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Therapeutic Management in Benign Prostatic

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Therapeutic Management in Benign Prostatic 6 Rev Rom Med Vet (2020) 30 | 4: 6-10 ISSN: 1220-3173; E-ISSN: 2457-7618 THERAPEUTIC MANAGEMENT IN BENIGN PROSTATIC HYPERTROPHY ASSOCIATED WITH PERIANAL HERNIA IN DOGS - CASE STUDY MANAGEMENTUL TERAPEUTIC ÎN HIPERTROFIA BENIGNĂ A PROSTATEI ASOCIATĂ CU HERNIA PERIANALĂ LA CÂINE - STUDIU DE CAZ G.M. BOBE1),2) , Diana Mihaela ALEXANDRU1) , M.C. UNGUREANU1) , Maria CRIVINEANU1),*) The association between perianal hernia and be- Asocierea herniei perianale cu hipertrofia benignă nign prostatic hypertrophy is commonly found in intact a prostatei este frecvent întâlnită la câinii masculi ne- male dogs aged over 5 years. Conservative drug the- castrați cu vârsta mai mare de 5 ani. Terapia conserva- rapy such as osaterone acetate is recommended when toare cu medicamente de tipul osateronului acetat the genetic value of reproduction, age or overlapping este recomandată atunci când valoarea genetică de conditions do not allow surgery. reproducție, vârsta sau afecțiunile suprapuse nu per- This case analyses the evolution of a dog diag- mit intervenția chirurgicală. nosed with benign prostatic hypertrophy associated Acest caz analizează evoluția unui câine diagnos- with bilateral perianal hernia, which initially followed a ticat cu hipertrofie benignă a prostatei asociată cu her- conservative treatment to maintain its reproductive nia perianală bilaterală, care inițial a urmat un trata- function, and later due to recurrence of symptoms ment conservativ pentru a-și păstra funcția reproduc- surgery was required. This case study highlights the tivă, urmând ca ulterior datorită recidivării simptoma- limited therapeutic efficacy of drug treatment com- tologiei să se recurgă la intervenția chirurgicală. Acest pared to surgical treatment. studiu de caz evidențiază eficacitatea terapeutică limi- Keywords: benign prostatic hypertrophy, tată a tratamentului medicamentos comparativ cu tra- perianal hernia, osaterone acetate, tamentul chirurgical. steroidal antiandrogens Cuvinte cheie: hipertrofia benignă a prostatei, hernia perianală, osateron acetat, steroizi antiandrogenici Perineal hernia occurs when the muscles of the tor ani and ischiourethralis muscles, bulbocavernosus pelvic diaphragm fail to support the rectal wall, thus and ischiocavernosus muscles (ventral hernia) (2, 9). appearing the persistence of rectal stasis and defec- The hernial contents are surrounded by a thin layer of tive defecation. The cause of pelvic diaphragm da- perineal fascia (hernial sac), subcutaneous tissue and mage is incompletely defined, but is believed to be skin. The hernial sac may contain pelvic or retroperito- associated with sex hormones and congenital or neal adipose tissue, serous fluid, deviated or dilated acquired muscle weakness. The pelvic diaphragm is rectum, a rectal diverticulum, prostate, bladder, or stronger in female dogs than in males. Pelvic dia- small intestine. Usually in cats, only the rectum is phragm atrophy, possibly of neurological origin, has found in the hernial sac (7, 9). also been reported. Any situation that causes an in- Perineal hernias are more common in dogs than in crease in intrapelvic pressure can accentuate the rup- cats. They occur almost exclusively in intact male dogs ture of the pelvic diaphragm (1, 3). (93%). Perineal hernias in females are often linked to Perianal hernia can be unilateral or bilateral. Most trauma. Dogs with short tails may be predisposed to herniations occur between the levator ani, external a- herniation. The most commonly affected are the nal sphincter and internal obturator muscles. There Boston Terrier, Boxer, Pekingese, Collie, Dachshund are also hernias between the sacrotuberous ligament breeds. Most perineal hernias occur in dogs over 5 and the coccygeus muscles (sciatic hernia), the leva- years of age. The average age is about 10 years (2, 3, 8). The main indication for this condition is surgery, 1) University of Agronomic Sciences and Veterinary Medicine, Faculty of Veterinary Medicine, Bucharest, Romania taking into account the whole symptomatic picture, 2) “Adorapet” Veterinary Clinic, Bucharest, Romania the overlapping conditions, the content of the hernial *) Corresponding author: [email protected] sac, the size of the prostate (3, 5). Rev Rom Med Vet (2020) 30 | 4 7 MATERIAL AND METHODS and urine samples were performed at a partner diag- nostic veterinary center. Case presentation A 7 years old, Jack Russel Terrier, was brought to RESULTS AND DISCUSSIONS the clinic for examination because the owner noticed that the dog had difficulties in defecating. The dog has By correlating the results of paraclinical investiga- Pedigree and it was used for breeding. The clinical exa- tions, the dog was diagnosed