Prostatic Disease

53 Prostatic Disease



Stanley I. Rubin, Mala Erickson



1. What are the most common features of prostatic disease in the dog?
• Urethral discharge, hematuria, and rectal tenesmus are the most frequent signs in dogs with prostatic disease.

• Dogs with acute bacterial prostatitis may have depression, anorexia, vomiting, and bloody urethral discharge.

• Straining to urinate, urethral discharge, anorexia, and depression are seen in dogs with prostatic abscesses.

• Recurrent urinary tract infection (UTI) is often a clue to the presence of chronic bacterial prostatitis.

• Dogs with prostatic neoplasia may have decreased appetite, weight loss, urethral discharge, and/or rear limb weakness.

• Dogs are infertile.

2. What are the major categories of prostatic disease?
• Benign prostatic hyperplasia (BPH)

• Acute/chronic prostatitis

• Prostatic abscessation

• Prostatic cyst

• Prostatic neoplasia

3. When should I perform a rectal examination to examine the prostate gland?
• A rectal examination should be routine on any male dog older than 2 years.

• Any male dog of any age with lower urinary tract signs should be examined.

4. How do I perform a rectal examination?
• Simultaneous rectal and caudal abdominal palpation to palpate the prostate per abdomen and to push the prostate toward the pelvic canal

• Best with dog standing

5. Are there any breeds that normally have big prostate glands?
• The Scottish Terrier is reported to have a prostate 4 times larger than that of dogs of similar age and weight.

6. What should be included in the diagnostic workup of a dog with prostatic disease?
• Rectal examination

• Complete blood count

• Serum biochemistry profile

• Radiography

• Culture and cytologic examination of prostatic fluid collected by ejaculate or prostatic wash

• Ultrasound

• Ultrasound-guided fine needle aspiration (possibly)

• Prostatic biopsy

7. Why would I want to evaluate prostatic fluid?
• Cytologically evaluating prostatic fluid and culturing prostatic fluid are useful means of differentiating between BPH, bacterial prostatitis, and prostatic neoplasia.

8. Why is an ejaculate useful?
• Prostatic fluid constitutes the largest volume of an ejaculate and makes up 95% of the volume of an ejaculate. Prostatic fluid is in the third fraction of the ejaculate and is normally clear and acellular.

• Blood may be present in the ejaculates of dogs with bacterial infection, BPH, prostatic cysts and prostatic neoplasia.

9. How do I collect an ejaculate?
1. Some ejaculates may be collected from most intact males by manual stimulation alone. A teaser bitch often aids in collection. The teaser may be in estrus, or an anestrous bitch with pheromone methyl-p-hydroxybenzoate applied to the vulva may be used with the dog.

2. Extrude the penis from the sheath and gently remove any preputial discharge from the penis with gauze sponges and warm water. If any soap or detergent is used, it must be rinsed off with sterile saline and the penis dried. Contamination of the sample with detergent may interfere with the quantitative culture results.

3. A rubber collection funnel (artificial vagina) with attached tube is slipped over the penis with one hand while the other hand holds the sheath retracted. The artificial vagina is placed over the entire penis and bulbis glandis as the male becomes aroused.

4. Pressure is maintained over the bulbis glandis with the hand holding the funnel and the penis is massaged caudal to the bulbis glandis with the other hand.

5. The first two fractions of the ejaculate appear within the first 1 to 2 minutes of collection and are composed of the presperm and sperm-rich fractions. After the first two fractions have passed, a second sterile tube is attached to the collection funnel and the prostatic fraction is collected.

6. Samples of the prostatic fluid are submitted for cytologic evaluation and quantitative bacterial culture.

10. What do I do if I cannot collect an ejaculate?
• Perform a prostatic wash.

11. How do I perform a prostatic wash?
1. The dog is taken out and allowed to void.

2. Light sedation with acepromazine may facilitate the procedure by minimizing physical restraint and decreasing the dog’s apprehension.

3. Using aseptic technique, a sterile urinary catheter is passed.

4. The bladder is emptied of urine and flushed several times with sterile saline. The last 5 ml of sterile saline is retained as prostatic massage sample 1.

5. A gloved finger is inserted into the rectum and the catheter is retracted just distal to the prostate. The prostate gland is massaged rectally or abdominally for 1 to 2 minutes. Sterile physiologic saline (5-10 ml) is flushed slowly past the prostatic urethra. The catheter is then advanced back slowly into the urinary bladder with simultaneous aspiration as the catheter is advanced. This sample is retained as prostatic massage sample 2.

6. Prostatic massage samples 1 and 2 are submitted for cytologic and quantitative microbiologic evaluation.

7. A recently described technique used a microbiological specimen brush in conjunction with prostatic massage to obtain samples for culture and cytologic examination. This technique was found to be useful for the diagnosis of neoplastic, hyperplastic, and bacterial prostatic disease.

12. How do I evaluate the results of a prostatic wash?
• The premassage and postmassage samples are evaluated cytologically and submitted for quantitative culture. Prostatic infection is likely when the postmassage specimen yields a higher bacterial count (>105 Gram-negative bacterial per milliliter) than the premassage sample. Cytologic evidence of inflammation (increased numbers of neutrophils and macrophages), particularly in the postmassage sample, has correlated well with the presence of infection.

13. When should I collect a prostatic biopsy?
• Biopsy techniques are useful for differentiating neoplastic from inflammatory prostatic disease but are less useful for differentiating infectious from noninfectious, inflammatory prostatic disease.

• A biopsy should be performed when castration does not alleviate prostatomegaly.

14. How are biopsies collected?
• Direct aspiration of the gland. It may be guided by ultrasound. Needle aspiration is usually done by the rectal, perirectal, or transabdominal approach, depending on the location of the gland.

• Core (Tru-cut). It is performed closed by the perirectal or transabdominal approaches or open after the gland is exposed surgically.

15. Are biopsies ever contraindicated?
• They are contraindicated in the dog with fever or leukocytosis.
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Jul 31, 2016 | Posted by in INTERNAL MEDICINE | Comments Off on Prostatic Disease

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