Surgery of the Prostate Gland - kisallatsebeszet.hu · Surgery of the Prostate Gland Dr. T. Németh, DVM, PhD, CertSACS Anatomy Anatomy Surgical diseases of the prostate gland Benign

Surgery of the Prostate GlandSurgery of the Prostate GlandSurgery of the Prostate GlandSurgery of the Prostate Gland

Dr. T. Németh, Dr. T. Németh, DVM, PhD, CertSACSDVM, PhD, CertSACSDr. T. Németh, Dr. T. Németh, DVM, PhD, CertSACSDVM, PhD, CertSACS

AnatomyAnatomyAnatomyAnatomy

AnatomyAnatomyAnatomyAnatomy Surgical diseases of the Surgical diseases of the prostate glandprostate gland

Surgical diseases of the Surgical diseases of the prostate glandprostate gland

Benign prostateBenign prostate--hyperplasiahyperplasia

Prostatic/paraprostatic cystProstatic/paraprostatic cystProstatic abscessationProstatic abscessation

Prostatic neoplasiaProstatic neoplasia












Benign prostateBenign prostate--hyperplasiahyperplasiaBenign prostateBenign prostate--hyperplasiahyperplasia

Incidence, aetiologyIncidence, aetiology–– in middle aged or older male dogsin middle aged or older male dogs–– androgenandrogen--estrogen imbalanceestrogen imbalance–– dihydrotestosterone (DHT) sensitivity of dihydrotestosterone (DHT) sensitivity of

the prostate gland the prostate gland

Incidence, aetiologyIncidence, aetiology–– in middle aged or older male dogsin middle aged or older male dogs–– androgenandrogen--estrogen imbalanceestrogen imbalance–– dihydrotestosterone (DHT) sensitivity of dihydrotestosterone (DHT) sensitivity of

the prostate gland the prostate gland

Benign prostateBenign prostate--hyperplasiahyperplasiaBenign prostateBenign prostate--hyperplasiahyperplasia Benign prostateBenign prostate--hyperplasiahyperplasiaBenign prostateBenign prostate--hyperplasiahyperplasia

DiagnosticsDiagnostics–– tenesmus (defecation and/or urination)tenesmus (defecation and/or urination)–– blood dripping after/during urination blood dripping after/during urination

(antibiotic irresponsiveness)(antibiotic irresponsiveness)

–– RDPRDP–– CytologyCytology–– USUS–– (Plain X(Plain X--ray)ray)

DiagnosticsDiagnostics–– tenesmus (defecation and/or urination)tenesmus (defecation and/or urination)–– blood dripping after/during urination blood dripping after/during urination

(antibiotic irresponsiveness)(antibiotic irresponsiveness)

–– RDPRDP–– CytologyCytology–– USUS–– (Plain X(Plain X--ray)ray)

Benign prostateBenign prostate--hyperplasiahyperplasiaBenign prostateBenign prostate--hyperplasiahyperplasia Benignus prostataBenignus prostata--hyperplasiahyperplasiaBenignus prostataBenignus prostata--hyperplasiahyperplasia

Benign prostateBenign prostate--hyperplasiahyperplasiaBenign prostateBenign prostate--hyperplasiahyperplasia

TherapyTherapy–– medicalmedical

exogenexogen estrogensestrogens ((negneg. . feedfeed backback) )

55--alphaalpha--reduktase inhibitors (inhibit testosteronreduktase inhibitors (inhibit testosteron--DHT DHT transformation: transformation: finasteridefinasteride))

DHT DHT receptor receptor blockersblockers ((ozateronozateron acetateacetate))

–– surgicalsurgical: : castrationcastration !!!!!!

TherapyTherapy–– medicalmedical

exogenexogen estrogensestrogens ((negneg. . feedfeed backback) )

55--alphaalpha--reduktase inhibitors (inhibit testosteronreduktase inhibitors (inhibit testosteron--DHT DHT transformation: transformation: finasteridefinasteride))

DHT DHT receptor receptor blockersblockers ((ozateronozateron acetateacetate))

–– surgicalsurgical: : castrationcastration !!!!!!









