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Y4 SA - Reproduction > Penile, testicular & prostatic disease > Flashcards

Penile, testicular & prostatic disease Flashcards

(45 cards)

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1
Q

Mating problems

A

Poor libido
- frequently results from inexperience or poor breeding management
- no evidence that it is caused by low plasma testosterone
- don’t give androgens -> negative impact on semen quality

Mating difficult
- inexperienced stud dog
- psychological problems
- abnormal prepuce or penis
- (inexperienced bitch)
- (incorrect mating time)
- (abnormal vulva, vagina)
- (male-female size difference)

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2
Q

Common testicular/scrotal diseases

A

Common
1. testicular tumours
2. abnormal testicular descent
3. testicular degeneration
Less common
4. torsion of the spermatic cord
5. orchitis
6. inguinal hernia

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3
Q

Testicular tumours - 3 common types

A
  • leydig cell tumour
  • Sertoli cell tumour
  • seminoma
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4
Q

Testicular tumours - potential characteristics

A
  • may, or may not, be endocrinologically active
  • may, or may not, cause testicular enlargement
  • may, or may not, metastasise (but this is rare - inguinal LN, kidney, lung are common sites)
  • diagnosis by palpation & US
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5
Q

If a testicular tumour produces oestrogen what signs can be seen?

A
  • preputial swelling
  • male attractiveness
  • bilaterally symmetrical non-pruritic alopecia
  • non-neoplastic testicle atrophies
  • normal testicular tissue within abnormal testicle also atrophies
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6
Q

Testicular tumours - diagnosis

A
  • clinical information, including full CE, esp palpable LNs
  • palpation
  • scrotal US
  • remove and histopath then re-evaluate
  • cornification of preputial epithelial cells

Some recommend
- complete blood count
- blood biochem
- urinalysis
- thoracic and abdominal rads
- abdominal US
- FNA

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7
Q

Testicular tumours - tx

A
  • hemi-castration (just removes testes with tumour - breeding animal - check semen after)
  • castration
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8
Q

One or no testes in scrotum - causes & their diagnosis

A

Previously castrated
- previous hx
- diagnosis by lack of response to testosterone to IV injection of hCG

Anorchid
- absence of both testes - extremely rare
- most cases are bilateral cryptorchid
- diagnosis by lack of response to testosterone to IV injection of hCG

Monorchid
- a single testicle in the body - extremely rare
- most cases are unilateral cryptorchid
- diagnosis by lack of response to testosterone to IV injection of hCG

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9
Q

Cryptorchidism - what is it? cause?

A
  • hidden testicle - unilateral or bilateral
  • testes normally descend by 10d after birth
  • cryptorchidism is likely to be sex-limited autosomal recessive trait:
    – female and male parents are carriers, homozygous males will be cryptorchid
  • the retained abdominal testes is more likely to become neoplastic
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10
Q

Cryptorchidism - tx

A

Medical therapy is not ethical:
- tx is by removal of both testes to prevent neoplasia and breeding
- surgical approach is to look dorsal to bladder for vas deriders then follow these to the testis

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11
Q

Testicular degeneration - what is it? potential causes?

A

Testes develops normally and has normal function but following an ‘insult’, fibrosis and degeneration occur

This may take several months during which time semen quality deteriorates.

Often the insult was not recognised by O
- high temp / local inflammation
- vascular lesions
- drugs
- endogenous hormones (tumours)
- exogenous hormones
- toxins
- auto-immune dz

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12
Q

Penile/preputial diseases (in vague order relating to how common)

A
  1. preputial discharge
  2. lymphoid hyperplasia
  3. balanoposthitis
  4. posthitis
  5. phimosis
  6. paraphimosis
  7. priapism
  8. canine herpes virus infection
  9. penile trauma
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13
Q

Preputial discharge - aetiology/cause

A
  • muco-purulent preputial discharge is normal
  • many species of aerobic bacteria are isolated
  • these are usually normal commensals
  • remember it is possible that we will see more Brucella Canis cases
  • rarely there is a pre-disposing cause such as FB, preputial adhesion, penile abnormality, phimosis
  • careful inspection of the inner surface of the sheath and the penile skin is warranted
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14
Q

Preputial discharge - tx

A

May be normal (don’t call it ‘abnormal’ or use antibiotic unless you are sure it is not normal)

Removal of predisposing causes
- flushing with saline
- (or antimicrobial or weak antiseptic solutions)
- parenteral drug administration has little value

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15
Q

Lymphoid hyperplasia - CS, what to do?

