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Acute Prostatitis
Acute Prostatitis
Gunner’s Road to Castration
Marlene Purden
Pharmacology and Pharmacy
Acute Prostatitis
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Gunner is a 10 year-old intact male working Belgian Malinois whom presented to the
clinic after police handler noticed a decrease appetite and no energy. His current weight is 67.3
pounds with a Body Condition Score (BCS) of 4/9. While working one night, handler noticed
Gunner had no drive and decrease response to command.
Patient Physical exam findings:
General appearance: Depressed
Temperature: 104.6
Skin/coat: Normal
Eyes/fundic exam: Normal
Ears/otoscopic exam: Normal
Oral cavity: Mucous membranes are pale with a capillary reflex time of less than 3 seconds, mild
calculus
Musculoskeletal: Hind limb muscle atrophy
Cardiovascular: Normal rate/rhythm, no murmurs
Gastrointestinal: No palpable abnormalities
Respiratory: Normal
Genitourinary: Enlarged prostate
Nervous system: Normal
Lymph nodes: No palpable lymphadenopathy
Upon physical exam, patient is noticeably depressed and without any drive. He is febrile
and refuses food when offered. Abdominal palpation showed no abnormalities and no palpable
pain is noted. The prostate exam showed enlargement of the prostate gland. Mucous membrane
color was pale and capillary refill time was less than 3 seconds. Based on physical exam
findings, doctor ordered CBC, chemistries, 4Dx, Urinalysis, and abdominal radiographs. Initial
blood work indicated that the patient was experiencing a urinary tract infection based on bacteria
and white blood cells present in urine. The CBC indicated a slight anemia since the total red
blood cells count was 4.52 and hematocrit was 29%. Chemistries were unremarkable; however,
serum color was noted as icteric. Due to the icteric nature of the serum, the doctor ordered a bile
acids test for liver function to be sent out to a laboratory. No significant findings were found on
abdominal radiographs. An outpatient ultrasound was requested at University of Illinois to rule
out hepatic disease since it was no evidence was seen on radiographs. Given the nature of the
diagnostic, treatment was started for the lethargy and elevated temperature.
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See Abdominal Radiographs below.
Doctor ordered fluid therapy and antibiotic injection. I placed an 18-gauge intravenous
catheter/injection port into left cephalic vein. At 11:00, the patient was placed on Lactated
Ringers Solution (LRS) at 230 ml/hour (3x maintenance dose). Doctor ordered Cefazolin at
22mg/kg intravenously and penicillin at 40,000 units/kg for urinary tract infection and to lower
temperature (Plumb, 2008). Patient was administered 7 ml (700 mg) Cefazolin intravenously
slowly and 4 ml (1,218,180 units) of Penicillin G procaine subcutaneously. Patient was then
monitored throughout the day. At 13:00, patient was offered food (E/N diet) in which he still
refused. Patient was temperature was noted as 102.5. No vomit was noted in the cage, but
patient was drooling and noted as nauseas. Doctor ordered Maropitant Citrate at 1mg/kg
subcutaneously (Plumb, 2008). Patient was administered 3 ml of drug subcutaneously. At 15:00,
patient was offered food (E/N) in which he ate on own. Temperature was taken and noted as
normal at 102.4. At 17:00, patient was released to handler for overnight observation. The handler
was instructed to bring in the following morning.
The next morning, patient was returned to clinic for continuing treatment. No noted
changes in attitude, but did continue to eat overnight. Temperature was noted in the morning as
104.5. Patient was noticeably depressed and mucous membranes were still pale. At 8:00, doctor
ordered change in antibiotic injection to Enrofloxacin at 5mg/kg (Plumb, 2008). The patient
received 1.5 ml (150 mg) of Enrofloxacin intramuscular. He was placed back on LRS at 230
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ml/hour (3x maintenance). Bile acid test results were received at 9:00. Both resting bile acids
and post-prandial bile acids were elevated. Doctor order Denamarin (S-adenosylmethionine) at
18mg/kg SID PO. Patient received a 425mg tablet orally at 10:00. Temperature was also noted
as 102.6. Patient was continuously monitored throughout the day with no significant changes. At
14:00, temperature was noted as 103.3. Doctor ordered Unasyn (Ampicillin sodium + Sulbactam
sodium) at 20 mg/kg (Plumb, 2008) due to elevated temperature. Patient received 20 ml (610
mg) Unasyn intravenously. Patient was then transferred to University of Illinois for outpatient
ultrasound.