ProstataProstata--cystacystaProstataProstata--cystacysta

Retention (prostatic) cystRetention (prostatic) cyst associated with prostateassociated with prostate--hyperplasia or hyperplasia or ––tumour tumour within the prostatic tissuewithin the prostatic tissuemonomono-- or polycystic formor polycystic form

Paraprostatic cystParaprostatic cyst originated from Mullerian duct and/or „uterus originated from Mullerian duct and/or „uterus

masculinus”masculinus” outside the prostatic tissueoutside the prostatic tissue usually with normal prostatic size and tissueusually with normal prostatic size and tissue

Retention (prostatic) cystRetention (prostatic) cyst associated with prostateassociated with prostate--hyperplasia or hyperplasia or ––tumour tumour within the prostatic tissuewithin the prostatic tissuemonomono-- or polycystic formor polycystic form

Paraprostatic cystParaprostatic cyst originated from Mullerian duct and/or „uterus originated from Mullerian duct and/or „uterus

masculinus”masculinus” outside the prostatic tissueoutside the prostatic tissue usually with normal prostatic size and tissueusually with normal prostatic size and tissue

Prostatic /paraprostatic cystProstatic /paraprostatic cystProstatic /paraprostatic cystProstatic /paraprostatic cyst

DiagnosticsDiagnostics–– can be asymptomaticcan be asymptomatic–– usually signs of prostateusually signs of prostate--hyperplasiahyperplasia–– USUS–– XX--rayray

DiagnosticsDiagnostics–– can be asymptomaticcan be asymptomatic–– usually signs of prostateusually signs of prostate--hyperplasiahyperplasia–– USUS–– XX--rayray

Prostatic cystProstatic cystUltrasonography Ultrasonography -- partitioned cystpartitioned cyst

Prostatic cystProstatic cystUltrasonography Ultrasonography -- partitioned cystpartitioned cyst

Prostatic/paraprostatic cystProstatic/paraprostatic cystProstatic/paraprostatic cystProstatic/paraprostatic cyst

TherapyTherapy–– castration !!! castration !!!

–– evacuation of the cyst (retention cyst > 2 cm)evacuation of the cyst (retention cyst > 2 cm) transabdominal drainagetransabdominal drainage marsupialisationmarsupialisation omentalisationomentalisation

–– cystcyst--removal (paraprostatic cyst)removal (paraprostatic cyst)




Prostatic cyst Prostatic cyst OmentalisationOmentalisationProstatic cyst Prostatic cyst OmentalisationOmentalisation






Prostatic cyst Prostatic cyst Omentalisation Omentalisation -- postop. USpostop. US

Prostatic cyst Prostatic cyst Omentalisation Omentalisation -- postop. USpostop. US Paraprostatic cyst Paraprostatic cyst

Plain radiographyPlain radiographyParaprostatic cyst Paraprostatic cyst

Plain radiographyPlain radiography

Paraprostatic cyst Paraprostatic cyst Positive contrast cystographyPositive contrast cystography

Paraprostatic cyst Paraprostatic cyst Positive contrast cystographyPositive contrast cystography

Paraprostatic cyst Paraprostatic cyst Ultrasonography Ultrasonography -- single cystsingle cyst

Paraprostatic cyst Paraprostatic cyst Ultrasonography Ultrasonography -- single cystsingle cyst

Prostatic/paraprostatic cystProstatic/paraprostatic cystProstatic/paraprostatic cystProstatic/paraprostatic cyst







Paraprostatic cystParaprostatic cystRemovalRemoval













Prostatic cystProstatic cystProstatic abscessationProstatic abscessation





Prostatic abscessationProstatic abscessationProstatic abscessationProstatic abscessation

IncidenceIncidence––secondary to...:secondary to...: abscedation of prostatic cystabscedation of prostatic cyst as a result of purulent prostatitis as a result of purulent prostatitis

IncidenceIncidence––secondary to...:secondary to...: abscedation of prostatic cystabscedation of prostatic cyst as a result of purulent prostatitis as a result of purulent prostatitis


DiagnosticsDiagnostics–– signs of the septic statesigns of the septic state–– signs of prostatesigns of prostate--hyperplasiahyperplasia–– RDPRDP–– US (puncture)US (puncture)–– (X ray)(X ray)

