Surgical diseases of the male reproductive system

Question 1

What are diseases of the prostate gland?

Answer 1

• Benign prostatic hyperplasia (BPH)
• Prostatitis +/- abscessation
• Intraprostatic
• Paraprostatic cysts
• Neoplasia

Question 2

What are possible CS of prostatic disease?

Answer 2

• 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

Question 3

How would you investigate prostate disease?

Answer 3

• 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

Question 4

What animals is benign prostatic hyperplasia seen in?
CS? Dx? Tx?

Answer 4

• Middle-aged, older entire male dogs
• CS = dyschezia, flattened faeces, dysuria, haemorrhagic discharge from peins
• Dx = rectal palp, US
• Tx = castration / antiandrogens

Question 5

What animals get prostatitis? CS? Dx?

Answer 5

• 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

Question 6

What is seen on lab findings with prostatitis?

Answer 6

• Haematology = leukocytosis or leukopenia
• Urinalysis = increased WBCs, RBCs, protein, microorganisms

Question 7

How would you treat prostatitis / abscessation?

Answer 7

• 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

Question 8

What are prostatic cysts?
How are they treated?

Answer 8

• 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

Question 9

What are paraprostatic cysts?
Tx?

Answer 9

• 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

Question 10

What animals get prostatic neoplasia? CS? Dx?

Answer 10

• 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)

Question 11

What is treatment of prostatic neoplasia?

Answer 11

• Palliative
• Analgesia, faecal softeners
• Can refer to oncologist = urethral stenting / chemo / radiotherapy
• Poor prognosis

Question 12

What is Phimosis? What can it cause? What causes it? CS? Tx?

Answer 12

• 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

Question 13

What is paraphimosis? What are causes? CS? Tx?

Answer 13

• 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

Question 14

What is priapism? Tx?

Answer 14

• Persistent erection
• Tx = penile amputation, scrotal urethrostomy

Question 15

What ae congenital urethral + penile abnormalities?
CS? Dx? Tx?

Answer 15

• 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

Question 16

What are penile injuries? Dx? Tx?

Answer 16

• Penile laceration = profuse haemorrhage
  -Dx = protrude penis + examine carefully
  -Tx = minimally debride + suture laceration (monofilament absorbable)
• Fractures of os penis +/- urethral tear/transection
  -CS = dysuria, haematuria
  -Dx = imaging - plain lateral / positive contrast retrograde urethrogram
  -Tx = if os penis fracture in isolation = analgesia
  -If concurrent penile urethral tear/laceration = place urethral foley catheter to bladder and leave indwelling for 5-7 days
  -Or perform partial penile amputation, or complete penile amputation and scrotal urethrostomy as salvage

Question 17

What can be done to penile / preputial neoplasias?

Answer 17

• Often amendable to surgical treatment
  -partial penile amputation with/out preputial shortening
  -complete penile amputation, preputial resection + scrotal urethrostomy ( requires castration in entire dogs)

Question 18

What are surgical conditions of the testes? Tx?

Answer 18

• Neoplasia
• Orchitis
• Trauma
• Scrotal hernia
• Torsion
• Tx = castration +/- scrotal ablation

Question 19

What should be done with cryptorchidism?

Answer 19

• Castrate = high risk of neoplasia + hereditary

Question 20

What animals get testicular neoplasia? What are the 3 types?

Answer 20

• Middle aged / older entire dogs (cryptorchids+++)
• Interstitial Cell (Leydig) tumours =
  -benign, increased testosterone production = perianal adenomas, perianal gland adenocarcinomas, perineal hernias
• Seminoma = benign (5-10% metastasise)
• Sertoli cell tumour = (5-15% metastasise)
  -can produce oestrogen = feminisation + bone marrow toxicity

Question 21

What is prognosis of testicular tumours?

Answer 21

• Excellent = interstitial cell tumours + seminomas
• Excellent for sertoli cell tumours except for in some cases w metastases or oestrogen associated myelotoxicity