Ch314 - Prostatic diseases Flashcards
(37 cards)
What percentage of prostatic diseases are subclinical?
75% of prostate diseases are subclinical.
Which breeds are predisposed to BPH?
Large breed dogs, including:
- Doberman Pinscher
- German Shepherd Dog
- Rhodesian Ridgeback
- Labrador Retriever
What is the frequency (in order of most common to least common) of prostatic disorders in dogs?
- BPH: 45%
- Acute or chronic prostatitis: 38.6%
- Abscesses: 7.7%
- Cysts: 5%
- Neoplasia: 2.6%
- Squamous metaplasia: 0.2%
How common is prostatic disease in cats?
Prostatic diseases are exceedingly rare in intact or neutered cats
What are the three main factors that contribute to BPH development?
- Older age
- Functioning testes
- Dihydrotestosterone (DHT) that concentrates in hyperplastic prostatic tissue
hat are the common clinical signs of BPH?
- Blood dripping from prepuce
- Hematospermia (1st and 3rd fraction of semen)
- Hematuria
- Tenesmus with thin tape-shaped feces
- Constipation
- Dyschezia
- Less commonly: dysuria or urinary incontinence
- Subfertility
How quickly does the prostate decrease in volume after castration for BPH?
The prostatic volume begins decreasing within 7-14 days after castration.
What are the two types of BPH and their characteristics?
- Glandular BPH:
* characterized by thickened epithelium with developed “alveoli” especially in the periurethral area. - Complex BPH:
* characteristics of the glandular form plus areas of atrophic epithelium and, eventually, cyst formation
What are the medical treatment options for BPH in breeding dogs and what are their actions?
- Finasteride (5-alpha-reductase inhibitor):
* 1. Prevents conversion of testosterone to DHT
* 1. Doesn’t reduce libido or sperm production - Osaterone acetate (progestogen/antiandrogen)
* Reduces prostate volume
* Minimal effect on fertility - Deslorelin acetate (GnRH analog):
* Subcutaneous implant
* Reduces prostate volume >50% after ~6 weeks
Deslorelin acetate (GnRH analog) reduces prostatic volume by how much and for how long?
Reduces prostate volume >50% after ~6 weeks
Effect lasts up to 48 weeks with 4.7 mg implants
What are the most common bacterial organisms found in septic prostatitis?
Aerobic organisms are most common, including:
* Escherichia coli
* Staphylococcus sp.
* Streptococcus sp.
* Proteus sp.
* Pseudomonas spp.
* Brucella canis
* Klebsiella sp.
What are the characteristics of antibiotics that best penetrate the prostate?
- High lipid solubility
- Low protein binding
- High pKa (like trimethoprim, clindamycin, chloramphenicol)
- Zwitterion characteristics (fluoroquinolones)
How long should antibiotics be given for prostatitis?
Acute prostatitis: 4-6 weeks
Chronic prostatitis or prostatic abscess: 6-8 weeks
What are the key differences between acute and chronic prostatitis symptoms?
Acute Prostatitis:
* Fever, anorexia, lethargy
* Vomiting, caudal abdominal pain
* Difficulty rising, painful stiff gait
* Low sperm quality
* Hematospermia, pyospermia
* Possible peritonitis/septic shock
Chronic Prostatitis:
* Often subclinical
* Recurrent urinary tract infections
* Low sperm quality
* Mild lethargy
* Urethral discharge
* Hypo/infertility
When should prostatic cultures be repeated during antibiotic treatment for prostatitis?
- 7-10 days after starting antibiotics
- 30 days after antibiotics are discontinued
What are the two main types of prostatic cysts?
- Retention cysts
- Paraprostatic cysts (PPCs)
How are retention cysts classified by size?
- Large: ≥3 cm in greatest diameter
- Medium: >1 to <3 cm
- Small: ≤1 cm
- Micro: ≤1 mm
What are the key characteristics of paraprostatic cysts?
- Usually associated with remnants of uterus masculinus
- Typically single structures around the prostate
- Attached to prostate capsule
- Large cysts can invade abdominal or pelvic cavity
- May be asymptomatic or show signs similar to BPH
What are the treatment options for prostatic cysts?
Surgical options:
* Surgical excision or debridement
* Omentalization
* Marsupialization
* Penrose drain positioning
Medical options:
* Castration (alone for small cysts)
* Medical treatment to reduce prostatic size
* Combination therapy recommended for large cysts
What constitutes a definitive diagnosis of prostatic infection based on culture?
Growth of >10,000 bacteria/mL
A 2-log difference between prostatic and urine colony-forming unit counts suggests bacterial prostatitis
What are the typical ultrasound findings in prostatic neoplasia?
- Focal to diffuse hyperechoic areas
- Areas of hemorrhage or necrosis
- Mineralization
- Asymmetry
- Irregular capsule outline
- Loss of normal contour
- May show sublumbar lymphadenopathy and visceral metastases
What are the typical examination findings in BPH on digital rectal examination?
- Large prostate
- Symmetrical
- Mobile
- Normally firm
- Not painful
- May have asymmetrical/irregular surface with soft “fluctuant” areas if cysts present
What are the typical laboratory findings in acute prostatitis?
- Neutrophilic leukocytosis with left shift
- Increased alkaline phosphatase activity
- Hematuria
- Bacteriuria
What are the ultrasound characteristics of BPH?
- Prostatomegaly
- Uniformly echogenic parenchyma
- May have nodular areas (usually isoechoic or slightly different from surrounding parenchyma)
- May show increased prostatic perfusion
- May have cysts with well-defined margins
