Abstract
Simple SummaryProstatectomy is a surgical procedure that involves the removal of the prostate, either partially (partial prostatectomy) or completely (total prostatectomy). Total prostatectomy is considered technically difficult to perform, carrying with it many complications and unwanted side effects. The standard total prostatectomy provides a caudal celiotomy: a pubic symphysiotomy or pubic and ischial osteotomies may be required in order to improve access to the prostate gland and the pelvic urethra. Perineal hernia refers to the herniation of pelvic and abdominal viscera into the subcutaneous perineal region through a pelvic diaphragm weakness. A concomitant prostatic disease is observed in 25–59% of cases: the prostate can remain in the physiological location or displace within the hernial contents. Surgery is the treatment of choice in case of perineal hernia. The aim of this article is to describe retrospectively the total perineal prostatectomy in dogs presenting perineal hernia with concomitant prostatic diseases which required the removal of the gland. The experience in six patients (three dogs with the prostate within hernial contents and three dogs with intrapelvic prostate) are reported as well as advantages, disadvantages, and limitations of the surgical procedure.Perineal hernia refers to the herniation of pelvic and abdominal viscera into the subcutaneous perineal region through a pelvic diaphragm weakness: a concomitant prostatic disease is observed in 25–59% of cases. Prostatectomy involves the removal of the prostate, either partially (partial prostatectomy) or completely (total prostatectomy). In case of complicated perineal hernia, staged procedures are recommended: celiotomy in order to perform colopexy, vasopexy, cystopexy, and/or to treat the prostatic disease, and perineal access in order to repair the perineal hernia. Very few reports relate prostatectomy using a perineal approach and, to the extent of the author’s knowledge, this technique has not been thoroughly investigated in the literature. The aim of this article is to retrospectively describe the total perineal prostatectomy in dogs presenting perineal hernia with concomitant prostatic diseases which required the removal of the gland. The experience in six dogs (three dogs with the prostate within hernial contents and three dogs with intrapelvic prostate) is reported as well as advantages, disadvantages, and limitations of the surgical procedure. In the authors’ clinical practice, total perineal prostatectomy has been a useful surgical approach to canine prostatic diseases, proven to be safe, well tolerated, and effective.
Highlights
Prostatectomy is a surgical procedure that involves the removal of the prostate, either partially or completely
A perineal hernia with concomitant prostatic disease was diagnosed in all dogs and the removal of the prostate was recommended
The diagnosis was unilateral right perineal hernia, bilateral perineal hernia: in three dogs the prostate was totally displaced in the hernial contents, whereas in three dogs a partially dislocated or intrapelvic prostate was observed
Summary
Prostatectomy is a surgical procedure that involves the removal of the prostate, either partially (partial prostatectomy) or completely (total prostatectomy). Total prostatectomy is carried out mainly in early detected non-metastatic prostatic tumors, but it can be used in the case of severe trauma, vascular disorders due to prostate dislocation, recurrent and/or unresponsive abscesses, or cystic formations. This complication occurs in over 90% of subjects [10], while according to others the percentage varies from 33% to 100% of treated cases [1,11]. For these reasons, it is usually preferred to treat prostate diseases through a conservative approach, in some cases it may be necessary to remove the gland. Given the particular localization of the gland, a pubic symphysiotomy [12] or pubic and ischial osteotomies may be required in order to improve access to the prostate gland and the pelvic urethra [12,13]
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