Influence of conventional versus unidirectional barbed suture on leakage pressures in canine vesicourethral anastomosis: An ex-vivo study.

OBJECTIVE: To compare leakage pressures of vesicourethral anastomosis (VUA) performed with conventional and unidirectional barbed sutures in canine cadaveric tissue. STUDY DESIGN: Experimental, ex-vivo, randomized study. ANIMALS: A total of 24 male canine bladders with the urethra. METHODS: Specimens after prostatectomy were randomly divided into a unidirectional barbed suture (UBS) or a conventional suture (C) group. For the UBS group, the VUA was performed with 4-0 unidirectional barbed sutures. For the C group, the VUA was performed with 4-0 monofilament absorbable suture. The VUA was completed with two simple continuous sutures. Surgical time, leakage pressure, site of leakage, and the number of suture bites were recorded. RESULTS: The median suturing time was 12.70 minutes (range: 7.50-16.10 min) for the UBS group and 17.30 minutes (range: 14.00-21.30 min) for the C group (p < .0002). The median leakage pressure was 8.60 mmHg (range: 5.00-17.20 mmHg) for the UBS group and 11.70 mmHg (range: 6.00-18.50 mmHg) for the C group (p = .236). The median number of suture bites was 14 (range:11-27) for the UBS group and 19 (range:17-28) for the C group (p = .012). CONCLUSION: Unidirectional barbed suture does not statistically affect the acute leakage pressure of VUA in normal cadaveric specimen. It resulted in a shorter surgical time and fewer suture bite placements. CLINICAL SIGNIFICANCE: A urinary catheter will still be required when a unidirectional barbed suture is used to complete a VUA in dogs to prevent extravasation of urine in the postoperative period.

First robot-assisted radical prostatectomy in a client-owned Bernese mountain dog with prostatic adenocarcinoma.

OBJECTIVE: To describe robot-assisted radical prostatectomy (RARP) and report the short-term outcome of a dog with prostatic cancer treated with RARP. STUDY DESIGN: Case report ANIMALS: Client-owned 6-year-old male-neutered Bernese mountain dog. METHODS: Robot-assisted radical prostatectomy was performed with a daVinci Si Surgical System through a transperitoneal approach. An interfascial nerve-sparing approach was used to preserve the neurovascular bundles and increase the likelihood of postoperative urinary continence. Urinary continence was assessed by placing white cloth bedding in the kennel during hospitalization and by owners' observation at home. RESULTS: The console time was 120 minutes, and the estimated intraoperative blood loss was 30 mL. No intraoperative complications were observed. The urinary catheter was removed after 7 days, at which point the dog urinated normally. Peritoneal carcinomatosis was diagnosed 43 days after surgery, and the dog was euthanized. CONCLUSION: Robot-assisted radical prostatectomy was successfully completed in a dog with prostatic neoplasia and led to postoperative urinary continence. CLINICAL SIGNIFICANCE: This single-case report provides evidence to justify further evaluation of RARP in dogs with prostatic neoplasms.

Total prostatectomy as a treatment for prostatic carcinoma in 25 dogs.

OBJECTIVE: To describe the complications and outcome after total prostatectomy in dogs with histologically confirmed prostatic carcinoma. STUDY DESIGN: Multi-institutional retrospective case series. ANIMALS: 25 client-owned dogs. METHODS: Medical records of dogs undergoing total prostatectomy were reviewed from 2004 to 2016. Data retrieved included signalment, presenting signs, preoperative clinical findings, laboratory data, diagnostic imaging, surgical technique, histologic diagnosis, postoperative complications, occurrence of postoperative metastasis, and survival. RESULTS: Twenty-five dogs underwent total prostatectomy for prostatic carcinoma. Urinary anastomotic techniques included urethrourethral anastomosis in 14 dogs, cystourethral anastomosis in 9 dogs, ureterocolonic anastomosis in 1 dog, and anastomosis between the bladder neck and penile urethra in 1 dog. All dogs survived to discharge. Fifteen dogs were diagnosed with transitional cell carcinoma, 8 dogs with prostatic adenocarcinoma, 1 with prostatic cystadenocarcinoma, and 1 with an undifferentiated carcinoma. Permanent postoperative urinary incontinence was present in 8 of 23 dogs. The median survival time was shorter in dogs with extracapsular tumor extension compared with those with intracapsular tumors. The overall median survival time was 231 days (range, 24-1255), with 1- and 2-year survival rates equal to 32% and 12%, respectively. CONCLUSION AND CLINICAL SIGNIFICANCE: Total prostatectomy, combined with adjunct therapies, prolongs survival and lowers complication rates compared to previous reports of dogs with prostatic carcinoma. It should be noted, however, that case selection likely played a significant role in postoperative outcome.

