findings / cytology
6
Q
What is seen on lab findings with prostatitis?
A
- Haematology = leukocytosis or leukopenia
- Urinalysis = increased WBCs, RBCs, protein, microorganisms
7
Q
How would you treat prostatitis / abscessation?
A
- Antibiotics for 4-6weeks based on culture + sensitivity of urine, prostatic aspirates or washes
- Surgical castration
- If abscess = US-guided drainage (every 3-5d)
or - Surgical = caudal coeliotomy, prostate drainage / partial prostatectomy, omentalisation
8
Q
What are prostatic cysts?
How are they treated?
A
- Fluid filled areas within prostatic parenchyma
- Usually a consequence of BPH
- Asymptomatic if small
- Clinical signs as for BPH
- If become infected then cysts become abscesses
- Tx = castration - if abscess = US-guided drainage
9
Q
What are paraprostatic cysts?
Tx?
A
- Unknown origin, fluid filled cysts that occur in region of prostate
- Vary in size (millilitres to litres), can cause defaecatory +/or urinary signs, and/ or abdominal distension / mass
- Tx = excision of (most of) cyst, leaving remnant near prostate / neck of bladder, with omentalisation + castration
10
Q
What animals get prostatic neoplasia? CS? Dx?
A
- Male entire + NEUTERED middle aged / older dogs
- Malignant + locally invasive w high metastatic potential (usually advanced by time of Dx)
- CS = urinary +/or defaecatory +/or orthopaedic
- Dx = Imaging, cytology/histopath (US-guided)
11
Q
What is treatment of prostatic neoplasia?
A
- Palliative
- Analgesia, faecal softeners
- Can refer to oncologist = urethral stenting / chemo / radiotherapy
- Poor prognosis
12
Q
What is Phimosis? What can it cause? What causes it? CS? Tx?
A
- Inability to protrude penis from prepuce - urine pooling in prepuce can lead to inflammation, irritation + infection
- Causes = congenital, 2ary to trauma, neoplasia, infection
- CS = licking prepuce, preputial discharge, inability to protrude penis
- Tx = surgical enlargement of preputial orifice
13
Q
What is paraphimosis? What are causes? CS? Tx?
A
- Inability to retract penis into prepuce
- Causes = congenital = weak preputial muscles, excessively large preputial orifice
-acquired = 2ary to trauma, FB, neoplasia, following mating - CS = protrusion of penis, may become congested + discoloured
-rarely will progress to penile necrosis +/or urethral obstruction - Tx =
-conservative = lubricants, hyperosmolar solutions, cold packs
-Surgical = Narrowing of preputial orifice, phalloplexy, partial / complete penile amputation, +/- castration
14
Q
What is priapism? Tx?
A
- Persistent erection
- Tx = penile amputation, scrotal urethrostomy
15
Q
What ae congenital urethral + penile abnormalities?
CS? Dx? Tx?
A
- Epispadias = urethra doesn’t develop into full tube + urine exits body from abnormal location
- Hypospadias = opening of urethra is not located at tip of penis
- CS = obvious abnormal anatomy, urination from ‘hole’ proximal to penis, excessive licking, recurrent UTIs
- Dx = obvious on clinical exam
- Tx = lubrication of penis, treat UTI / inflammation
-surgery
