Total Perineal Prostatectomy: A Retrospective Study in Six Dogs

Perineal hernia refers to the herniation of pelvic and abdominal viscera into the subcutaneous perineal region through a pelvic diaphragm weakness: a concomitant prostatic disease is observed in 25–59% of cases. Prostatectomy involves the removal of the prostate, either partially (partial prostatectomy) or completely (total prostatectomy). In case of complicated perineal hernia, staged procedures are recommended: celiotomy in order to perform colopexy, vasopexy, cystopexy, and/or to treat the prostatic disease, and perineal access in order to repair the perineal hernia. Very few reports relate prostatectomy using a perineal approach and, to the extent of the author’s knowledge, this technique has not been thoroughly investigated in the literature. The aim of this article is to retrospectively describe the total perineal prostatectomy in dogs presenting perineal hernia with concomitant prostatic diseases which required the removal of the gland. The experience in six dogs (three dogs with the prostate within hernial contents and three dogs with intrapelvic prostate) is reported as well as advantages, disadvantages, and limitations of the surgical procedure. In the authors’ clinical practice, total perineal prostatectomy has been a useful surgical approach to canine prostatic diseases, proven to be safe, well tolerated, and effective.

MRI Finding of Prostatic Ductal Adenocarcinoma

Ductal adenocarcinoma is a variant of prostatic adenocarcinoma, originating from the epithelial lining of the primary and secondary ducts of the prostate. We report a 63-year-old male with prostatic ductal adenocarcinoma, presenting as urinary retention and a prostate-specific antigen (PSA) level of 11.71 ng/mL and biopsy-proven prostate cancer (Gleason score 3 + 3). MRI showed 2 hemorrhagic, multilocular cysts projecting into the bladder side from the prostatic inner gland and between the prostate and the right seminal vesicle. The prostate inner gland showed high signal intensity on the T2-weighted image and included tiny hyperintense spots on the fat-suppression T1-weighted image. In the part of the border of the hemorrhagic, multilocular cyst, a solid portion showing slight low intensity on T1-weigthed imaging and markedly restricted diffusion was observed, suggesting prostate cancer. He underwent total prostatectomy, and ductal adenocarcinoma (Gleason score 4 + 4) in the prostate inner gland and multilocular cysts was pathologically diagnosed. After the operation, his PSA level gradually increased, and MRI 8 months after the operation showed a vesical multilocular cyst, suggesting local recurrence. After he underwent radiation therapy and hormonal therapy, PSA level decreased, and no re-recurrence was observed during 8 years. We suggest its inclusion in the differential diagnosis of cases of prostatic ductal adenocarcinoma’s multiloculated cystic formation around the prostate and the bladder.

Assessment of Periprostatic and Subcutaneous Adipose Tissue Lipolysis and Adipocyte Size from Men with Localized Prostate Cancer

The prostate is surrounded by periprostatic adipose tissue (PPAT), the thickness of which has been associated with more aggressive prostate cancer (PCa). There are limited data regarding the functional characteristics of PPAT, how it compares to subcutaneous adipose tissue (SAT), and whether in a setting of localized PCa, these traits are altered by obesity or disease aggressiveness. PPAT and SAT were collected from 60 men (age: 42–78 years, BMI: 21.3–35.6 kg/m2) undergoing total prostatectomy for PCa. Compared to SAT, adipocytes in PPAT were smaller, had the same basal rates of fatty acid release (lipolysis) yet released less polyunsaturated fatty acid species, and were more sensitive to isoproterenol-stimulated lipolysis. Basal lipolysis of PPAT was increased in men diagnosed with less aggressive PCa (Gleason score (GS) ≤ 3 + 4) compared to men with more aggressive PCa (GS ≥ 4 + 3) but no other measured adipocyte parameters related to PCa aggressiveness. Likewise, there was no difference in PPAT lipid biology between lean and obese men. In conclusion, lipid biological features of PPAT do differ from SAT; however, we did not observe any meaningful difference in ex vivo PPAT biology that is associated with PCa aggressiveness or obesity. As such, our findings do not support a relationship between altered PCa behavior in obese men and the metabolic reprogramming of PPAT.

Inadvertent iatrogenic prostatectomy and urethrectomy in 2 dogs

Two dogs were referred because of dysuria following inadvertent iatrogenic total prostatectomy and urethrectomy. In both cases an existing perineal hernia was not recognized by the referring veterinarians and the caudally herniated prostate gland was diagnosed as a perianal neoplasia and subsequently removed. Both dogs were treated with isolation of the urinary bladder from the urethra and a permanent prepubic cystostomy tube.

Total prostatectomy combined with urethral anastomosis in a dog: a case report

Prostate cancer is the most common prostate disease diagnosed in castrated dogs. However, prostate cancer is considered to be quite rare in dog population. The presence of prostate tumours can lead to urethral obstruction. Other clinical signs include asymmetric, painful, hard growths on rectal examination, neurological deficit or lameness of the pelvic limbs and general symptoms such as anorexia, weight loss or difficult urination. The neoplastic process may spread to the neighbouring organs and give metastases to the lymph nodes, lungs and skeletal system. Patient with histopathologically confirmed prostate cancer should be examined for metastases. The prognosis is usually unfavourable because of late diagnosis and the presence of metastases. Therapeutic options include surgery, chemotherapy and radiotherapy. Complete prostatectomy carries with it many complications and often requires osteotomy of pelvic fusions. For that reason, total prostatectomy is not commonly performed in companion animals; however, it should be considered in cases of early detection with the absence of metastases. This report presents the procedure of a complete prostatectomy in a dog with a pre-pubic anastomosis of the urethra, without osteotomy of the pelvic septum. The anastomosis of the urinary tract was placed outside the abdominal cavity, caudally from the laparotomy wound. The presented technique seems to be appropriate for the treatment of malignant tumours of the prostate gland in dogs.