Anatomy Surgery of the Prostate Gland Dr. T. Németh, DVM, PhD, CertSACS Anatomy Surgical diseases of the prostate gland Benign prostate-hyperplasia Prostatic/paraprostatic cyst Prostatic abscessation Prostatic neoplasia Surgical diseases of the prostate gland Benign prostate-hyperplasia Prostatic/paraprostatic cyst Prostatic abscessation Prostatic neoplasia Benign prostate-hyperplasia Incidence, aetiology in middle aged or older male dogs androgen-estrogen estrogen imbalance dihydrotestosterone (DHT) sensitivity of the prostate gland
Benign prostate-hyperplasia Benign prostate-hyperplasia Diagnostics tenesmus (defecation and/or urination) blood dripping after/during urination (antibiotic irresponsiveness) RDP Cytology US (Plain X-ray) Benign prostate-hyperplasia Benignus prostata-hyperplasia Benign prostate-hyperplasia Therapy medical exogen estrogens (neg neg. feed back) 5-alpha alpha-reduktase inhibitors (inhibit testosteron-dht transformation: finasteride) DHT receptor blockers (ozateron acetate) surgical: castration!!! Surgical diseases of the prostate gland Benign prostate-hyperplasia Prostatic/paraprostatic cyst Prostatic abscessation Prostatic neoplasia
Prostata-cysta Retention (prostatic) cyst associated with prostate-hyperplasia or tumour within the prostatic tissue mono- or polycystic form Paraprostatic cyst originated from Mullerian duct and/or uterus masculinus outside the prostatic tissue usually with normal prostatic size and tissue Prostatic /paraprostatic cyst Diagnostics can be asymptomatic usually signs of prostate-hyperplasia US X-ray Prostatic cyst Ultrasonography - partitioned cyst Prostatic/paraprostatic cyst Therapy castration!!! evacuation of the cyst (retention cyst > 2 cm) transabdominal drainage marsupialisation omentalisation cyst-removal (paraprostatic cyst) Prostatic cyst Omentalisation Prostatic cyst Omentalisation
Prostatic cyst Omentalisation Prostatic cyst Omentalisation Prostatic cyst Omentalisation Prostatic cyst Omentalisation Prostatic cyst Omentalisation - postop. US Paraprostatic cyst Plain radiography
Paraprostatic cyst Positive contrast cystography Paraprostatic cyst Ultrasonography - single cyst Prostatic/paraprostatic cyst Paraprostatic cyst Removal Therapy castration!!! evacuation of the cyst (retention cyst > 2 cm) transabdominal drainage marsupialisation omentalisation cyst-removal (paraprostatic cyst) Paraprostatic cyst Removal Paraprostatic cyst Removal
Paraprostatic cyst Removal Paraprostatic cyst Removal Surgical diseases of the prostate gland Benign prostate-hyperplasia Prostatic cyst Prostatic abscessation Prostatic neoplasia Prostatic abscessation Incidence secondary to...: abscedation of prostatic cyst as a result of purulent prostatitis Prostatic abscessation Prostatic abscessation Ultrasound Diagnostics signs of the septic state signs of prostate-hyperplasia RDP US (puncture) (X ray)
Prostatic abscessation Ultrasound Prostatic abscessation Therapy castration evacuation and drainage Omentalisation antibiotics Prostatic abscessation Transabdominal drainage Prostatic abscessation Transabdominal drainage Surgical diseases of the prostate gland Benign prostate-hyperplasia Prostatic cyst Prostatic abscessation Prostatic neoplasia Prostatic neoplasia Incidence over 7 years of age (mostly in castrated males!) carcinoma, lymphosarcoma metastasis to sublumbar lymphonodes, lumbal vertebrae, pelvis, lungs neurologic / orthopedic signs!
Prostatic neoplasia Diagnostics signs of prostate-hyperplasia signs of metastatised organs (orthopedic, neurologic disorders) tumour-cells in urine sediment RDP Cytology US, biopsy X-ray Prostatic neoplasia Ultrasound Prostatic neoplasia Ultrasound Prostatic-neoplasia Therapy castration (-) IL-2 (cytokine) COX-2 inhibitor NSAIDs prostatectomy partial (cytoredukció) total (urinary incontinence!) Prostatic neoplasia Prostatic neoplasia L Eplattenier et al: Partial prostatectomy using Nd:YAG Laser for management of canine prostate carcinoma. Vet Surg (2006), 35, pp406-411 411 4 healthy beagles + 8 prostate carcinoma patients Partial prostatectomy (laser)+il-2+meloxicam Median survival: 103 days (5-239) No urinary incontinence!
Cryptorchidism in Small Animals Incomplete descent of one or both testis Incidence dog, cat unilateral or bilateral abdominal, inguinal (within the inguinal canal or subcutaneously) Pathogenesis hereditary condition in the postnatal 1-2 month the descent of testes ends Should be finally judged by 6th month neoplastic transformation is likely after 2-3 years of age Diagnostics history (if owner realises) inguinal palpation (US) (X-ray) Inguinal tumourous cryptorchidism (Sertoli) Inguinal tumourous cryptorchidism (Sertoli)
Inguinal tumourous cryptorchidism (Sertoli) Abdominal cryptorchidism in a cat VIDEO Therapy orchidectomy (no breeding!!!) start with inguinal exposure along the route of testicular descence! Inguinal tumourous cryptorchidism (Sertoli) Abdominal cryptorchidism in a cat
Abdominal cryptorchidism in a cat Torsion of the cryptorchid testis tumour Torsion of the cryptorchid testis tumour Castration in Small Animals Castration in Small Animals removal of testis and epididymis Indication I. - to the owner s request (decrease aggressivity) - neoplasia of the testis - injury of the testis - cryptorchidism II. - prostate-hyperplasia, cyst, abscess - perineal hernia - perianal / circumanal neoplasia Castration in Small Animals Surgical technique closed --- open with or without scrotectomy Dog closed castration with scrotectomy open castration without scrotectomy Cat open castration via transcrotal incision
Closed castration with scrotectomy in dog Closed castration with scrotectomy in dog Closed castration with scrotectomy in dog Closed castration with scrotectomy in dog Closed castration with scrotectomy in dog Closed castration with scrotectomy in dog
Closed castration with scrotectomy in dog Closed castration with scrotectomy in dog Closed castration with scrotectomy in dog VIDEO Castration in Small Animals Surgical technique closed --- open with or without scrotectomy Dog closed castration with scrotectomy open castration without scrotectomy Cat open castration via transcrotal incision Open castration without scrotectomy Open castration without scrotectomy
Open castration without scrotectomy Open castration without scrotectomy Open castration without scrotectomy Open castration without scrotectomy Open castration without scrotectomy Castration in Small Animals Surgical technique closed --- open with or without scrotectomy Dog closed castration with scrotectomy open castration without scrotectomy Cat open castration via transcrotal incision
Open castration in cats Open castration in cats Open castration in cats Open castration in cats Open castration in cats Open castration in cats
Open castration in cats Castration in Small Animals Complications bleeding scrotal hematoma, seroma, abscess scrotal dermatitis