Total cysto-prostatectomy: Technique description and results in 2 dogs.

We describe a novel technique for total cysto-prostatectomy, followed by uretero-urethral anastomosis in 2 dogs. The technique was successful and was performed without pubic osteotomy. Post-operative urinary tract infections may be a potentially serious event.

Cysto-prostatectomie totale : description technique et résultats chez 2 chiens. Nous décrivons une technique innovatrice pour la cysto-prostatectomie totale, suivie d'une anastomose urétéro-urétrale chez 2 chiens. La technique a été réussie et réalisée sans l'ostéotomie du pubis. Les infections postopératoires des voies urinaires peuvent représenter une réaction indésirable potentiellement grave.(Traduit par Isabelle Vallières).

Placement of an artificial urethral sphincter for treatment of passive urinary incontinence after inadvertent prostatectomy and balloon dilation treatment for stricture formation in a 5-month-old dog.

OBJECTIVE: Describe the management of incontinence with several therapies, culminating with the apparently successful treatment utilizing artificial sphincter placement following an inadvertent prostatectomy. ANIMAL: 5-month-old 7.5-kg male neutered Miniature Schnauzer. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES: The patient was referred for dysuria and persistent stranguria following an iatrogenic total prostatectomy and urethrectomy. An extra pelvic urethral anastomosis was performed, followed by hospitalization for 2 weeks with a urinary catheter. The patient was further investigated for persistent stranguria, and a contrast urethrogram revealed a urethral stricture at the anastomosis site, which was treated with fluoroscopic balloon dilation. The stranguria resolved, but an acute nocturnal grade 3 passive urinary incontinence occurred, which was nonresponsive to medical management of phenylpropanolamine hydrochloride and estriol. An artificial urethral sphincter was placed, leading to continence after 5 top-ups to a total volume of 0.9 mL. The patient remained continent for 5.5 weeks before abrupt incontinence recurred, which was resolved by another 0.1-mL top-up. No further signs of incontinence occurred in the 11 months following. TREATMENT AND OUTCOME: The placement of an artificial urethral sphincter successfully managed urinary incontinence in this patient. Continence was achieved with no significant complications other than a transient loss of continence. Long-term follow-up 14 months after sphincter placement revealed that the patient had remained continent since the final sphincter top-up. The owner reported a significant improvement in the patient's quality of life following successful incontinence management. CLINICAL RELEVANCE: This case highlighted the benefits of placing an artificial urethral sphincter in managing urinary incontinence after select cases of prostatectomy in dogs that are unresponsive to medical management.

Anuria due to inadvertent prostatectomy during cryptorchidectomy.

This report describes an 8-month-old male Labrador retriever dog that was evaluated for a 2-day history of anuria and vomiting following a suspected inadvertent prostatectomy during a cryptorchidectomy. A positive contrast urethrogram was performed to definitively diagnose the absence of a patent prostatic urethra and necropsy confirmed inadvertent prostatectomy.

Anurie attribuable à une prostatectomie par inadvertance durant une cryptorchidectomie. Ce rapport décrit un chien Labrador Retriever mâle âgé de 8 mois qui a été évalué pour une anamnèse de 2 jours d'anurie et de vomissements suite à une prostatectomie par inadvertance suspectée durant une cryptorchidectomie. Une urétrographie à contraste positif a été réalisée pour diagnostiquer définitivement l'absence d'une urètre prostatique et la nécropsie a confirmé une prostatectomie par inadvertance.(Traduit par Isabelle Vallières).

Suture-related urolithiasis following repair of inadvertent prostatectomy in a dog.

A 10-month-old male chow chow mixed breed dog was presented for anuria secondary to inadvertent prostatectomy performed during unilateral cryptorchidectomy. Surgical repair was successfully performed; however, this resulted in suture-associated urolith formation 3 months later, requiring a second surgical intervention and urethrostomy.

Preclinical Evaluation of the Versius Surgical System, a New Robot-assisted Surgical Device for Use in Minimal Access Renal and Prostate Surgery.

