Reproductive Tract Surgery: Prostate and Pyometra

sole accessory sex organ in dogs?

prostate

the prostate starts as a ? organ but migrates to the ? with enlargement

pelvic, caudal abdomen

3 multiple choice options

the urethra as well as the vascular and nerve supply is closer to the ? surface of the prostate

dorsal

inflammatory diseases of the prostate?

benign prostatic hyperplasia

intraparenhcymal prostatic cysts

paraprostatic cysts

prostatic calculi

infectious diseases of the prostate?

prostatic abscess

diffuse prostatitis

neoplastic diseases of the prostate?

prostatic carcinoma

urothelial carcinoma

signalment for inflammatory and infectious prostatic disease?

male intact

middle to older age

most common signalment for prostatic carcinoma?

male neutered

middle to older age

what neoplasia of the prostate is NOT androgen dependent?

prostatic carcinoma

1 multiple choice option

clinical signs of prostatic disease?

LUT signs (e.g. stranguria, dysuria, hematuria, pollakiuria, discharge, anuria)

Tenesmus

Gait abnormalities

Limb edema

Vague systemic signs

diagnostics for suspect prostatic disease?

rectal exam

CBC/chem/UA

Abdominal ultrasound

Abdominal radiographs

Cytologic/fluid analysis of cyst or abscess

CT

avoid prostatic FNA if there are concerns for

neoplasia

benign prostatic hyperplasia tx?

orchiectomy

characteristics of prostate on rectal exam with BPH?

non-painful

symmetrical

homogenous

how quickly will the prostate regress after surgery?

80% reduction in 12 weeks

important ddx for prostatitis?

brucella

prostatitis etiology?

BPH with ascending infection (e.g. e.coli, pseudomonas, proteus, staph, brucella)

characteristics of prostate on rectal exam with prostatitis?

painful

symmetrical

prostatitis tx?

Orchiectomy

Abx

often incidental/asymptomatic finding in the prostate characterized by intraparenchymal squamous metaplasia that predisposes to abscesses

prostatic cyst

prostatic cyst tx?

orchiectomy

surgical drainage (rare)

prostate condition characterized by dilated embryonic mullerian duct remnants outside the parenchyma resulting in a non-painful but assymetrical prostate

paraprostatic cyst

paraprostatic cyst tx?

orchiectomy

surgical drainage or excision

cytology/histo

prostatic abscesses can be secondary to

BPH and/or cyst

characteristics of prostate on rectal exam with prostatic abscess?

painful

asymmetrical

prostatic abscess tx?

orchiectomy

surgical drainage or excision

abx

what antibiotics can used for prostatic abscesses and prostatitis?

Fluoroquinolones

TMS

Macrolides

Chloramphenicol

how long should the course of antibiotics be for prostatic abscesses and prostatitis?

4-8 weeks

Because prostatitis and prostatic abscesses have very similar presentations, how can you tell them apart?

prostatitis is symmetrical on rectal exam and abscesses are asymmetrical

3 multiple choice options

what prostatic pathology can result in a septic abdomen?

prostatic abscesses

prostatic disease characterized by chronic lower urinary tract signs with tenesmus, pain with asymmetry on rectal exam, and often enlarged lymph nodes

prostatic neoplasia

how is prostatic neoplasia diagnosed?

thoracic radiographs

cystoscopy

CT

prostatic neoplasia tx?

prostatectomy

chemotherapy

RT

urethral stent

NSAIDs

very important drawback of prostatectomies in the treatment of prostatic neoplasia

urinary incontinence

how can you treat prostatic neoplasia palliatively?

urethral stent (may still become incontinent)

NSAIDs if not obstructive

if prostatic neoplasia is non-obstructive, you can palliatively treat with

NSAIDs

important post-operative monitoring for prostatic disease surgical tx?

normal urination

normal defectation

pain management

adequate antibiotic treatment

What part of the uterus/ovary is directly connected to the aorta?

ovarian arteries

?% of female intact dogs develop pyometra by 10 years of age

23-24%

What condition progresses/develops into pyometra?

cystic endometrial hyperplasia

what hormone drives cystic endometrial hyperplasia and pyometra?

progesterone

predominant bacteria with pyometra in most studies?

e. coli

clinical signs/PE findings with pyometra?

vague systemic signs

PU/PD

vaginal discharge

abdominal distention

possible signs of sepsis

pyos typically occur how long after the last heat cycle?

4-12 weeks

bloodwork findings seen with pyometra?

leukocytosis to neutropenia

anemia

azotemia

hypoproteinemia

evaluate for sepsis

abdominal radiograph findings associated with pyometra?

tubular soft tissue opacity structure in the ventral abdomen

AUS finding typical of pyometra?

hypoechogenic tubular structure between bladder and colon

pyo tx?

preoperative stabilization (e.g. fluid therapy, blood etc.)

antibiotics (based on antibiogram)

what antibiotics are used for pyometras?

fluoroquinolones +/- unasyn

what type of pyometra MUST be treated surgically?

closed

1 multiple choice option

if a pyometra is open or there are no signs of septicemia, surgical treatment is urgent or emergent

urgent

1 multiple choice option

if a pyometra is closed and/or there are signs of septicemia, surgical treatment is urgent or emergent?

emergent

1 multiple choice option

medical management for open pyometra?

prostaglandins

what is different with pyometra OVH compared to a normal OVH?

Friable tissue

Double ligate ovarian pedicles

Clamp after ligatures prior to removal to prevent abdominal spillage

Lavage uterine pedicle

Do not oversewn

post-operative considerations for pyometra OVH?

Monitor for AKI

Maybe post operative antibiotics (up for debate)

Histopathology if ovary/uterus looks grossly abnormal

Good prognosis

how do stump pyometras occur?

an ovarian remnant must be present

stump pyometra tx?

Debridement and drainage of the stump

Find and remove ovarian remnant