Prostate, penile, preputial disease, uterine/vaginal prolapse Flashcards
Describe the pathophysiology of:
a. Benign prostatic hyperplasia (BPH) and cystic benign prostatic hyperplasia (CBPH)
b. Squamous metaplasia
a. Benign prostatic hyperplasia (BPH) and cystic benign prostatic hyperplasia (CBPH)
- Prostatic cell growth is under the influence of dihydrotestosterone (DHT) (and to a much lower extent testosterone), estradiol-17-beta, and many other local growth factors. Age-related changes in the androgen : estrogen ratio seem important for development of BPH. DHT represents the main mediator of BPH, promoting growth of stromal and glandular elements. BPH can progress to cystic BPH as well as predispose dogs to chronic bacterial prostatitis that can progress to cystitis, epididymitis, and orchitis.
b. Squamous metaplasia
- Squamous metaplasia occurs as a consequence of hyperestrogenism, either of endogenous (functional Sertoli cell tumor, adrenal gland dysfunction) or exogenous (therapy for BPH, inadvertent exposure to transdermal hormone replacement therapy in human) origin. Prostatic epithelial squamous metaplasia is accompanied by secretory stasis; intraprostatic cysts can form
What are the clinical signs associated with CPBH and BPH?
Can present without clinical signs; The most common clinical signs of BPH and CBPH are blood (of prostatic origin) dripping from the urethra/prepuce, hemospermia and hematuria; Tenesmus secondary to colonic compression from marked prostatomegaly can be seen in advanced cases;
Prostate is not painful upon palpation but is usually prominent, sometimes with mild asymmetry.
What are the clinical signs associated with squamous metaplasia?
The prostate gland enlarges and is firm on palpation.
Compression of the urethra and colon can cause dysuria and tenesmus, prompting an emergency presentation.
Other physical findings typical of hyperestrogenism can be present: attractiveness to males, gynecomastia, symmetrical
alopecia, hyperpigmentation, testicular atrophy
or dissymmetry (if a mass is present) and a pendulous prepuce. The presence of an abdominal (cryptorchid) testis should be ruled out when two scrotal testes are not present.
Estrogen toxicity to bone marrow can cause pale mucous membranes (anemia), petechiation or haemorrhage (thrombocytopenia), and fever (secondary to neutropenia)
What are the clinical signs associated with paraprostatic cysts?
Large cysts can encroach on the urethra or colon, causing dysuria, incontinence or tenesmus, abdomenomegaly or perineal swelling
What are the clinical signs associated with infectious prostatitis?
Lumbar or abdominal pain, lethargy, fever or tenesmus. The prostate is painful on palpation; sublumbar lymphadenomegaly can be present. Hemorrhagic and purulent urethral discharge, excessive preputial licking, dysuria, constipation and tenesmus can be present.
Dogs are commonly febrile, anorexic, and lethargic,
exhibiting pain on ambulation and kyphosis. Ejaculation can be painful, and affected dogs may be reluctant to breed or be collected. Peritonitis can cause nausea and abdominal discomfort
Recurrent UTIs –> chronic prostatitis
What are the clinical signs associated with prostatic neoplasia?
Tenesmus and constipation due to compression of the rectum accompanied by sublumbar lymphadenomegaly, overdistension of the urinary bladder due to urethral compression, lumbar pain from invasion into the lumbar vertebrae and nerve roots, and lower urinary tract signs of stranguria, dysuria, pollakiuria, and hematuria.
Concurrent urinary tract infection is not uncommon. Pelvic limb ataxia and paresis or paralysis can occur. Physical examination findings commonly include prostatomegaly, sublumbar lymphadenomegaly, abdominal pain, and gait abnormalities. The prostate is unusually enlarged for a neutered dog. Anorexia and associated weight loss reduce body condition.
What are the most commonly identified bacterial organisms in dogs with acute bacterial prostatitis?
- Escherichia coli (70%)
- followed by Staphylococcus spp., Klebsiella spp., Proteus mirabilis, Mycoplasma canis, Pseudomonas aeruginosa, Enterobacter spp., Streptococcus spp., Pasteurella spp., and Haemophilus spp.