BACKGROUND: Minimal access surgery (MAS) is well-established in urological surgery. However, MAS is technically demanding and associated with a prolonged learning curve. Robot-assisted laparoscopy has made progress in overcoming these challenges. OBJECTIVE: The aim of this study was to evaluate the feasibility of a new robot-assisted surgical system (the Versius Surgical System; CMR Surgical, Cambridge, UK) for renal and prostate procedures in a preclinical setting, at the IDEAL-D phase 0. DESIGN, SETTING, AND PARTICIPANTS: Cadaveric sessions were conducted to evaluate the ability of the system to complete all surgical steps required for a radical nephrectomy, prostatectomy, and pelvic lymph node dissection. A live animal (porcine) model was also used to assess the surgical device in performing radical nephrectomy safely and effectively. Procedures were performed by experienced renal and prostate surgeons, supported by a full operating room team. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Surgical access and reach were evaluated by the lead surgeon using a visual analogue scale. The precise surgical steps conducted to make the assessment that the procedures could be completed fully were recorded, as well as instruments used (including manual laparoscopic instruments) and endoscope angle. RESULTS AND LIMITATIONS: In total, all 24 procedures were completed successfully in cadavers by eight different lead surgeons. Positioning of the ports and bedside units reflected the lead surgeon's preferred laparoscopic set-up and enabled good surgical access and reach, as quantified by a median visual analogue score of ≥6.5. Radical nephrectomies performed in pigs were all completed successfully, with no device- or non-device-related intraoperative complications recorded. Testing in human cadavers and pig models balances the bias introduced by each model; however, it is impossible to completely replicate the experience and performance of the robot for surgery in live humans. CONCLUSIONS: This is the first preclinical assessment of the Versius Surgical System for renal and prostate procedures. The safety and effectiveness of the system have been demonstrated and warrant progressive assessment in a clinical setting utilising the IDEAL-D framework. PATIENT SUMMARY: In this report, we looked at the usability of a new robot-assisted surgical device for renal and prostate surgery by testing the system in cadavers and pigs. We found that a number of different surgeons and operating team personnel were able to use the system to successfully complete the procedures under evaluation. We conclude that the system is ready to be tested in live human studies.

Prostatic leiomyosarcoma in a dog treated using a multimodal approach.

Prostatic leiomyosarcoma is an uncommon tumor encountered in male dogs, with only 2 cases reported in the veterinary literature with no follow-up described. A 12-year-old male intact German Wirehaired Pointer presented for evaluation of straining to defecate and urinate. Whole body computed tomography (CT) examination identified a spherical multicavitary expansile mass arising from the prostate gland and severely obliterating the pelvic canal. Partial subcapsular prostatectomy was performed, and histological and immunohistochemical results were consistent with prostatic leiomyosarcoma. Metronomic cyclophosphamide and nonsteroidal anti-inflammatory drugs were administered as adjuvant chemotherapy. Follow-up CT 10 months later indicated no signs of recurrence or metastasis. To the best of our knowledge, this patient represents the first report of successful multidisciplinary treatment consisting of partial subcapsular prostatectomy and adjuvant chemotherapy for prostatic leiomyosarcoma in a dog. After 15 months of follow-up, the patient remained recurrence-free without metastasis.

Porcine small intestinal submucosa augmentation urethroplasty and balloon dilatation of a urethral stricture secondary to inadvertent prostatectomy in a dog.

A 10-month-old, male German shepherd dog experienced inadvertent prostatectomy during cryptorchidectomy. Cystourethral anastomosis was performed 1 day later. The dog developed stranguria and incontinence. A proximal urethral stricture was diagnosed with a contrast urethrogram 5 weeks later. Urethral augmentation with an onlay graft of porcine small intestinal submucosa was performed. Urinary diversion was accomplished with a urethral catheter followed by a cystostomy tube. The stricture recurred over the next 6 weeks. Three urethral balloon dilatations were performed 3 days apart, with the third attempt resulting in expansion of the stricture. Twenty-two months postdilatation, the dog intermittently urinated with a steady stream and had mild to moderate urinary incontinence.

Prostatectomy as a treatment for canine prostate cancer: a literature review.

Canine prostate cancer is a relatively rare condition that accounts for less than 1% of all cancers diagnosed in dogs (Obradovich et al., 1987; Bryan et al., 2007). Out of 431 dogs with prostatic conditions diagnosed in a Dutch center, 56 suffered from prostatic carcinoma (Teske et al., 2002). Several forms have been identified, of which adenocarcinoma (AC), transitional cell carcinoma (TCC), and undifferentiated cell carcinoma are the most common (Bennett et al., 2018; Cunto et al., 2019).

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.

Preliminary results of intraoperative photodynamic therapy with 5-aminolevulinic acid in dogs with prostate carcinoma.