DiagnosticsDiagnostics–– signs of the septic statesigns of the septic state–– signs of prostatesigns of prostate--hyperplasiahyperplasia–– RDPRDP–– US (puncture)US (puncture)–– (X ray)(X ray)

Prostatic abscessation Prostatic abscessation UltrasoundUltrasound





TherapyTherapy––castrationcastration––evacuation and drainageevacuation and drainageOmentalisationOmentalisation

––antibioticsantibiotics

TherapyTherapy––castrationcastration––evacuation and drainageevacuation and drainageOmentalisationOmentalisation

––antibioticsantibiotics

Prostatic abscessation Prostatic abscessation TransabdominalTransabdominal drainagedrainageProstatic abscessation Prostatic abscessation TransabdominalTransabdominal drainagedrainage

Prostatic abscessation Prostatic abscessation TransabdominalTransabdominal drainagedrainageProstatic abscessation Prostatic abscessation TransabdominalTransabdominal drainagedrainage









Prostatic neoplasiaProstatic neoplasiaProstatic neoplasiaProstatic neoplasia

IncidenceIncidence–– over 7 years of age (mostly in castrated males !)over 7 years of age (mostly in castrated males !)–– carcinoma, lymphosarcomacarcinoma, lymphosarcoma–– metastasis to sublumbar lymphonodes, lumbal metastasis to sublumbar lymphonodes, lumbal

vertebrae, pelvis, lungsvertebrae, pelvis, lungs–– neurologic / orthopedic signs!neurologic / orthopedic signs!

IncidenceIncidence–– over 7 years of age (mostly in castrated males !)over 7 years of age (mostly in castrated males !)–– carcinoma, lymphosarcomacarcinoma, lymphosarcoma–– metastasis to sublumbar lymphonodes, lumbal metastasis to sublumbar lymphonodes, lumbal

vertebrae, pelvis, lungsvertebrae, pelvis, lungs–– neurologic / orthopedic signs!neurologic / orthopedic signs!

Prostatic neoplasiaProstatic neoplasiaProstatic neoplasiaProstatic neoplasiaDiagnosticsDiagnostics

–– signs of prostatesigns of prostate--hyperplasiahyperplasia–– signs of metastatised organs (orthopedic, signs of metastatised organs (orthopedic,

neurologic disorders)neurologic disorders)–– tumourtumour--cells in urine sedimentcells in urine sediment–– RDPRDP–– CytologyCytology–– US, biopsyUS, biopsy–– XX--ray ray

DiagnosticsDiagnostics–– signs of prostatesigns of prostate--hyperplasiahyperplasia–– signs of metastatised organs (orthopedic, signs of metastatised organs (orthopedic,

neurologic disorders)neurologic disorders)–– tumourtumour--cells in urine sedimentcells in urine sediment–– RDPRDP–– CytologyCytology–– US, biopsyUS, biopsy–– XX--ray ray

Prostatic neoplasia Prostatic neoplasia UltrasoundUltrasound




ProstaticProstatic--neoplasianeoplasiaProstaticProstatic--neoplasianeoplasia TherapyTherapy

–– castration (castration (--))–– ILIL--2 (cytokine)2 (cytokine)–– COXCOX--2 inhibitor NSAIDs2 inhibitor NSAIDs–– prostatectomyprostatectomy

partial (cytoredukció)partial (cytoredukció) total (urinary incontinence!)total (urinary incontinence!)

TherapyTherapy–– castration (castration (--))–– ILIL--2 (cytokine)2 (cytokine)–– COXCOX--2 inhibitor NSAIDs2 inhibitor NSAIDs–– prostatectomyprostatectomy

partial (cytoredukció)partial (cytoredukció) total (urinary incontinence!)total (urinary incontinence!)

