Prostatic and Vaginal Surgery

What is the only accessory sex gland in a dog?

Prostate

What does the prostate do?

Secrete alkaline seminal fluid that aids survival or spermatozoa within acidic female reproductive tract

Where is the prostate located?

Encircled around the proximal urethra caudal to the bladder

What does the size of the prostate depend on?

Age, breed, body weight

Maintenance of the normal prostate is driven by what?

Androgen

What happens to the prostate after castration?

Involution

Where is the prostate at birth?

Abdominal

Where is the prostate at 2 months?

Pelvic

Where is the prostate at puberty?

Partially abdominal

Where does the prostate move with age?

Cranially

What is the prostate bound by dorsally?

Rectum

Where is the prostate bound by laterally?

Levator ani muscles

What is the prostate bound by ventrally?

Pubic symphysis and abdominal wall

What is craniodrosal to the prostate?

Ductus deferens

Where is the blood supply to the prostate?

Dorsal

What supplies the prostate with blood?

Prostatic artery branching from internal pudendal

Prostatic and urethral vein joins the internal iliac vein

Where is the innervation of the prostate?

Dorsal

What provides sympathetic innervation to the prostate?

Hypogastric nerve

What provides parasympathetic innervation to the prostate?

Pelvic nerve

When does the prostate begin to enlarge in a dog?

35-45 weeks

When is the prostate the maximum sign in a dog?

2 years

What are clinical signs of problems with the prostate?

Tenesmus

Stranguria

Hematuria

Purulent penile discharge

Pyrexia

Caudal abdomen discomfort

What can you find on a physical exam of a prostate?

size, symmetry, position, mobility, consistency, pain

What does a normal prostate feel like?

Symmetrical, smooth, distinct dorsal median groove, not painful

What diagnostics should be done with prostatic problems?

CBC, serum biochem, urinalysis

Brucella canis titer

What diagnostic imaging should be used for the prostate?

RX, US, CT

How do you sample the prostate?

US guided FNA

Transurethral washing, ejaculate sampling

Biopsy

How do you expose the prostate surgically?

Caudal celiotomy from umbilicus to pubis

What surrounds the prostate?

Periprostatic or urethral fat

How should you remove periprostatic or urethral fat?

From its ventral surface

T/F urethral catheter should be placed when working on the prostate surgically?

True

Where should you place the stay suture when working on the prostate?

At the level of the bladder

What is the most common prostatic disorder in dogs?

Benign prostatic hyperplasia

What are the C/S of BPH (benign prostatic hyperplasia)?

Constipation, tenesmus, altered stool shape, dysuria

What can a BPH lead to the development of?

Perineal hernia

What are the 2 forms of BPH?

Glandular

Complex

Describe glandular BPH

As early as 2-3 years with uniform glandular enlargement

Describe complex BPH

>6 years characterized by the presence of cystic lesions admixed with areas of glandular hyperplasia

Describe a rectal exam of BPH

Symmetric, nonpainful prostatic enlargement that is soft and smooth with an intact median cleft

Describe a radiograph of BPH

Diffusely enlarged with the colon potentially displaced dorsally and bladder cranially

Describe an ultrasound of BPH

Diffuse symmetric prostatic involvement with multiple small cysts

You should treat asymptomatic animals with BPH?

False

How do you treat BPH?

Surgical castration is best

Chemical castration

Conservative treatment

When would you treat BPH with chemical castration?

If dog is not suitable for surgical intervention

When would you treat BPH with conservative treatment?

To keep breeding potential

What is deslorelin?

Drug for chemical castration

What patients usually get prostatitis?

Intact males from an ascending bacterial infection

What is a predisposing factor for prostatitis?

BPH

What are the C/S of prostatitis?

Caudal abdominal pain, tenesmus, stranguria, preputial discharge, pyrexia

Painful rectal exam

T/F prostatitis can spread to the testes?

True

How do you treat prostatitis?

Castration and antibiotics

What antibiotics are best for prostatitis?

Penetrate the prostatic-blood barrier like FQs, sulfas, phenicols

How long do you give antibiotics for prostatitis?

4-6 weeks

What are prostatic abscess a sequela to?

Chronic prostatitis or acute prostatitis with cystic hyperplasia

What are the C/S of prostatic abscess?

dysuria, tenesmus, purulent or hemorrhagic discharge, enlarged painful prostate that is asymmetrical

T/F abscessed prostates can be concurrently neoplasitc?