Six client-owned dogs with prostate carcinoma were treated with a combination of (1) partial subcapsular prostatectomy using an Nd:YAG laser, (2) intraoperative photodynamic therapy using a halogen broad band lamp after local administration of a photosensitiser, and (3) systemic treatment with meloxicam. Median survival time was 41days (range 10-68days), which compared negatively with previous reports of subtotal laser prostatectomy combined with topical interleukin-2 administration, and photodynamic therapy alone. Despite treatment, the disease progressed locally, causing signs of stranguria to recur, and in the form of distant metastases. The recurrence of clinical signs due to the primary tumour despite photodynamic therapy is probably largely explained by insufficient penetration of light into the tissue. Better results may be obtained using other light sources (e.g. laser) and alternative techniques of light delivery, such as fibres or catheters allowing interstitial diffusion of light.

Subtotal intracapsular prostatectomy as a useful treatment for advanced-stage prostatic malignancies.

OBJECTIVES: Palliative surgery for advanced-stage prostatic cancers was tested with regard to survival rate and complications in a prospective randomised clinical study of dogs. Currently, therapeutic approaches have a grave long-term prognosis in clinically significant prostatic cancer. METHODS: Of 167 dogs with prostatic disorders, 24 were diagnosed with prostatic cancer. Eleven dogs underwent subtotal intracapsular prostatectomy, while in 10 dogs total prostatectomy was performed. The remaining three dogs were euthanased at their owner's request. Dogs treated by subtotal intracapsular prostatectomy and those treated by total prostatectomy were followed until their death. RESULTS: It was found that dogs treated by subtotal intracapsular prostatectomy survived 5.63 times longer (mean [sd] 112.0 [63.03] days) than those treated by total prostatectomy (19.9 [10.67] days) (P<0.01). Moreover, a significant decrease in postoperative complications after subtotal intracapsular prostatectomy was recorded, especially with regard to urinary incontinence. CLINICAL SIGNIFICANCE: It was concluded that, in the authors' facility, treatment of prostatic cancer by subtotal intracapsular prostatectomy was superior to that by total prostatectomy, with respect to both postoperative survival and serious complications.

Urinary bladder retroversion and neourethrocystostomy for treatment of inadvertent prostatectomy and urethrectomy in a dog.

CASE DESCRIPTION A 15-month-old male Newfoundland was examined because of an inability to urinate, lethargy, inappetence, and intermittent vomiting that first became evident after bilateral cryptorchidectomy 2 days previously. The patient was referred for further evaluation and treatment. CLINICAL FINDINGS Results of physical examination, serum biochemical analysis, and abdominocentesis led to a diagnosis of uroperitoneum. Retrograde cystography indicated urinary tract obstruction. In view of the history of recent elective cryptorchidectomy, a diagnosis of uroperitoneum with urethral obstruction secondary to iatrogenic prostatectomy and urethrectomy was made. TREATMENT AND OUTCOME During a ventral midline celiotomy, the inadvertent prostatectomy and urethrectomy were found to have resulted in insufficient urethral length for primary repair. Surgical repair of the urethral defect was achieved by means of a novel technique of bladder retroversion and neourethrocystostomy at the apex of the bladder. A urethral stricture evident 1.5 months after surgery was initially treated with balloon dilatation, followed by temporary and then permanent placement of a self-expanding metallic stent. At the last follow-up 6.6 years after stent placement, the dog remained continent while receiving phenylpropanolamine and the owner was highly satisfied with the outcome. CLINICAL RELEVANCE Caudal intraabdominal bladder retroversion with apex neourethrocystostomy may be a viable alternative to more complex urethral lengthening procedures in dogs and can potentially preserve lower urinary tract function. This treatment might be considered for patients with urethral trauma or malignant neoplasia necessitating extensive urethral resection. Urethral strictures may be effectively managed with stenting.

Transurethral canine prostatectomy with the Nd:YAG laser.

Although laser energy in combination with conventional techniques has been used to ablate prostatic tissue in the dog, the use of the Nd:YAG laser alone to perform transurethral prostatectomies has not been feasible because of the difficulty of directing the laser energy into the prostate. In this study, a 600-microns quartz laser fiber with an attached gold-plated metal alloy reflector and a 1.06-microns Nd:YAG laser were used to perform transurethral laser prostatectomies in 10 mongrel dogs. Each dog received approximately 3600 J to each quadrant of the prostate. No signs of urinary incontinence were noted in any of the dogs postoperatively. Transurethral laser prostatectomies can be performed safely and effectively in the dog and can significantly decrease the incidence of postoperative urinary incontinence.

