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Jul 30, 2013 - Scientifical    No Comments

SUBTOTAL INTRACAPSULAR RESECTION OF PROSTATE ADENOMA WITH TOTAL ABLATION OF THE INTRAPROSTATIC URETHRA IN DOGS

Bogdan Alexandru VIŢĂLARU, Faculty of Veterinary Medicine Bucharest, Romania, alexandrumv@yahoo.com
Ion DRAGOMIRIŞTEANU, Hospital of Urology Professor Theodor Burghele
Ion Alin BÎRŢOIU, Faculty of Veterinary Medicine Bucharest, Romania,
Cătălin PANDELAŞ, Faculty of Veterinary Medicine Bucharest, Romania
Mihaela-Alina FLOREA, Faculty of Veterinary Medicine Bucharest, Romania, student

 

Key words: canine, prostate, adenoma, intracapsular, resection.

 

ABSTRACT

Subtotal intracapsular resection of prostate adenoma with total ablation of the intraprostatic urethra and urinary continence preservation in dogs is an operation that has a high degree of difficulty and it is done in severe cases, acute blockage of the urinary and digestive transit, consecutive to total prostate volume augmentation. Subtotal prostatectomy is indicated in valuable breeding dogs for benign prostatic hyperplasia in lieu of castration and in stable dogs with abscessation or cysts in lieu of drainage procedures.

In the Clinic of Obstetrics and Gynecology of the Faculty of Veterinary Medicine Bucharest, we have performed this surgery in 2 male dogs, common breed, with prostate adenoma, age 8 and 9 respectively. Using the electroscalpel, we dissected all parenchyma except a 2 mm shell attached to the capsule. We resected all the urethra except a 1-2 cm dorsal strip, trying to maintain the integrity of the Seminal colliculus and not to reach the striate sphincter of the urinary bladder.

Before closing the prostatic lodge and restoring all the anatomic layers, we had placed a drainage tube to collect all residual urine from the prostatic lodge.
The drainage tube was removed after 5 days and the urethral catheter was maintained for 10 days.
The urinary continence was not affected as we conserved the striated sphincter of the urinary bladder (Seminal colliculus). No blood has been seen into the urine starting with the 5th day post surgery in both patients.

The defecation and the urination went form better to normal from day one to day 10 post surgery in both cases.

Both patients became independent and autonomous after 10-12 days after surgery.

After 25 days we have observed the shrinkage of the prostate lodge at ultrasound check in both cases.

 

INTRODUCTION

 

Subtotal intracapsular resection of prostate adenoma with total ablation of the intraprostatic urethra and urinary continence preservation in dogs is an operation that has a high degree of difficulty and it is done in severe cases, acute blockage of the urinary and digestive transit, consecutive to total prostate volume augmentation. This is considered to be an emergency decision and a life saving operation.

Subtotal prostatectomy is indicated in valuable breeding dogs for benign prostatic hyperplasia in lieu of castration and in stable dogs with abscessation or cysts in lieu of drainage procedures (Fossum, Theresa Welch, 2002).

 

MATERIALS AND METHODS

 

The prostate is the accessory sex gland, the ducts of which (Ductuli prostatici) open beside the seminal colliculus. The prostate has a body (external part) with two glandular lobes and a slight disseminate part (internal part), the glandular lobules of which are located within the wall of the urethra and surrounded by the urethralis muscle. Prostate is the only gland in the dog and it is situated in the posterior abdomen in old dogs and in the pelvic cavity in young ones.

This gland covers the neck of the bladder and it has two lobes.

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Fig. 1. The topography of the organs in the posterior abdomen

and the pelvis in the dog (orig., adapt. from Budras, K. D., 2007)

2

Fig. 2. Male genitalia in the dog (orig., adapt. from Budras, K. D., 2007)

 

In the Clinic of Obstetrics and Gynaecology of the Faculty of Veterinary Medicine Bucharest, we have performed this surgery in 2 male dogs, common breed, with prostate adenoma, age 8 and 9 respectively. Blood tests, RX and ultrasound check have been performed for both of them before the surgery. The blood tests were normal, latero-lateral radiographs reveal the presence of a large mass in the posterior abdomen that moved the bladder and rectum dorso-cranially. In both dogs, the prostate covered more than 70% of the distance between the cranial edge of the pubis and the promontory. On ultrasound exam, prostate parenchyma was homogeneously, slightly hyperechoic.

prostata inainte 1

Fig. 3. Ultrasound exam, first case, shows prostate parenchyma

homogeneously, slightly hyperechoic, 6,43/4,54 cm diameter (orig.).

prostata inainte 2

Fig. 4. Ultrasound exam, second case, shows prostate parenchyma

homogeneously, slightly hyperechoic, 4,79 cm diameter (orig.).

 

Intracapsular subtotal prostatectomy starts, after laparotomy, with the incision of the ventral median septum with an electroscalpel. We used, for this incision, for the first time in veterinary medicine, the VIO 300D System which can be programmed for any individual work style, for a specific procedure or for any medical specialty.

DSC_3434

Fig. 5. VIO 300D System using the Bipolar Soft (orig.)