A
  • found in a very large number of dogs
  • raised nodule-like lesions at the base of the penis, or preputial lining
  • normally pale in colour and firm (not vesicular)
  • may bleed when prepuce is retracted or semen collected or at normal mating
  • requires no tx
  • must be differentiated from canine herpes virus lesions which are normally vesicular and red in colour or may be ulcerated in the later stage
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16
Q

Balanoposthitis - what is it? tx

A
  • inflammation of the penis (balanitis) and preputial lining (posthitis)
  • usually associated with moist prepuce tip
  • overgrowth of commensal bacteria
  • commonly seen in dogs that frequently lick the prepuce (therefore common in dogs with a ‘normal’ prepuce discharge)
  • may require topical cleaning / local antiseptic / topical antibiotic creams / systemic antibiotics
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17
Q

Balanitis - what is it? CS?

A
  • inflammation of the penis
    – technically balanitis = inflammation of the glans penis
    – technically phallitis = inflammation of all the penis
    – but, in dogs we only really see balanitis
  • noted as haemorrhagic spots on the penile skin
  • may process to thickening penile skin
  • may be associated with masturbation
  • seen in some cases with phimosis and urine retention within prepuce
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18
Q

Phimosis - what is it? CS?

A
  • abnormally small preputial orifice
  • congenital or the result of trauma or inflammation

Signs
- narrowing stream of urine
- urine pooling within prepuce
- may cause balanoposthitis
- unable to copulate

Preputical wedge resection is normally curative

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19
Q

Paraphimosis - what is it? causes? tx?

Study These Flashcards
A

= failure of the glans penis to be retracted fully into the prepuce

Causes
- small preputial orifice
- inversion of the preputial skin/hair
- hair ring (tom cat)
- short prepuce

Penis may become dry and necrotic

Tx
- ensure that there is ability to urinate
- according to cause
– prepucial wedge resection
– removal of hair
– preputial advancement
– penile amputation

20
Q

Poor semen quality - causes

Study These Flashcards
A
  • semen contamination
  • abnormalities of
    – number
    – motility
    – morphology
21
Q

Azoospermia - what is it?

Study These Flashcards
A
  • apparent normal ejaculation but contains no sperm so usually clear fluid
22
Q

Azoospermia - possible causes & how to differentiate these

Study These Flashcards
A
  • not producing sperm (gonadal dysfunction, either congenital or acquired)
  • incomplete ejaculation
  • obstructive azoospermia (obstruction of the vas)

Measurement of alkaline phosphatase (AP) concentration in seminal plasma may be helpful in differentiating these since AP is produced in the epididymis
- high AP in the sample with no sperm means that you have an epididymal sample i.e. the dog has fully ejaculated and doesn’t have obstruction, so is not producing sperm

23
Q

Tx of dogs with poor semen quality

Study These Flashcards
A

Often more about establishing prognosis

May require repeated sampling to establish if values are stable, improving or deteriorating
- normally done with a gap of 60d
– sufficient time for spermatogenic cycle to occur and sperm to pass down epididymis. return of normal spermatogenesis. re-exam 2m after finding problem to see how it has changed -> this will help prognosis

Most medical tx are useless

24
Q

Diagnostic techniques for prostate gland

Study These Flashcards
A
  1. rectal palpation
  2. US
  3. semen evaluation
  4. radiography
  5. prostatic massage
  6. urinalysis
  7. prostatic aspiration
  8. prostatic biopsy
  9. haematology
  10. blood culture

7-10 usually performed only following earlier numbered techniques and when chronic dz or suspicion of neoplasia