Noninvasive ultrasonic subtotal ablation of the prostate in dogs.

OBJECTIVE: To determine whether high-intensity focused ultrasound (HIFU) can be used for subtotal ablation of the prostate gland in dogs without causing damage to surrounding tissues. DESIGN: Experimental trial. ANIMALS: Adult hounds > or = 5 years old and weighing between 20 and 30 kg. PROCEDURE: Prostatic ablation was performed in all dogs, using a transrectal HIFU probe. Acute effects of HIFU treatment were evaluated in 4 dogs. These dogs were euthanatized and necropsied 4 hours after the procedure. Chronic effects were evaluated in the other 3 dogs. Serial CBC, serum biochemical analyses, urinalyses, and transrectal ultrasonography were performed. Dogs were euthanatized and necropsied 3 months (1 dog) or 1 year (2 dogs) after HIFU treatment. RESULTS: Histologic examination of the prostate glands from the 4 dogs euthanatized 4 hours after treatment revealed that 80 to 90% of the gland had undergone hemorrhagic, liquefactive necrosis. Only slight discoloration of the prostatic capsule was detected, and there were not any gross or histologic lesions of the rectal mucosa or urinary bladder. All 3 dogs followed up after HIFU treatment developed cystic cavities within the prostate. Clinicopathologic testing did not indicate any long-term adverse effects. CONCLUSIONS AND CLINICAL RELEVANCE: This method was effective in causing subtotal ablation of prostatic tissue in dogs. Further study of morbidity is required before the technique can be used clinically.

Prostatic adenocarcinoma in a cat.

Prostatic adenocarcinoma was diagnosed in an 11-year-old neutered cat. Clinical signs of the disease included hematuria and a mass in the caudal portion of the abdomen. Prostatectomy was performed. Doxorubicin was administered IV at a dosage of 30 mg/m2 of body surface, followed by cyclophosphamide (300 mg/m2, IV). After 4 treatments, low urine specific gravity and proteinuria developed, and treatment was discontinued. The cat was euthanatized 10 months after surgery because of recurrence of the neoplasm. Necropsy revealed metastasis to the lungs and pancreas.

Use of partial prostatectomy for treatment of prostatic abscesses and cysts in dogs.

OBJECTIVE: To determine whether dogs had prostatic disease, urinary incontinence, or urinary tract infection 1 year after partial prostatectomy to treat prostatic abscesses and cysts. DESIGN: Prospective study. ANIMALS: 20 male dogs with prostatic abscesses or cysts. Fifteen dogs had evidence of urinary tract infection. Only 8 dogs urinated normally; the remainder dribbled, had obstructions, or required medical treatment. PROCEDURE: Partial prostatectomy was performed on each dog. Sexually intact dogs (n = 12) also were castrated. RESULTS: None of the dogs had return of prostatic cystic enlargement or clinical signs of prostatic disease during the first year after surgery. Two dogs were euthanatized within 1 year after surgery, with 1 dog having prostatic enlargement and adenocarcinoma and 1 dog having unrelated lymphosarcoma. Fifteen dogs were continent. The remaining 5 dogs urinated normally but had intermittent and minor incontinence. Eleven dogs had no signs of infection 1 year after surgery, 5 had pyuria or positive urine bacteriologic culture results, 2 did not have urinalysis performed, and 2 were euthanatized. CLINICAL IMPLICATIONS: Dogs with severe prostatic abscesses or cysts and infections can be successfully treated by partial prostatectomy with an ultrasonic surgical aspirator and castration, resulting in long-term disease resolution. Although most dogs with severe prostatic disease do not urinate normally before surgery, nearly all dogs resume normal micturition after partial prostatectomy. Postoperative results of partial prostatectomy appear to be better than those of previous drainage techniques for treatment of prostatic cavitary disease.

Prostatic surgery in the dog.

Prostatic diseases are commonly encountered in the dog and a significant proportion of these will require some form of surgical intervention for their successful resolution. The previous perception of the prostate as an obscure pelvic organ coupled with a range of heretofore complex and unsatisfactory surgical techniques have deterred many surgeons from attempting surgical intervention. The recent introduction of omentalization techniques for the management of prostatic infections and secretory abnormalities, which require only modest surgical expertise, has now provided simple solutions for all benign parenchymal diseases. However, neoplastic disease remains a difficult disease both to diagnose and manage.