Penile, testicular and prostatic disease

• Mating problems - poor libido

  Frequently results from inexperience or poor breeding management. No evidence that it is caused by low plasma testosterone.

  Do not give androgen!!!
• Mating problems - mating difficulty

  Inexperienced stud dog.

  Psychological problems.

  Abnormal prepuce or penis.

  (inexperienced bitch, incorrect mating time, abnormal vulval or vagina, male-female size differences).
• Common testicular/ scrotal disease

  In some sort of order relating to how common:

  1. Testicular tumours
  2. Abnormal testicular descent
  3. Testicular degeneration.
  4. Torsion of the spermatic cord
  5. Orchitis
  6. Inguinal hernia.
• What are the 3 common tumour types?

  Leydig Cell Tumour

  Sertoli Cell Tumour

  Seminoma.
• What can testicular tumours do and how to diagnose?

  May, or may not, be endocrinologically active.

  May, or may not, cause testicular enlargement.

  May, or may not, metastasise (but this is rare - inguinal lymph node, kidney, lung are common sites).

  Diagnosis by palpation and ultrasound examination.
• Testicular tumours - oestrogen production

  Oestrogen production = feminisation

  • Preputial swelling
  • Male attractiveness
  • Bilaterally symmetrical non-pruritic alopecia.
  • Non-neoplastic testicle atrophies.
  • Normal testicular tissue within abnormal testicle also atrophies.
• Testicular tumours - Diagnosis and treatment

  Diagnosis:

  • Clinical information, palpation, ultrasonography.
  • Cornification of preputial epithelial cells.

  Treatment:

  • Hemi-castration or castration.
• What is Anorchid?

  Absence of both testes - extremely rare.

  Most cases are bilateral cryptorchid.

  Diagnosis by lack of response of testosterone to intravenous injection of hCG.
• What is Monorchid?

  A single testicle in the body - extremely rare.

  Most cases are unilateral cryptorchid.

  Diagnosis by response of testosterone to intravenous injection of hCG.
• What is cryptorchidism?

  Hidden testicle - unilateral or bilateral.

  Testes normally descended by 10 days after birth.

  Cryptorchidism is likely to be sex-limited autosomal recessive trait:

  • Female and male parents are carriers homozygous males will be cryptorchid.

  The retained abdominal testes is more likely to become neoplastic.
• Cryptorchidism - medical therapy

  Medical therapy is not ethical.

  • Treatment is by removal of both testes to prevent neoplasia and breeding.
  • Surgical approach is to look dorsal to bladder for vas deferens then follow these to the testis.
• Testicular degeneration

  Testes develops normally and has normal function but following an ‘insult’, fibrosis and degeneration occur.

  This may take several months during which time semen quality deteriorates.

  Often the ‘insult’ was not recognised by owner:

  • High temperature/ local inflammation.
  • Vascular lesions
  • Drugs
  • Endogenous hormones (tumours), exogenous hormones.
  • Toxins
  • Auto-immune disease
• Penile/ preputial diseases

  In some sort of order relating to how common:

  1. Preputial discharge
  2. Lymphoid hyperplasia
  3. Balanoposthitis
  4. Posthitis
  5. Phimosis
  6. Paraphimosis
  7. Priapism
  8. Canine herpes virus infection
  9. Penile trauma.
• What is preputial discharge?

  Muco-prurulent preputial discharge is normal.

  Many species of aerobic bacteria are isolated.

  These are usually normal commensals.

  Remember it is possible that we will see more Brucella Canis cases.

  Rarely there is a pre-disposing cause such as foreign body, preputial adhesion, penile abnormality, phimosis.

  Careful inspection of the inner surface of the sheath and the penile skin is warranted.
• Treatment for preputial discharge?

  May be normal (don’t call it ’abnormal’ or se antibiotic unless you are sure it is not normal).

  Removal of predisposing causes

  • FLushing with saline
  • (or antimicrobial or weak antiseptic solutions).
  • Paraenteral drug administration has little value.
• Lymphoid hyperplasia

  Found in a very large number of dogs.

  Raised nodule-like lesions in at the base of the penis, or preputial lining.

  Normally pale in colour and firm (not vesicular).

  May bleed when prepuce is retracted or semen collected or at normal mating.

  Requires no treatment.

  Must be differentiated from Canine Herpes Virus lesions which are normally vesicular and red in colour or may be ulcerated in the later stage.
• Balanoposthitis

  Inflammation of the penis (Balanit is) and prepucial lining (posthitis).

  Usually associated with moist prepuce tip.

  Overgrowth of commensal Bacteria.

  Commonly seen in dogs that frequently lick the prepuce (therefore common in dogs with a ‘normal’ prepuce discharge).