- Infections with anaerobic bacterial or fungal organisms have been reported rarely, including one dog with prostatic pythiosis
Fill in the following sentences:
a. Results of urine and prostatic fluid cultures are …………… correlated
b. The prostatic contribution to the total fluid volume of semen is …………., making semen an ……………. sample for cytology and microbial culture
c. The pH of the prostatic fluid is typically ………….. . This ………………. environment makes it easier for drugs with a …………….. pH to enter the prostate. Antibiotics that are ………………………….., e.g. ………………………………, will cross the blood–prostate barrier easier than their ……………. counterparts
d. Highly lipid soluble drugs, e.g. the …………………………………………………………………………, cross the prostatic acini …………………., whereas poorly lipid soluble drugs ………………………………..
a. Results of urine and prostatic fluid cultures are highly correlated, Because prostatic fluid normally refluxes into the urinary bladder, urinary tract infection is usually present whenever there is bacterial prostatitis
a. The prostatic contribution to the total fluid volume of semen is >90%, making semen an ideal sample for cytology and microbial culture
b. The pH of the prostatic fluid is typically <7.4 (lower than that of blood). This acidic environment makes it easier for drugs with a higher pH to enter the prostate. Antibiotics that are more basic than 7.4, e.g. erythromycin and trimethoprim, will cross the blood–prostate barrier easier than their acidic counterparts
c. Highly lipid soluble drugs, e.g. the fluoroquinolones, chloramphenicol and trimethoprim-sulfa, cross the prostatic acini easily, whereas poorly lipid soluble drugs cannot cross the prostatic acini
What breeds are most commonly affected by TCC?
Scottish Terriers (18-fold), Shetland Sheepdogs, Beagles, Wirehaired Fox Terriers, and West Highland White Terriers are the breeds most commonly affected by TCC.
Describe the surgical technique of en bloc uterine amputation of a prolapsed uterus?
- To amputate the uterus, a smooth, cylindrical object should be placed into the uterine lumen and four stay sutures placed at equidistant points around the prolapsed uterus. All the layers of the uterus are incised to the inserted object, one quadrant at a time. Immediately after incising one quadrant, the inner and outer layers of the prolapsed uterus are anastomosed with simple interrupted absorbable sutures before incising the next quadrant. This process is repeated until the entire uterus is amputated. Care must be taken to ligate the uterine arteries separately and the urethra must be catheterized and carefully protected. Broad-spectrum systemic antibiotics for 7–14 days are warranted
Describe the three different types of vaginal prolapse
- Type I: Slight-to-moderate eversion of vaginal mucosa originating from the vaginal floor cranial to the urethral opening but confined to the vestibulum. This appears as a bulge at the perineum
- Type II: A well-developed swelling of the vaginal floor that may include the lateral vaginal walls with protrusion of the vaginal mucosa through the vulvar labia. This incomplete prolapse appears dome shaped
- Type III (true vaginal prolapse): Complete protrusion of the entire circumference of the vaginal wall through the vulvar lips. This complete prolapse appears donut shaped
Causes of vaginal fold prolapse
- Oestrogen influence (during proestrus or early oestrus –> oedema and hyperplasia of the mucosa + relaxation of the vulvar and perivulvar musculature and associated tissues
- Constipation
- Trauma from forced separation during coitus
- Size discrepancy between breeding animals
- Vaginal tumors
Name 7 common breeds predisposed to vaginal prolapse
- American Pit Bull Terrier
- Boxer
- Bulldog
- Chesapeake Bay Retriever
- Dalmatian
- German Shepherd Dog,
- Labrador Retriever
- Mastiff, Springer Spaneil
- St Bernard,
- Walker Hound
- Weimeraner.
- How can you differentiate between ischemic and non-ischemic priapism?
Ischemic: usually painful and corpus cavernosa fully rigid, cavernous blood gas abnormal (pH <7.25, pO2<30, pCO2>60)
Non-ischemic: Pain and corpus cavernosa rigidity uncommon, normal cavernous blood gas (pH 7.4, pO2>90, pCO2<40)
- Describe the guidelines for the treatment of priapism in people
- First line management: decompression of the corpora cavernosa via penile aspiration with a 19G butterfly needle or a 16-18G angiocatheter
- Blood is evacuated until fresh red blood is obtained
- If it re-occurs: injection of a sympathomimetic agent such as phenylephrine (diluted w normal saline to 100-500 ug/ml and given in 1ml doses every 5min); max dose 1mg for no more than 1h
- If not successful surgical management: shunting blood via a surgically created vent that allows blood to exit the corpora cavernosa