 

We used the spray coagulation mode and then combined it with the VIO’s BiClamp mode which reacts dynamically to the quality of the individual tissue and automatically adjusts the current output. Once the optimal degree of vessel or tissue fusion has been achieved, the electrosurgical activation is automatically switched off as an additional safety factor. We continued the incision through the parenchyma into the ventral urethra. Using the electroscalpel, we dissected all parenchyma except a 2 mm shell attached to the capsule. We resected all the urethra except a 1-2 cm dorsal strip, trying to maintain the integrity of the Seminal colliculus and not to reach the striate sphincter of the urinary bladder.

DSC_3597

Fig. 6. The spray coagulation mode of the VIO’s electroscalpel,

closing all the vessels (orig.)

3

 Fig. 7. The site of surgery. Anatomic view. (orig. adapt. from Budras, K. D., 2007)

 

We performed the lavage of the prostatic shell, sealed all the vessels with the spray coagulation mode and closed the capsule over a urethral catheter positioned in the urinary bladder. We used an approximating pattern for the first layer and an inverting pattern for the second layer of closure with 3-0 polydioxanone. Before closing the prostatic lodge and restoring all the anatomic layers, we had placed a drainage tube to collect all the residual urine from the prostatic lodge.

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Fig. 8. VIO’s BiClamp used to enter in the abdomen (top). Using the electroscalpel,

to dissect prostatic parenchyma (down). (orig.)

 

 

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Fig. 9. Prostatic lodge after removing the prostatic parenchyma. (orig.)

 

 

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Fig. 10. Suture of the prostatic capsule (top).

Prostatic lodge after closing the prostatic parenchyma (down). (orig.)

20130425_114423(0)

20130425_121425Fig. 11. The drainage tube placed to collect all the residual urine from the prostatic lodge (top).

Final image with the patient after the surgery (down). (orig.)

 

The drainage tube was removed after 5 days and the urethral catheter was maintained for 10 days.

We have used Ceftriaxone for the intravenous treatment, 25 mg/kg every 12 hours, for 3 days, then we continued with oral administration for another 7 days, raising the total daily dose to 35 mg/kg.

 

RESULTS AND DISCUSSIONS

 

The general body temperature was normal in both cases, we have observed a slight increase, but within normal limits in the first 3 days.

The urinary continence was not affected as we conserved the striated sphincter of the urinary bladder (Seminal colliculus). No blood has been reported into the urine starting with the 5th day post surgery in both patients.

The defecation and the urination went form better to normal from day one to day 10 post surgery in both cases.

Both patients became independent and autonomous 10-12 days after surgery.

After 25 days we have observed the shrinkage of the prostate lodge at ultrasound check in both cases.

prostata dupa

Fig. 12. Ultrasound exam, first case, shows prostate parenchyma

homogeneously, slightly hyperechoic, 2,04/2,09 cm diameter (orig.).

 

 prostata dupa 2Fig. 13. Ultrasound exam, second case, shows prostate parenchyma

homogeneously, slightly hyperechoic, 2,63/1,94 cm diameter (orig.).

 

 

CONCLUSIONS

 

Subtotal prostatectomy is the elective surgery in valuable breeding dogs for benign prostatic hyperplasia in lieu of castration and in stable dogs with abscessation or cysts in lieu of drainage procedures.

In dogs with bigger benign prostatic hyperplasia, it is easier to perform the subtotal prostatectomy due to the migration of the prostate to the abdominal cavity.

The spray coagulation mode combined with the VIO’s BiClamp mode makes the operation easier to perform due to the lack of haemorrhage.

Maintaining the integrity of the Seminal colliculus and not reaching the striate sphincter of the urinary bladder leads to success in preserving the urinary continence.

A drainage tube placed to collect all the residual urine from the prostatic lodge, before closing the prostatic lodge and restoring all the anatomic layers, helps in maintaining the normal body temperature.

The defecation and the urination went form better to normal from day one to day 10 post surgery in both cases.

After 25 days we have observed the shrinkage of the prostate lodge at ultrasound check in both cases.

 

ACKNOWLEDGEMENTS

The author would like to thank the staff from the Hospital of Urology Professor Theodor Burghele (Dr. Ion Dragomirişteanu) for the help in performing and adapting the techniques from human medicine to dogs.

We are also grateful to Dr. Ana Doicescu from ELMED medical for providing the ERBE System.

 

REFERENCES

Budras, K. D., McCarthy, P. H., Fricke, W., Renate Richter – Anatomy of the Dog, 2007, Fifth Edition, Schlütersche Verlagsgesellschaft mbH & Co. KG, Hans-Böckler-Allee 7, 30173 Hannover

Fossum, Theresa Welch – Small Animal Surgery, Second Edition, 2002, Mosby editure,  (ISBN 10: 0323012388 / ISBN 13: 9780323012386)

Freitag T, Jerram RM, Walker AM, Warman CG. – Surgical management of common canine prostatic conditions. Compend Contin Educ Vet. 2007 Nov;29(11):656-8, 660, 662-3 passim; quiz 673.

Morrison, W. B. – Cancer in dogs and cats: medical and surgical management, Second Edition, 2002, ISBN 1-893441-47-4, China

North, Susan M., Banks, Tania Ann – Small Animal Oncology: An Introduction, 2009 Elsevier Limited, ISBN: 978-0-7020-2800-7

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