Prostate gland

image of Prostate gland
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Indications for ultrasonographic examination of the prostate gland in the dog include: recurrent or chronic urinary tract infections; haematuria; dysuria; dyschezia; prostatomegaly (palpable or radiographic); pyrexia of unknown origin; caudal abdominal pain; orchitis; and haemospermia. This chapter expounds the value of ultrasonography compared with radiography and computed tomography before moving on to imaging technique and normal ultrasonographic appearance. Diffuse disease, focal disease and particular considerations for sampling are covered. This chapter contains 10 video clips.

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15.1 Sagittal ultrasonogram of the bladder neck and prostate gland (x–x). The urethra is visible as a hypoechoic linear structure running through the prostatic parenchyma. Edge shadowing is seen to the right of the image (arrowed).
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15.2 Sagittal ultrasonogram of the prostate gland (x–x) in an entire male dog, showing a homogeneous, relatively echogenic parenchyma. The urethra (arrowed) is visible as a hypoechoic linear structure. Sagittal ultrasonogram of a normal prostate gland (x–x) in a young male dog, which is positioned close to the bladder neck. The prostate gland appears relatively small and hypoechoic. The capsule is seen as a thin echogenic line surrounding the prostate gland, and is more obvious than in (a) due to the contrast with the parenchyma.
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15.3 BPH: the prostatic parenchyma (arrowed) is heterogeneous and contains numerous small cystic areas.
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15.4 Irregularly marginated, anechoic cavitary lesion within the prostate gland. The cavity was aspirated and cultured.
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15.5 Transverse image showing asymmetry of the prostate gland. Both lobes (arrowed) contain anechoic cystic areas. A mixed growth was cultured following aspiration of the cavities and the lesions resolved following appropriate antibiotic therapy.
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15.6 Ultrasonogram showing mineralization within the prostate gland (x–x), characterized by echogenic foci with distal acoustic shadowing (arrowed). The prostate gland is generally heterogeneous. Histological diagnosis was squamous cell carcinoma.
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15.7 Sagittal ultrasonogram of a prostate gland showing two anechoic lesions: one small and well defined, and the other larger with slightly irregular margins. The prostate gland otherwise appears homogeneous. Differential diagnoses for these lesions includes cysts and abscesses. Diagnosis in this case was confirmed as cysts associated with BPH.
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15.8 Ultrasonogram showing a paraprostatic cyst. The contents of the cyst are predominantly anechoic, and echogenic internal septations are present. The prostate gland (not pictured) appeared large, echogenic and contained a small intraprostatic cyst.
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15.9 Sagittal ultrasonogram of an abscessed prostate gland. The abscess appears septated and contains echoes, which were swirling on real-time imaging (see also clip on DVD). Other than a peripheral rim, little normal prostatic tissue remains.
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15.10 Sagittal ultrasonogram showing a urinary catheter within the prostatic parenchyma. The catheter was withdrawn slightly prior to a wash sample being taken.


Normal prostate gland (1).

The transducer has been placed in a parapreputial position in a 1-year-old entire male Dobermann. Initially the bladder, containing a moderate quantity of urine, is seen; the neck of the bladder lies towards the right of the screen. As the ultrasound beam sweeps sagittally, the smoothly rounded prostate gland can be seen lying just caudal to the bladder neck.

Normal prostate gland (2).

After locating the neck of the bladder in this 3-year-old entire male Golden Retriever, the ultrasound beam is swept in a sagittal plane to find the prostate gland lying caudal to the bladder. The prostate gland has a smooth outline and homogeneous parenchyma.

Benign prostatic hyperplasia (1).

At the start of this clip, the caudal part of the bladder, containing anechoic urine, is seen to the left of the screen. As the ultrasound beam sweeps through the prostate gland in a sagittal plane, two symmetrical lobes are seen with the urethra running between them. The prostatic parenchyma is slightly heterogeneous, but this 6-year-old Springer Spaniel showed no clinical signs related to prostatic disease. Benign prostatic hyperplasia was the presumed diagnosis.

Benign prostatic hyperplasia (2).

Transverse view of the same dog as in Benign prostatic hyperplasia (1). The clip starts with a transverse plane through the bladder neck. The ultrasound beam then sweeps caudally through the prostate gland, which is smoothly rounded in this plane.

Benign prostatic hyperplasia (3).

This clip shows the prostate gland of an asymptomatic 5-year-old entire male Labrador. A sagittal sweep of the ultrasound beam through the prostate gland shows a relatively homogeneous, echogenic appearance with a few small hypoechoic foci. The margins of the gland are smooth. A degree of benign prostatic hyperplasia was presumed, but no cytology/histology performed.

Prostatic carcinoma (1).

A 9-year-old neutered male collie-cross dog presented with spinal pain. This short clip shows that the prostate gland is heterogeneous with multiple hyperechoic foci, and is irregular in shape with a 2 cm nodular area. Carcinoma was diagnosed on a prostatic wash.

Prostatic carcinoma (2).

This short clip, of the same dog as in Prostatic carcinoma (1), initially shows part of the bladder lying superficially to the aorta. The beam moves a little to the left, showing the left medial iliac lymph node, which is enlarged and cystic. Spread of the carcinoma to the regional lymph nodes was presumed.

Prostatic cysts (1).

A transverse sweep of the caudal abdomen in this 5-year-old entire male Cocker Spaniel initially shows two thin-walled, fluid-filled structures flanking the urethra. As the ultrasound beam sweeps cranially, the prostate gland appears. The prostate gland remains symmetrically bilobed but is subjectively enlarged, hyperechoic and mildly heterogeneous. The clip finishes at the bladder neck. A prostatic wash yielded mixed inflammatory cells, dysplastic epithelium and haemorrhage; culture was negative. A diagnosis of benign prostatic hypertrophy with prostatic cysts was made and the dog was subsequently castrated.

Prostatic cysts (2).

A 5-year-old Bichon Frise presented with haematuria; the prostate gland was large but non-painful on palpation. The initial sagittal image shows a large echogenic prostate gland on the left, lying in close proximity to the bladder neck. As the beam sweeps through the prostate gland, several small discrete anechoic cystic areas are seen. A larger cyst is present on the lateral margin of the prostate gland. Shaking of the image is due to the dog’s panting. A prostatic wash was negative on culture and yielded dysplastic cells.

Prostatic abscess.

The prostate gland is imaged in a sagittal plane; although subjectively large, it has smooth, well defined margins. However, there is only a thin rim of normal prostatic tissue around the periphery with the remainder of the prostate gland containing fluid with swirling echoes. The final diagnosis was a prostatic abscess.

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