True

How can you treat prostatic abscesses?

Castration

Antibiotics for 6 weeks

US-guided percutaneous drainage

When can you use percutaneous drainage for a prostatic abscess?

Select cases with small abscess and dogs with mild to moderate C/SWhat

What is the risk of recurrence with percutaneous drainage to treat prostatic abscesses?

50%

When should you reassess the prostate after treating prostatitis?

1 month

What is a prostatic cyst?

Nonseptic, fluid filled cacity within or attached to the prostate

What are the 2 types of prostatic cysts?

Prostatic (parenchymal) cysts

Paraprostatic cysts

What is a Prostatic (parenchymal) cysts?

Occur within or have a physical communication with prostatic parenchyma can be associated with BPH

What is a paraprostatic cyst?

Adjacent and attached to the prostate but rarely communicates with the parenchyma

How do you treat a prostatic cyst?

Castration and omentalization

How do you treat a paraprostatic cyst?

Castration

Complete resection

Partial resection and omentalization

What do prostatic cysts sometime communicate with?

Urethra

What is the most common prostatic disease in neutered dogs?

Prostatic neoplasia

What are the tumor types int he prostate?

Adenocarcinoma, transitional cell carcinoma, undifferentiated carcinoma, squamous cell carcinoma, leiomyosarcoma, hemangiosarcoma

T/F prostatic carcinomas are locally invasive and metastasize early to regional lymph node, lung and bone

True

What do most prostatic tumors involve?

The trigone and have metastasized at the time of diagnosis

What are the C/S of prostatic neoplasia?

Dysuria, hematuria, tenesmus, urinary retention, orthopedic or neurologic symptoms possible

What is seen on a rectal exam of prostatic neoplasia?

Prostate is firm and irregular with enlarged lymph nodes

Why do you do a chest RX, abdominal RX, and abdominal US after diagnosing prostatic neoplasia?

Detect metastasis

How do you diagnose prostatic neoplasia?

US-guided FNA

What medications do you give patients with prostatic neoplasia?

Pain relief, stool softeners and antibiotics if needed

How do you treat prostatic neoplasia?

Total prostatectomy

Subtotal intracapsular prostatectomy

When do you use a total prostatectomy to treat prostatic neoplasia?

Dogs with early-stage disease due to risk of post-operative incontinence

What are some palliative treatments for prostatic neoplasia?

Subtotal intracapsualr prostatectomy, urinary catheter, cystostomy tube, urethral stent

What is a palliative treatment?

Treatment designed to improve quality of life

What is the blood supply of the vagina?

Vaginal artery branching from internal pudendal

What is the blood supply for the vulva?

External pudendal

What is the venous return from the vagina and vulva?

Vaginal vein into the internal iliac vein

What provide autonomic innervation to the vagina and vula?

Pelvic plexus

What provides sensory innervation to to the vagina and vulva?

Pudendal nerveWhat

What are the C/S of vaginal disease?

Vaginal discharge, alteration in urination behavior, excessive licking at the perivulvar region, and a visible mass protruding from the vulvar fissure

How can you examine the vagina?

rectal exam

Digital exam

When doing a digital exam of the vagina what do you need to do?

Use aseptic technique and perform it under sedation or anesthesia

What are some complementary exams when examine the vagina?

Cytology

Culture

Endoscopy

Diagnostic imaging

What is an anovulvar cleft?

Incomplete closure of the skin and mucosa between anus and dorsal commissure of the vulva

T/F most dogs are asymptomatic with anovulvar cleft?

True

What can an anovulvar cleft predispose the patient to?

Recurrent vaginitis or ascending UTI secondary to fecal contamination

What is a rectovaginal fistula?

Connection between rectum and vagina

What are rectovaginal fistula associated with?

Atresia ani

How do you diganos rectovaginal fistula?

Detection of feces passing into the vagina and vestibule

Contrast radiography

How can you surgically fix a rectovaginal fistula?

Resection of the fistula through a midline perineal approach and closing the vagina and rectal defects

What are some complications of fixing a rectovaginal fistula?

Fecal incontinence, stricture, dehiscence

What is a recessed vulva?

Excess skin folds around vulva

What do recessed vulva cause?

Perivulvar dermatitis and recurrent UTI

What should be treated before surgery w/ recessed vulva?

Skin fold pyoderma