Prostatic neoplasiaProstatic neoplasiaProstatic neoplasiaProstatic neoplasiaProstatic neoplasiaProstatic neoplasiaProstatic neoplasiaProstatic neoplasia

L’Eplattenier et al: Partial prostatectomy L’Eplattenier et al: Partial prostatectomy using Nd:YAG Laser for management of using Nd:YAG Laser for management of canine prostate carcinoma. canine prostate carcinoma. Vet Surg (2006), 35, pp406Vet Surg (2006), 35, pp406--411411–– 4 healthy beagles + 8 prostate carcinoma patients4 healthy beagles + 8 prostate carcinoma patients–– Partial prostatectomy (laser)+ILPartial prostatectomy (laser)+IL--2+Meloxicam2+Meloxicam–– Median survival: 103 days (5Median survival: 103 days (5--239)239)–– No urinary incontinence!No urinary incontinence!

L’Eplattenier et al: Partial prostatectomy L’Eplattenier et al: Partial prostatectomy using Nd:YAG Laser for management of using Nd:YAG Laser for management of canine prostate carcinoma. canine prostate carcinoma. Vet Surg (2006), 35, pp406Vet Surg (2006), 35, pp406--411411–– 4 healthy beagles + 8 prostate carcinoma patients4 healthy beagles + 8 prostate carcinoma patients–– Partial prostatectomy (laser)+ILPartial prostatectomy (laser)+IL--2+Meloxicam2+Meloxicam–– Median survival: 103 days (5Median survival: 103 days (5--239)239)–– No urinary incontinence!No urinary incontinence!

Cryptorchidism in Small Cryptorchidism in Small AnimalsAnimals

Cryptorchidism in Small Cryptorchidism in Small AnimalsAnimals

Cryptorchidism in Small AnimalsCryptorchidism in Small AnimalsCryptorchidism in Small AnimalsCryptorchidism in Small Animals

Incomplete descent of one or both testisIncomplete descent of one or both testis

IncidenceIncidence–– dog, catdog, cat

–– unilateral or bilateralunilateral or bilateral–– abdominal, inguinal (within the inguinal canal abdominal, inguinal (within the inguinal canal

or subcutaneously)or subcutaneously)

Incomplete descent of one or both testisIncomplete descent of one or both testis

IncidenceIncidence–– dog, catdog, cat

–– unilateral or bilateralunilateral or bilateral–– abdominal, inguinal (within the inguinal canal abdominal, inguinal (within the inguinal canal

or subcutaneously)or subcutaneously)


PathogenesisPathogenesis–– hereditary conditionhereditary condition–– in the postnatal 1in the postnatal 1--2 month the descent of 2 month the descent of

testes endstestes ends–– Should be finally judged by 6th monthShould be finally judged by 6th month–– neoplastic transformation is likely after 2neoplastic transformation is likely after 2--

3 years of age3 years of age

PathogenesisPathogenesis–– hereditary conditionhereditary condition–– in the postnatal 1in the postnatal 1--2 month the descent of 2 month the descent of

testes endstestes ends–– Should be finally judged by 6th monthShould be finally judged by 6th month–– neoplastic transformation is likely after 2neoplastic transformation is likely after 2--

3 years of age3 years of age


DiagnosticsDiagnostics–– history (if owner realises)history (if owner realises)–– inguinal palpationinguinal palpation–– (US)(US)–– (X(X--ray)ray)

DiagnosticsDiagnostics–– history (if owner realises)history (if owner realises)–– inguinal palpationinguinal palpation–– (US)(US)–– (X(X--ray)ray)

Cryptorchidism in Small AnimalsCryptorchidism in Small AnimalsInguinal tumourous cryptorchidism (Sertoli)Inguinal tumourous cryptorchidism (Sertoli)Cryptorchidism in Small AnimalsCryptorchidism in Small Animals

Inguinal tumourous cryptorchidism (Sertoli)Inguinal tumourous cryptorchidism (Sertoli)Cryptorchidism in Small AnimalsCryptorchidism in Small Animals


Inguinal tumourous cryptorchidism (Sertoli)Inguinal tumourous cryptorchidism (Sertoli)



Abdominal cryptorchidism in a catAbdominal cryptorchidism in a catCryptorchidism in Small AnimalsCryptorchidism in Small Animals

Abdominal cryptorchidism in a catAbdominal cryptorchidism in a cat


TherapyTherapy–– orchidectomy (no breeding!!!)orchidectomy (no breeding!!!)–– start with inguinal exposure along the route start with inguinal exposure along the route

of testicular descence! of testicular descence!

