By Dr Veronica Damian
History:
A 5 year-old male entire, Staffordshire terrier was presented to a Melbourne veterinary clinic for Abdominal ultrasound for history of recurrent haematuria that resolved while under NSAID and enrofloxacin. A repeat urinalysis showed haematuria and bacteriuria again. Ultrasound was recommended to rule out prostatic pathology. Current therapy NSAID and Amoxicillin and clavulanic acid.
Soundiagnosis abdominal ultrasound findings:
The ultrasound revealed 2 large anechoic cystic-like cavitations with echogenic striations, right cranial to the prostate measuring 8.02cm x5.01cm in size and a caudal one of 1.1cm x 1.2cm in size left lateral to the prostate.
Large single cystolith in the bladder lumen (3.18cm)
Hypoechoic nodule in the head of the spleen 1.3 x 1.4cm
Diagnosis:
2 Paraprostatic cysts
1 Large cystolith in the bladder lumen
Hypoechoic nodule in the head of the spleen (most likely incidental)
Comments and Outcome:
Routine pre-scrotal castration was performed, and also exploratory laparotomy was performed at the same time where cystotomy was performed to remove the large urolith in the lumen and was sent for analysis. Also, dissection of both paraprostatic cysts were performed and the cysts were omentalized. The ureters were assessed and to confirm there was no involvement of them in relation to the cysts observed.
Paraprostatic cysts are embryologic remnants of the female reproductive tract that are found in male dogs and they become filled with fluid. When they reach large sizes they are difficult to differentiate from an abscess or the bladder itself. Ultrasound is useful for its diagnosis together with the patient’s history and clinical signs. These cysts can have large sizes and can create pressure to other organs and create significant discomfort.
The treatment of choice is total excision of the prostatic cyst. If complete resection is not possible “omentalization” of the cyst is also performed to provide internal drainage and help with resolution. Castration on its own is unlikely to be of benefit but can help if the cysts are removed.
In this case routine pre-scrotal castration was performed, and also exploratory laparotomy was performed at the same time where cystotomy was performed to remove the large urolith in the bladder lumen and was sent for analysis. Also, dissection of both paraprostatic cysts were performed and the cysts were omentalized. The ureters were assessed and to confirm there was no involvement of them in relation to the cysts observed.
Images:
Images 1. Urinary bladder with thin wall but with a cystolith gravity dependent casting distal acoustic shadowing.
Image 2: The prostate preserved normal bilobed shape but an anechoic structure is arising from the right lobar region (see next image for full picture of the paraprostatic cyst discovered)
Image 3 and 4: 2 paraprostatic cysts with anechoic content and multiple debris and a second one with striations present in the lumen. Note the similarity in appearance to the urinary bladder, however, by seeing 3 bladders in the caudal abdomen this should "ring the bell" about 2 of them benign cysts.
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