  May require topical cleaning/ local antiseptic/ topical antibiotic creams/ systemic antibiotics.
• What is Balanitis?

  Inflammation of the penis.

  Noted has haemorrhagic spots on the penile skin. May progress to thickening penile skin. May be associated with masturbation. Seen in some cases with with phimosis and urine retention within prepuce.
• What is Phimosis?

  Abnormally small preputial orifice. Congenital or the result of trauma or inflammation.
• What are the signs of Phimosis?

  Narrow stream of urine.

  Urine pooling within prepuce.

  May cause balanoposthitis.

  Unable to copulate.

  Treat with preputical wedge resection is normally curative.
• What is paraphimosis?

  Failure of the glans penis to be retracted fully into the prepuce.
• What causes paraphimosis?

  Small preputial orifice

  Inversion of the preputial skin/ hair.

  Hair ring (tom cat)

  Short prepuce.
• What is the treatment for paraphimosis?

  Ensure that there is ability to urinate.

  According to the cause:

  • Prepucial wedge resection.
  • Removal of hair.
  • Preputial advancement
  • Penile amputation.
• Poor semen quality - Azoospermia

  Apparently normal ejaculation but contains no sperm so usually clear fluid.
• What are the possible causes of Azoospermia?

  Not producing sperm:

  • Gonadal dysfunction (either congenital or acquired).

  Incomplete ejaculation.

  Obstructive azoospermia (obstruction of the vas)
• How to diagnose Azoospermia?

  Measurement of alkaline phosphatase (AP) concentration is seminal plasma may be helpful in differentiatng these since AP is produced within the epididymis.

  • High AP in the sample with no sperm means that you habe an epidydimal sample.
• Treatment of dogs with poor semen quality

  Often more about establishing prognosis.

  May require repeated sampling to establish of values are stable, improving or deteriorating.

  • Normally done with a gap of 60 days.

  Most medical treatments are useless.
• What are the diagnostic techniques for the prostate gland?

  Rectal palpation

  Ultrasonography

  Semen evaluation

  Radiography

  Prostatic massage

  Urinalysis

  Prostatic aspiration

  Prostatic biopsy

  Haematology

  Blood culture
• What does rectal palpation assess?

  Assessment of gland size:

  • Gland size
  • Pain
  • Moveability
  • Sublumbar lymph nodes
  • Other structures (rectal wall, pelvic wall).
• How to evaluate semen in the dog?

  Useful for assessment of first and third fractions of the ejaculate:

  • Colour
  • Cellular content
  • Bacteriology
• Benign prostatic hyperplasia - overview

  Hyperplasia of the prostatic epithelium begins early in life associated with altered androgen/ oestrogen ratios.

  Often present without clinical signs

  In later life the enlarged gland impinges on the pelvic viscera:

  • Faecal tenesmus
  • Haematuria
  • Haemospermia
• Benign prostatic hyperplasia - diagnosis

  Rectal palpation: symmetrical, freely mobile, non-painful.

  Radiography: prostatomegaly, dorsal displacement of colon, cranial displacement of bladder, narrowed prostatic urethra, urinary retention.
• Benign prostatic hyperplasia - view on ultrasound

  Older animals

  Symmetry

  Hyperechoic

  Small cysts

  
• Benign prostatic hyperplasia - on histology

  Prostatic massage: poor harvest of cells, normal prostatic epithelial cells (few).

  Semen evaluation; normal except haemospermia

  Prostatic aspiration: normal prostatic epithelial cells
• Benign prostatic hyperplasia - treatment

  Castration

  Progestogens (e.g. osaterone)

  GnRH depot agonist (deslorelin)
• Acute bacterial prostatitis - overview

  Often young adults.

  Or, superimposed on another pathology

  Ascending infection commonly E.coli

  Clinical signs include systemic illness, with vomiting and caudal abdominal pain.
• Acute bacterial prostatitis - diagnosis

  Rectal palpation:

  • Assymetrical, moveable associated with great pain.

  Radiography:

  • Normal size or marginally increased, loss of detail in caudal abdomen indicating local peritonitis.

  Ultrasonography:

  • Large, hypoechoic/ marbled, sub-capsular oedema.
• Prostatitis - overview

  Increased volume

  Sub-capsular oedema

  Marbled parenchyma
• Acute bacterial prostatitis - on histology

  Prostatic massage: painful.

  Semen evaluation: usually not capable of producing an ejaculate.

  Urinalysis: often many bacteria present.
• Acute bacterial prostatitis - treatment

  3-4 week duration antibiotic therapy.

  • Blood/prostatic fluid barrier not intact therefore good antibiotic penetration.

  Urinalysis and examination of prostatic fluid to ensure that does not become chronic infection.

  Castration.