Case Study

Benign prostatic hyperplasia and prostatic cyst drainage in a 11 year old MI Staffordshire Bull Terrier

An 11-year-old MI Staffordshire Bull Terrier was presented for hematuria with no signs of straining. On physical examination, the prostate was not palpable on rectal examination. Bilirubinuria and hematuria was evident on urinalysis. Although the urine culture was negative, the patient was treated with a course of antibiotics. Ultrasonography and castration were recommended. Urinalysis showed only hematuria. Abnormalities on CBC and blood chemistry were elevated HCT, low MCHC, neutrophilia, lymphopenia, elevated CK, and high Anion Gap. Total T-4 and free t-4 were both normal.

DX

Benign prostatic hyperplasia and prostatic cyst

Sonographic Differential Diagnosis

Benign prostatic hypertrophy with cyst formation and prostatitis likely. Mild potential for neoplasia.

Image Interpretation

A mixed echogenic, nodular and cystic prostate is noted, The cysts derive form the caudal aspects of the prostatic lobes and enter the pelvic inlet. The lobes of the prostate obscure the visibility of the urethra and deviate the colon indicating that the prostatic pathology is causing clinical signs in both organ systems.

Outcome

Attempts to follow-up with owner to schedule a neuter appointment were unsuccessful.

Comments

With this type of interventional ultrasound, neuter and aggressive antibiotic treatment with quinolones or sulphamides provide the best results. Without neutering, the cyst drainage is only palliative. The antibiotics may not have been necessary after evaluating the cytology report, but were used regardless as an empirical measure while the patient was sedated for the drainage procedure in case infectious cytology was eventually found.

Clinical Differential Diagnosis

Bladder disease – uroliths, bacterial cystitis, neoplasia. Prostatic disease – benign hyperplasia, prostatitis, abscessation, cysts, neoplasia.

Sampling

US-guided drainage of the cysts, antibiotic injection of the prostatic cavities, and parenchymal FNA were all performed. Cytology taken from prostatic parenchyma and prostatic cyst showed normal-to-hyperplastic prostatic epithelial cells and cystic fluid.