VSR 421: Regional Veterinary Surgery (2+1)

 CONDITIONS AFFECTING THE PROSTATE GLAND

• Dogs commonly suffer from prostatic diseases. Male dogs showing tenesmus, dysuria, anuria, pyuria, haematuria, caudal abdominal pain and difficulty in walking with the hindlimbs should be examined for prostatic involvement.
• Prostatic diseases are rare in cats. Diagnosis of prostatic diseases may be made from history and clinical signs, per rectal digital palpation of the prostate, plain and contrast radiography, ultrasonography, laparoscopy, biopsy and laboratory evaluation of blood, urine and ejaculate.
• Benign prostatic hyperplasia is the most common prostatic disease affecting dogs. It is a normal old age related condition in which the prostate gets enlarged and the enlargement of the gland is testosterone dependant. Constipation, tenesmus, bloody urethral discharge or retention of urine may be seen. Dyschezia is more characteristic than dysuria due to the physical obstruction caused by the enlarged prostate to the expansion of the rectum in the pelvis. Prolonged straining to pass feces may lead to weakening of the pelvic diaphragm and subsequent perineal hernia. Digital palpation per rectum reveals a uniformly enlarged non-painful prostate with a normal spongy consistency. Haemogram and biochemical parameters are usually normal. Bacterial cultures of urine, prostatic fluid and ejaculate are negative. Biopsy may be required for confirmation. However, the latter is reserved for cases that do not respond to treatment.
• The recommended treatment for benign prostatic hyperplasia is bilateral orchiectomy. Once the stimulation to the prostatic cells by testosterone is removed, permanent involution of the prostate and clinical relief is obtained in 2 to 3 weeks. In cases where castration is not desired oestrogenic preparations may be used. However, they have the potential to cause feminization and loss of fertility. In valuable animals where it is desirable to retain the fertility, drugs like finasteride may be administered orally. However, the condition may return when the drug is stopped.
• Prostatitis and prostatic abscess are not rare findings in dogs. The close proximity of the prostate to the urethra which normally has resident bacteria predisposes it to infection. The condition may be acute or chronic. Clinical signs in acute cases include pyrexia, lethargy, anorexia, urine retention, constipation, purulent urethral discharge, signs of caudal abdominal pain and hind limb gait abnormality. Systemic signs of sepsis may be seen. Palpation of the gland reveals it to be asymmetrically swollen, painful and fluctuant when abscesses are present. Application of pressure on the fluctuating swelling may cause drainage of pus from the urethra. In cases where the abscesses have ruptured signs of peritonitis and septic shock may develop. Urine may be collected and evaluated revealing haematuria and pyuria. Culture of urine and prostatic fluid obtained by catheterization or fine needle aspiration reveals bacteria. Plain and contrast radiography, ultrasonography and laparoscopy may further help in diagnosis.

Prostatic abcess