TherapyTherapy–– orchidectomy (no breeding!!!)orchidectomy (no breeding!!!)–– start with inguinal exposure along the route start with inguinal exposure along the route

of testicular descence! of testicular descence!

Cryptorchidism in Small AnimalsCryptorchidism in Small AnimalsVIDEOVIDEO

Cryptorchidism in Small AnimalsCryptorchidism in Small AnimalsVIDEOVIDEO


Inguinal tumourous cryptorchidism (Sertoli)Inguinal tumourous cryptorchidism (Sertoli) Cryptorchidism in Small AnimalsCryptorchidism in Small AnimalsAbdominal cryptorchidism in a catAbdominal cryptorchidism in a cat

Cryptorchidism in Small AnimalsCryptorchidism in Small AnimalsAbdominal cryptorchidism in a catAbdominal cryptorchidism in a cat



Cryptorchidism in Small AnimalsCryptorchidism in Small AnimalsTorsion of the cryptorchid testis tumourTorsion of the cryptorchid testis tumour




Castration in Small AnimalsCastration in Small AnimalsCastration in Small AnimalsCastration in Small Animals


removal of testis and epididymisremoval of testis and epididymis IndicationIndication

I. I. -- to the owner’s request (decrease aggressivity)to the owner’s request (decrease aggressivity)-- neoplasia of the testisneoplasia of the testis-- injury of the testisinjury of the testis-- cryptorchidismcryptorchidism

II. II. -- prostateprostate--hyperplasia, cyst, abscesshyperplasia, cyst, abscess-- perineal herniaperineal hernia-- perianal / circumanal neoplasiaperianal / circumanal neoplasia

removal of testis and epididymisremoval of testis and epididymis IndicationIndication

I. I. -- to the owner’s request (decrease aggressivity)to the owner’s request (decrease aggressivity)-- neoplasia of the testisneoplasia of the testis-- injury of the testisinjury of the testis-- cryptorchidismcryptorchidism

II. II. -- prostateprostate--hyperplasia, cyst, abscesshyperplasia, cyst, abscess-- perineal herniaperineal hernia-- perianal / circumanal neoplasiaperianal / circumanal neoplasia


Surgical techniqueSurgical technique–– closed closed ------ openopen–– with or without scrotectomy with or without scrotectomy

DogDog–– closed castration with scrotectomyclosed castration with scrotectomy–– open castration without scrotectomyopen castration without scrotectomy

CatCat–– open castration via transcrotal incisionopen castration via transcrotal incision




Closed castration with Closed castration with scrotectomy in dogscrotectomy in dog
















Closed castration with scrotectomy in dogClosed castration with scrotectomy in dogVIDEOVIDEO

Closed castration with scrotectomy in dogClosed castration with scrotectomy in dogVIDEOVIDEO Castration in Small AnimalsCastration in Small AnimalsCastration in Small AnimalsCastration in Small Animals







Open castration Open castration without scrotectomywithout scrotectomy













Open castration Open castration without scrotectomywithout scrotectomy Castration in Small AnimalsCastration in Small AnimalsCastration in Small AnimalsCastration in Small Animals







Open castration in catsOpen castration in catsOpen castration in catsOpen castration in cats Open castration in catsOpen castration in catsOpen castration in catsOpen castration in cats



Open castration in catsOpen castration in catsOpen castration in catsOpen castration in catsCastration in Small AnimalsCastration in Small AnimalsCastration in Small AnimalsCastration in Small Animals

ComplicationsComplications–– bleedingbleeding–– scrotal hematoma, seroma, abscessscrotal hematoma, seroma, abscess–– scrotal dermatitisscrotal dermatitis

ComplicationsComplications–– bleedingbleeding–– scrotal hematoma, seroma, abscessscrotal hematoma, seroma, abscess–– scrotal dermatitisscrotal dermatitis

Documents

Surgery of the Prostate Gland - kisallatsebeszet.hu · Surgery of the Prostate Gland Dr. T. Németh, DVM, PhD, CertSACS Anatomy Anatomy Surgical diseases of the prostate gland Benign