Dear all,

Dear all,

This is KENZO, a 7year old, male intact, 31kg Bernese Mountain dog. History of severe tenesmus. Probably strnaguria, too. History is unclear to me, im just performing US. Patient had a general abd US. Findings revealed the prostatic severe enlargement and irregular pattern with cystic/cavernous formations, there was mild free fluid around the neck of bladder. Left medial iliac LN enlarged and hyperechoic but not distorted; there was mildly dishomogeneous liver parenchyma with poorly defined hypoechoic areas/nodules. My suggestion at that time was proceeding to ADAIN procedure. After 2+ weeks (where dog was on oral baytril) and no response was obtained, the neutering and prostatic procedure where booked.

So these are the clips and I am posting for a few reasons. It is the first time I have done this and I would like some reassurance and I have few questions. Also, I think it is cool seeing the cyst shrinking and I feel like sharing and I have nobody that would understand why I am so excited…(bare in mind it is the first time I do it).

I had read as much as possible about the procedure before attempting and the prostate is so big I felt quite confident I could get to the lesions. I just want to check few minor (or major) details.

I did the castration first, then attempted the prostatic sampling (I thought this is the order to follow due to clean-less clean procedure (potential abscess?) logic…). Does it matter?. Also, I had pre-treated the patient with Vit K although all blood work was normal (however, there was no APTT/PT test done for a couple of reasons: our lab is not very reliable, and dog did not seem to have any hepatic or platelets issue, so considering it was FNA rather than biopsy…I proceeded without it.

I did not have a 14g-16g IV catheter and I was concerned about it…I used a 18g 1.5inch needle attached to a 5ml syringe. I measured the distance from skin to middle of cyst before attempting so that I knew it was possible. I was aiming for draining the 2 bigger cavernous structures. I must say I got them straight away and there has been no complications of bleeding ( I check after procedure and 2hours later). There were no complications of any kinds, to be honest but I am very concerned about the number of pokes I did. So…here is my question. each cyst is in different lobes, which means I poked twice for draining and once for the AB injection (I used a 23gneedle).

The content was clear serous in both cysts…so no pus:(. So now I am worried at neoplasia (well, I was worried even before cause the prostate looks very nasty) and at having increased the risk of spreading (a potential neoplasia, that is) by the 3 pokes… Is it a reason to worry???…Should have I done it differently? Would the catheter had minimized the number of pokes? ( I assummed the catheter is more for a more continuous drainage of a larger volume…)

From the samples, we are culturing and sending for cytology  (spun and selected the sediment and also FNA cytology of parenchyma) to external lab. I kept a couple of slides for me but I havent had time to look at them yet. I am sending dog on baytril for 4 weeks initially (and US review then) and also from 24h after procedure I wanted to start pyroxicam (0.3mg/kg every other day+sucralfate) ..any objections to this?.

I performed a FNA of the noncystic parenchyma, too…now I realized that I could have used one of the needles from the cystic lesion and after having drained the cyst, have the needle redirected into parenchyma and do a jab motion…to save one poke…(is that possible? any reasons why it may not be recommended?).

Finally…I got disappointed at the look of the prostate after drainage…it still looked very much cavernous and filled with fluid:( I think the cystic lesions may be interconnected…

I think these is all I had to share…I apologize for the long post…I hope I can learn more about this for the next one.

Thanks in advance for any input.