Case Study

Benign prostatic hyperplasia, prostatic cysts, and bilateral abdominal cryptorchidism in a 7 year old MI German Shepherd Dog

A 7 year old male intact German Shepherd Dog was presented for evaluation due to not defecating for the past few days, dribbling urine, and exhibiting lethargy. The patient was also cryptorchid, but the testicles had not been found surgically. On rectal palpation, digital entrance to the rectum was obstructed. UA and CBC/Chem were not available at the time of the sonogram.

DX

Benign prostatic hyperplasia, complex prostatic pelvic cyst, bilateral hydroureter, bilateral intraabdominal cryptorchidism

Sonographic Differential Diagnosis

Large, pelvic prostatic cyst. Dilated prostatic urethra, due to cyst impingement. Bilateral hydroureter, due to prostatic impingement on the ureteral entry into the urinary bladder. Chronic moderate renal changes, secondary to chronic hydronephrosis. Bilateral intraabdominal cryptorchid. There was no overt evidence of neoplasia.

Image Interpretation

The left testicle was retained in this patient and measured 3.24 x 1.5 cm with a hypoechoic, nodular change. Both testicles were intraabdominal. The left testicle was lateral to the urinary bladder at the region of the cystourethral junction. The right testicle was also retained near the mid duodenum and measured 3.64 cm. The prostate was enlarged with a dilated prostatic urethra. A large mixed echoic cyst at the caudal aspect of the prostate measured 11.2 x 7.3 cm. This is consistent with prostatic cyst and/or abscessation. The cystic portions of the prostate appeared to enter into the pelvic canal in this patient. The prostatic presentation would be most consistent with benign hypertrophy and secondary cystic change with potential abscessation. Bilateral ureteral dilation was noted in this patient; it is likely the ureters were obstructed by the prostatic pathology.

Outcome

The dog went to OSU Vet school and had another ultrasound. Benign BPH with large prostatic cyst was diagnosed. No other follow up is available.

Comments

Ultrasound-guided drainage of the cysts as well as bilateral cryptorchid removal would be recommended and should allow for adequate urine flow. The cyst may be approached surgically; however, it may be difficult to manipulate in the pelvic canal. The sonographer may be able to reach to the prostatic cyst through a perineal approach or intraabdominal approach. However, abdominal surgery for bilateral cryptorchid removal would be recommended. Urine culture and sensitivity would be recommended as well with recheck sonogram in 4 weeks after surgery has been performed as well as prostatic drainage. Aggressive antibiotic therapy such as Enrofloxacin and Ampicillin combination would be recommended.

Clinical Differential Diagnosis

Urinary symptoms – prostatic disease (benign hyperplasia, cystic hyperplasia, prostatitis, neoplasia, abscessation). Rectal occlusion – intra-pelvic neoplasia, abscess, granuloma, lymphadenomegaly.