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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., (© 2023 American College of Veterinary Surgeons.)

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., (© 2020 The American College of Veterinary Surgeons.)

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., (© 2018 The American College of Veterinary Surgeons.)

Objective: To report a technique for partial prostatectomy by laser dissection and to evaluate outcome and complications in dogs with prostate carcinoma (PCA)., Study Design: Experimental and clinical case series., Animals: Four normal dogs and 8 dogs with PCA., Methods: Subcapsular partial prostatectomy, sparing the urethra and the dorsal aspect of the prostatic capsule, using Nd:YAG laser dissection to remove the prostatic parenchyma and control hemorrhage was performed in 4 normal dogs and subsequently in 8 dogs with histologically confirmed PCA. Additional treatment of PCA dogs included local application of interleukin-2 and systemic administration of meloxicam. Prostate size, complications, and survival time were recorded. Laser-associated thermal damage to surrounding tissue was evaluated by histology., Results: In normal dogs, no damage to the dorsal prostatic capsule or urethra was detected. In PCA dogs, median survival was 103 days (range, 5-239 days). Three dogs died from complications within 16 days, whereas 5 (median survival, 183 days; range, 91-239 days) had improvement or resolution of clinical signs. Urinary incontinence did not occur., Conclusion: Laser assisted subcapsular partial prostatectomy can be performed in dogs with PCA without development of postoperative incontinence., Clinical Relevance: Subcapsular partial prostatectomy is a potential palliative treatment for PCA in dogs and may lead to the resolution of clinical signs for several months.

In an attempt to reduce postoperative incontinence associated with excisional prostatectomy and the recurrence of prostatic disease after less radical surgeries, a new technique for subtotal prostatectomy was developed using an ultrasonic surgical aspirator. During laparotomy, a longitudinal incision was made in the ventral surface of each lobe of the prostate gland. Biopsies for histology and culture were taken. Through the ventral incisions, the ultrasonic surgical aspirator was used to resect approximately 85% of the glandular tissue from inside the capsule. The ultrasonic surgical aspirator allowed resection of the glandular tissue without damaging the vessels, nerves, and connective tissue stroma. The ventral portion of the capsule was excised. The dorsal portions of the capsule were apposed on the ventral midline by suturing their ventral margins to form a periurethral cuff. As preclinical research, seven intact male dogs were evaluated by physical examination, complete blood cell count, serum urea nitrogen, urinalyses, and urethral pressure profile (UPP) with urethral electromyograms (EMGs). The dogs underwent subtotal prostatectomy and castration. All dogs were continent after surgery. UPPs and EMGs at 1 and 2 months after surgery were no different than before surgery. This contrasts to our previous studies in which excisional prostatectomy reduced maximal urethral closure pressure (MUCP) in dogs without prostatic disease. The use of the ultrasonic surgical aspirator for intracapsular subtotal prostatectomy facilitated removal of glandular tissue with decreased hemorrhage and provided preservation of the prostatic urethra, nerves, and vessels involved in maintaining urinary continence.

Percutaneous nephrostomy catheters modified by cutting off the tubing connectors were implanted in three dogs with prostatic neoplasia to relieve or prevent stranguria. One catheter was implanted with a guide wire through a perineal urethrotomy, and two catheters were implanted via celiotomy and cystotomy. Morbidity and complications were minimal. Inflammation of the abdominal incision was present from day 4 to day 8 in the dogs with celiotomy. Urinary incontinence was continuous in one dog and intermittent in two dogs. Hematuria occurred in two dogs. The retained urethral catheter was a suitable palliative treatment for urethral obstruction in three dogs with prostatic neoplasia.

Eleven dogs with prostatic disease were treated by total prostatectomy. Urinary incontinence persisted in three of nine dogs, two of which were also incontinent before surgery. The incidence of postoperative incontinence may be reduced by undermining the prostatic capsule to preserve as much prostatic urethra as possible. The risk of postoperative incontinence appeared greater if there was prostatic neoplasia or preoperative urinary incontinence.

Urinary diversion by implantation of the ureters into an isolated segment of jejunum was evaluated in eight clinically normal male dogs. Total cystectomy and subtotal intracapsular prostatectomy were performed, and the intestinal loop was sutured to the prostatic remnant. General health, renal function, acid-base balance, urinary tract infection, and urinary continence were monitored during observation periods of 4 to 30 weeks. All dogs survived the observation period and seven were in excellent general health at the time of euthanasia. Six of the 16 ureterointestinal anastomoses were complicated by complete ureteral obstruction. Absorption of urea from the intestinal loop was speculated as the reason for significant increases in serum urea nitrogen concentrations in all of the dogs. Serum creatinine concentrations generally remained within the normal range, but were significantly increased from preoperative baseline values by week 30. There was dilation of 12 renal pelves and ureters in seven dogs. Urine bacterial cultures were positive in six dogs, but histologic evidence of pyelonephritis was present in only five kidneys. Ejaculation was not affected by the procedure, but epididymitis was present in five dogs. The dogs could urinate consciously and did not dribble urine continuously; however, they urinated hourly. While the procedure was well tolerated by the dogs, the frequency of urination makes this technique unacceptable for most household pets.

A technique was developed for subtotal prostatectomy in dogs with the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser. In six normal dogs, full-thickness necrosis of the prostate occurred if the central-lateral region within 5 mm of the urethra was photoablated at 60 watts for 1 second. Moderate to superficial necrosis occurred when the prostate within 5 mm of the urethra was photoablated at 35 watts for 2 seconds or 60 watts for 0.5 second. At necropsy, leakage of the urethra occurred in two dogs at sites treated at 60 watts for 1 second. In a clinical study, complications associated with subtotal prostatectomy with the Nd:YAG laser (n = 6) were compared with complications associated with prostatic drainage (n = 6) in dogs with prostatic disease. Intraoperative death (2/6 dogs) and nocturnal incontinence (4/4 surviving dogs) occurred with subtotal prostatectomy. Uncontrolled prostatic infection (2/6 dogs) occurred with prostatic drainage and resulted in the death of one dog on day 11. Four of five dogs surviving prostatic drainage developed recurrent urinary tract infection.

Prostatectomy in dogs with clinical prostatic disease has been associated with a high incidence of urinary incontinence. In this study, urodynamic alterations after prostatectomy in 10 dogs without clinical prostatic disease were evaluated. Measurements of residual urine volume, simultaneous urethral pressure profilometry and electromyography, and carbon dioxide cystometry were made before and 14 and 20 weeks after prostatectomy. Voiding was observed daily for 20 weeks after prostatectomy. All dogs remained continent for 20 weeks after prostatectomy, and only minor urodynamic abnormalities were noted. Castration had no effect on urodynamic changes associated with prostatectomy. Prostatectomy produced minimal functional changes in dogs without clinical prostatic disease.