25
Rectal palpation use
Assessment of: - gland size - pain - moveability - sub lumbar LN - other structures (rectal wall, pelvic wall)
26
Prostatic US use
- measures of prostatic size are not especially accurate
27
Semen evaluation use
Useful for assessment of 1st and 3rd fractions of the ejaculate - colour - cellular content - bacteriology
28
Prostate radiology use
- lateral pneumocystogram - extravasation of contrast is common in normal prostate and is not indicative of neoplasia
29
Prostatic massage use
- identification of additional cellular material
30
Urinalysis use
- common sequelae is lower urinary tract infection which needs tx
31
Common prostate dz
- benign prostatic hyperplasia - acute bacterial prostatitis - prostatitis - chronic bacterial prostatitis - prostatic abscessation - prostatic cysts - prostatic neoplasia
32
Benign prostatic hyperplasia - cause and signs
Hyperplasia of the prostatic epithelium begins early in life associated with altered androgen/oestrogen ratios Often present without CS In lateral life the enlarged gland impinges on the pelvic viscera - faecal tenesmus - haematuria - haemospermia (blood in ejaculate) If not breeding, they are presented later as issues not noticed so more likely to have signs of faecal tenesmus, perineal swelling/hernia.
33
Benign prostatic hyperplasia - diagnosis
Rectal palpation - symmetrical - freely mobile - non-painful - no adhesions - no LN enlargement - smooth margins Radiography - prostatomegaly - dorsal displacement of colon - cranial displacement of bladder - narrowed prostatic urethra - urinary retention US - prostatomegaly - hyperechoic regions - narrowed prostatic urethra - often multiple small cystic lesions Prostatic massage - poor harvest of cells - normal prostatic epithelial cells (few) Semen evaluation - normal except haemospermia Prostatic aspiration - normal prostatic epithelial cells - proliferation of NORMAL cells
34
Benign prostatic hyperplasia - tx
Castration - lowers testosterone -> prostate degeneration -> gets smaller Progestogens - e.g. osaterone (Ypozanel) - reduce testosterone concentration - impacts semen quality GnRH depot agonist - deslorelin (Suprelorin) - knocks out spermatogenesis Finasteride - human medicinal POM - a specific 5-alpha reductase inhibitor which prevent site conversion of testosterone into active dihydrotestosterone (marketed as Prosper) - can be used under cascade for BREEDING ANIMALS
35
Acute bacterial prostatitis - signalment & signs
- often young adult dogs - or, superimposed on another pathology - ascending infection commonly pathogenic E.coli CS include - systemic illness - v+ - caudal abdominal pain - painful prostate
36
Acute bacterial prostatitis - diagnosis
Rectal palpation - asymmetrical - moveable associated with great pain Radiography - normal size or marginally increased - loss of serosal detail in caudal abdomen indicating peritonitis US - large, hypoechoic (increased vascular supply) / marbled, sub-capsular oedema Prostatic massage - painful Semen evaluation - usually not capable of producing any ejaculate Urinalysis - often many bacteria present Prostatic aspiration - high white cell count - bacteria (usually E.coli) Prostatic biopsy - not indicated Haematology - acute and profound leucocytosis Blood culture - positive if pt has become bacteraemic
37
Acute bacterial prostatitis - tx
3-4w duration antibiotic therapy - blood/prostatic fluid barrier not intact therefore good antibiotic penetration - cephalosporins: gram -ve&+ve, reasonable penetration, broad spec - important to not develop chronic prostatitis Urinalysis & exam of prostatic fluid to ensure that doesn't become chronic infection Castration
38
Chronic bacterial prostatitis - cause, signs, tx
- acute lesions may become chronic and pockets of purulent exudate form - often in the form of micro-abscesses and diffuse inflammation (may later lead to prostatic abscessation) - signs are often recurrent cystitis - painful palpation - gland fibrosed: inflammation - more difficult to move gland around - LN enlargement - even more AB/castration
39
Prostatic abscessation - cause, signs
Chronic prostatitis where purulent exudate accumulates in the parenchyma of the gland CS variable but can be similar to: - acute bacterial prostatitis although less fulminating - or progress to exaggerated signs of chronic prostatitis
40
Prostatic cysts - 2 types
1. parenchymal retention cysts - start within the parenchyma of the prostate, causing distortion of the outline - usually there's an underlying prostatic dz (BPH or metaplasia (Sertoli cell tumour)) 2. cystic uterus masculinus - originate adjacent to the prostate gland but attached by a thin stalk - persistence of part of female repro tract that accumulates fluid Some cysts (irrespective of origin) may become infected
41
Prostatic cysts - tx
- castration - surgical excision - ± omentalisation
42
Prostatic neoplasia - most common type, characteristics
- adenocarcinoma most common - 5% of dogs with prostatic dz have neoplasia - tend to mets to iliac and sub-lumbar LN, and to caudal lumbar vertebrae - castration not protective
43
Prostatic neoplasia - diagnosis
Rectal palpation - usually large and painful - may be sub-lumbar swelling Radiography - prostatomegaly - sub-lumbar swelling - vertebral involvement - filling defect to prostatic urethra - reaction changes associated with sub-lumbar lymphadenopathy US - disruption of normal architecture (mixed echogenicity) - areas of increased echogenicity - areas of fluid accumulation - may be iliac LN involvement
44
Prostatic neoplasia - tx
Palliative hormonal tx - GnRH depot agonist - progestogens NSAIDs (Intra-op radiation tx) (Prostatectomy) - previously abandoned as caused faecal and urinary incontinence - now trying more to protect nervous supply to anus - referral procedure/salvage
45
Common prostate tx
Castration GnRH depot super agonists - initial stimulation then down-regulation - e.g. deslorelin (Suprelorin) Progestogens - -ve feedback to reduce androgen, and direct effect on prostate - e.g. proligestone (Delvosteron), osaterone (Ypozane) Finasteride - human medical product Prosper - is a specific 5-alpha reductase inhibitor which prevents the conversion of testosterone into dihydrotestosterone

Y4 SA - Reproduction (18 decks)

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