with benign prostatic mination showed a good general condition, the patient hypertrophy, urinary tract infection and bilateral peri- was normothermic with normal sensitivity to transab- anal hernia. dominal palpation. Rectal examination was also Biochemical and haematological analysis revealed performed, which showed an increase in the volume of normal levels (Tables 1 and 2). the prostate and the presence of a rectal diverticulum Urine summary evaluation showed: increased on the right side. specific urinary density, pH 8 and proteinuria. Staphy- In order to establish a diagnosis and the thera- lococcus pseudintermedius colonies (> 100,000 cfu / peutic management, it was decided to perform a set of mL of urine) developed on culture media. After perfor- paraclinical investigations. Blood tests were per- ming the antibiogram, it was found that Staphylo- formed - biochemistry and haematology, urine sedi- coccus pseudintermedius is sensitive to: amoxicillin + ment and summary examination, urine culture, abdo- clavulanic acid, cephalexin, cefazolin, cefoxitin, imi- minal ultrasound and ultrasound-guided puncture of penem, trimethoprim + sulfamethoxazole, enrofloxa- the prostate, abdominal radiography. cin, marbofloxacin, oxytetracycline, cephalothin, and Blood samples were collected and used for bioche- it is resistant to ampicillin, chloramphenicol, erythro- mical and haematological analysis. Biochemical analy- mycin, tetracycline, penicillin. sis was performed with Spotchem SP-4430 (Arkray, The abdominal ultrasound showed a prostate with Japan) and haematological tests were performed with a homogeneous structure, slightly hyperechoic, regu- BC-2800 vet (Mindray, China). Abdominal ultrasound lar contour, with the size of 34.3 mm / 43.4 mm. After was performed with M5vet (Mindray, China). The pros- examination of the sample collected by ultrasound- tate puncture was performed and the sample was sent guided puncture, cellularity specific to benign pros- to a partner veterinary laboratory. Also, radiographs tatic hypertrophy was identified (Fig. 1) (6). 8 Rev Rom Med Vet (2020) 30 | 4 It inhibits the effects of excess male hormones (testosterone) through various mechanisms: it pre- vents androgens from binding to their prostate recep- tors and blocks the transport of testosterone into the prostate. No adverse effects on sperm quality were observed (4, 10). In order to obtain the remission of urinary tract infection, Enrofloxacin was administered at a dose of 5 mg /kg, twice per day for 21 days. It was recommended to take one teaspoon of Laxavet twice per day and Florentero probiotics 1 per day. A diet rich in soluble and insoluble fibre, prebiotics and probiotics has also been recommended. Given the complications that can occur in the case of perineal hernia, surgery was recommended to cor- rect muscle defects. General anaesthesia was per- Fig. 1. Transabdominal ultrasound image of the formed with midazolam 0.2 mg / kg IM, butorphanol prostate of the presented case indicating benign 0.15 mg / kg IM + ketamine 10 mg / kg IV. prostatic hypertrophy. The prostate is symmetrically The surgical approach was performed as follows: a enlarged and normoechoic to slightly hyperechoic curvilinear incision was made starting from the cranial to the coccygeal muscles, curving over the hernia sac Following the radiological examination, it was ob- 2 cm laterally to the anus and extending up to 2-3 cm served the partial prolapse of the prostate in the pelvic ventrally on the pelvic floor. The hernial contents were duct and that the pelvis and the spine had normal con- identified and reduced by subcutaneous dissection formation (Fig. 2). (Fig. 3) (7). Fig. 3. Intraoperative aspect of hernial sac, weakening Fig. 2. Left lateral abdominal radiographs of the of the fascia and muscles of the perineum presented case indicating the partial prolapse of the prostate in the pelvic duct and the ventral deviation of The muscles involved in the hernia, the internal the urinary bladder pudendal artery and vein, the pudendal nerve, the caudal rectal vessels and the sacrotuberous nerve and Taking into account the high genetic value of the ligament were identified. The suture with non-absor- patient, it was established the initiation of the con- bable 2/0 monofilament thread was started between servative therapeutic management and the postpone- the external sphincter and the levator years, and the ment of the orchidectomy operation. The purpose of coccygeal muscles. The sutures were placed at a dis- the treatment was: to decrease in prostate size, the tance of 1 cm. Sutures were made in the ventral area remission of urinary tract infection, ensuring a normal between the external anal sphincter and the internal intestinal transit, and the prevention of constipation. obturator muscle. Blood vessels and nerves have been
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