Surgery of the Prostate Gland

Anatomy
Surgery of the Prostate Gland
Dr. T. Németh, DVM, PhD, CertSACS
Anatomy
Surgical diseases of the
prostate gland
 Benign prostateprostate-hyperplasia
 Prostatic/paraprostatic cyst
 Prostatic abscessation
 Prostatic neoplasia
Surgical diseases of the
prostate gland
 Benign prostateprostate-hyperplasia
 Prostatic/paraprostatic cyst
Benign prostateprostate-hyperplasia
 Incidence, aetiology
– in middle aged or older male dogs
– androgen
androgen--estrogen imbalance
 Prostatic abscessation
 Prostatic neoplasia
– dihydrotestosterone (DHT) sensitivity of
the prostate gland 
Benign prostateprostate-hyperplasia
Benign prostateprostate-hyperplasia
 Diagnostics
– tenesmus (defecation and/or urination)
– blood dripping after/during urination
(antibiotic irresponsiveness)
– RDP
– Cytology
– US
– (Plain XX-ray)
Benign prostateprostate-hyperplasia
Benignus prostataprostata-hyperplasia
Benign prostateprostate-hyperplasia
Surgical diseases of the
prostate gland
 Therapy
 Benign prostateprostate-hyperplasia
– medical

exogen estrogens (neg
neg.. feed back
back))

5-alpha
alpha--reduktase inhibitors (inhibit testosterontestosteron -DHT
transformation: finasteride
finasteride))

 Prostatic/paraprostatic cyst
 Prostatic abscessation
DHT receptor blockers (ozateron acetate
acetate))
– surgical
surgical:: castration !!!
 Prostatic neoplasia
Prostata--cysta
Prostata
 Retention (prostatic)
Prostatic /paraprostatic cyst
cyst
 Diagnostics
 associated with
prostate--hyperplasia or –tumour
prostate
 within the prostatic tissue
 mono
mono-- or polycystic form
– can be asymptomatic
– usually signs of prostateprostate-hyperplasia
– US
 Paraprostatic cyst
– X-ray
 originated
from Mullerian duct and/or „uterus
masculinus”
 outside the prostatic tissue
 usually with normal prostatic size and tissue
Prostatic cyst
Prostatic/paraprostatic cyst
Ultrasonography - partitioned cyst

Therapy
– castration !!!
– evacuation of the cyst (retention cyst > 2 cm)

transabdominal drainage

marsupialisation

omentalisation
– cyst
cyst--removal (paraprostatic cyst)
Prostatic cyst
Prostatic cyst
Omentalisation
Omentalisation
Prostatic cyst
Prostatic cyst
Omentalisation
Omentalisation
Prostatic cyst
Prostatic cyst
Omentalisation
Omentalisation
Prostatic cyst
Omentalisation - postop. US
Paraprostatic cyst
Plain radiography
Paraprostatic cyst
Paraprostatic cyst
Positive contrast cystography
Ultrasonography - single cyst
Prostatic/paraprostatic cyst

Paraprostatic cyst
Removal
Therapy
– castration !!!
– evacuation of the cyst (retention cyst > 2 cm)

transabdominal drainage

marsupialisation

omentalisation
– cyst
cyst--removal (paraprostatic cyst)
Paraprostatic cyst
Paraprostatic cyst
Removal
Removal
Paraprostatic cyst
Paraprostatic cyst
Removal
Removal
Surgical diseases of the
prostate gland
Prostatic abscessation
 Benign prostateprostate-hyperplasia
 Prostatic cyst
 Incidence
– secondary to...:
abscedation of prostatic cyst
 as a result of purulent prostatitis

 Prostatic abscessation
 Prostatic neoplasia
Prostatic abscessation
 Diagnostics
– signs of the septic state
– signs of prostateprostate-hyperplasia
– RDP
– US (puncture)
– (X ray)
Prostatic abscessation
Ultrasound
Prostatic abscessation
Prostatic abscessation
Ultrasound
 Therapy
– castration
– evacuation and drainage
 Omentalisation
– antibiotics
Prostatic abscessation
Prostatic abscessation
Transabdominal drainage
Transabdominal drainage
Surgical diseases of the
prostate gland
Prostatic neoplasia
 Benign prostateprostate-hyperplasia

Incidence
– over 7 years of age (mostly in castrated males !)
 Prostatic cyst
– carcinoma, lymphosarcoma
 Prostatic abscessation
– metastasis to sublumbar lymphonodes, lumbal
vertebrae, pelvis, lungs
 Prostatic neoplasia
– neurologic / orthopedic signs!
Prostatic neoplasia
Prostatic neoplasia
Ultrasound
 Diagnostics
– signs of prostateprostate-hyperplasia
– signs of metastatised organs (orthopedic,
neurologic disorders)
– tumour
tumour--cells in urine sediment
– RDP
– Cytology
– US, biopsy
– X-ray
Prostatic neoplasia
Prostatic--neoplasia
Prostatic
Ultrasound

Therapy
– castration ((-)
– IL
IL--2 (cytokine)
– COX
COX--2 inhibitor NSAIDs
– prostatectomy
Prostatic neoplasia

partial (cytoredukció)

total (urinary incontinence!)
Prostatic neoplasia

L’Eplattenier et al: Partial prostatectomy
using Nd:YAG Laser for management of
canine prostate carcinoma.
Vet Surg (2006), 35, pp406pp406-411
– 4 healthy beagles + 8 prostate carcinoma patients
– Partial prostatectomy (laser)+IL(laser)+IL- 2+Meloxicam
– Median survival: 103 days (5(5- 239)
– No urinary incontinence!
Cryptorchidism in Small Animals
 Incomplete descent of one or both testis
Cryptorchidism in Small
Animals

Incidence
– dog, cat
– unilateral or bilateral
– abdominal, inguinal (within the inguinal canal
or subcutaneously)
Cryptorchidism in Small Animals
 Pathogenesis
– hereditary condition
– in the postnatal 11-2 month the descent of
testes ends
– Should be finally judged by 6th month
– neoplastic transformation is likely after 223 years of age
Cryptorchidism in Small Animals
 Diagnostics
– history (if owner realises)
– inguinal palpation
– (US)
– (X
(X--ray)
Cryptorchidism in Small Animals
Cryptorchidism in Small Animals
Inguinal tumourous cryptorchidism (Sertoli)
Inguinal tumourous cryptorchidism (Sertoli)
Cryptorchidism in Small Animals
Cryptorchidism in Small Animals
Inguinal tumourous cryptorchidism (Sertoli)
Abdominal cryptorchidism in a cat
Cryptorchidism in Small Animals
Cryptorchidism in Small Animals
VIDEO
 Therapy
– orchidectomy (no breeding!!!)
– start with inguinal exposure along the route
of testicular descence!
Cryptorchidism in Small Animals
Inguinal tumourous cryptorchidism (Sertoli)
Cryptorchidism in Small Animals
Abdominal cryptorchidism in a cat
Cryptorchidism in Small Animals
Cryptorchidism in Small Animals
Torsion of the cryptorchid testis tumour
Abdominal cryptorchidism in a cat
Cryptorchidism in Small Animals
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
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