Ultrasound results showed no abnormalities of liver. However, the prostate was enlarged
and had multiple cystic regions were noted. Definitive diagnosis of acute prostatitis with benign
cystic hypertrophy was evident. Prostatitis is an inflammation of the prostate gland. In the case of
acute prostatitis, an infection is causing the inflammation and clinical can include fever, lethargy,
anorexia, abdominal pain (Tilley & Smith, 2011). Gunner’s handler was informed of this
diagnosis. Castration is strongly recommended to prevent recurrence of the infection (Tilley
&Smith, 2011). Gunner’s handler expressed concern on castration and worried that it would
decrease his aggressiveness and prey drive. I advised handler that at 10 years, the patient’s drive
to work would not be altered with castration. Without castration, recurrence of the infection will
likely happen and risk of other prostatic disease increases (Tilley and Smith, 2011). We advised
handler to begin an antibiotic regiment of Clavamox (Amoxicillin/Clavulanate) at 12.5 mg/kg for
one week prior to castration surgery. The patient was sent home with Clavamox with the
instruction to give 375mg by mouth twice daily for one week.
One week later, Gunner presented to the clinic for castration. Upon physical exam,
Gunner was prostate was still enlarged, but had decrease in size and no palpable pain was present.
He also had a weight gain, weighing 70 pounds. Pre-operative chemistries were unremarkable
and Gunner was determined healthy enough for anesthesia.
Pre-operative exam findings.
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General appearance: Normal
Temperature: 100.8
Skin/coat: Normal
Eyes/fundic exam: Normal
Ears/otoscopic exam: Normal
Oral cavity: Mild calculus
Musculoskeletal: Mild hind end muscle atrophy
Cardiovascular: 132 bpm with normal rate/rhythm, no murmurs
Gastrointestinal: No palpable abnormalities
Respiratory: 88 breaths per minutes (panting), Normal auscultation.
Genitourinary: Prostate enlargement decreased, no pain present
Nervous system: Normal
Lymph nodes: No palpable lymphadenopathy
Once determined healthy, I began to prep Gunner for surgery. I placed a 20 g
catheter/injection port into the right cephalic. I started Gunner at 5ml/kg/hour of Lactated
Ringers (Lerche & Thomas 2011). The patient was started on 160 ml/hr. Gunner received presurgical pain medication of Carprofen at 2mg/kg (Plumb 2008). I administered 1.3 ml (32 mg) of
Carprofen subcutaneously at 11:00. At 11:30, anesthesia was induced by using a combination of
telazol, butorphanol, and dexmedetomidine (TTDex) at 0.015ml/kg (Lerche & Thomas, 2011).
Gunner received 0.5ml IM of TTDex. Gunner was intubated at 11:40 with a size 10 endotracheal
tube. He was clipped from prepuce to just ventral of the scrotum and laterally into inguinal areas
(Busch, 2006). Patient was placed in dorsal recumbence and he was surgically prepped with
chlorhexadine scrub and alcohol. Castration surgery began at 11:45. Patient was maintained on
isoflurane at 1.5% and Oxygen at 3L(0.5L/10kg of body weight) (Lerche & Thomas, 2011). A 2
cm incision was made in prescrotal region. The right tesitcle was pushed through incision and the
vaginal tunic was incised and testicle was pushed through. The ductus deferens and the vascular
cord were ligated with 2-0 Monosorb. The testicle was then transected distally from the ligatures.
The procedure was repeated for the left testicle. The subcutaneous and subcuticular tissue were
closed with 2-0 Monosorb in simple continuous suture pattern. Skin was then close 2-0 Monofil
in a simple interrupted suture pattern. Patient was maintained on pure oxygen at 3L for the next
10 minutes following his surgery. The patient was moved from the surgery table to a cage where
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I continue to monitor him. He was place on a warming blanket and I deflated his cuff on the
endotracheal tube and untied the tube. Once Gunner regained his ability to swallow, the
endotracheal tube was removed (Lerche & Thomas, 2011). The patient was monitored
throughout the entirety of the day. He was release to the care of his handler at 17:00 with post
surgery instructions that would fit the patient working conditions.
Post surgery instructions were given to the handler. Given that Gunner is a police K9,
restricted activity was advised for the 3 days following the procedure. Handler was advised to
closely watch Gunner at all times to ensure incision is kept clean and dry. Also, handler was
advised to make sure that Gunner did not chew or lick incision area, as an Elizabethan collar
would hinder his work. Scrotal hematoma is a possible complication of castration and was an
area of concern with a working canine like this patient (Busch, 2006). Gunner’s handler was
advised to use a cold compress if he noticed any swelling of the scrotal area. Gunner was sent
home with Clavamox 375 mg by mouth twice daily for 14 days and Carprofen 75 mg twice daily
by mouth for 7 days.
Gunner has done well with recovery. His sutures were removed 14 day post-surgery.
His incision has healed nicely and no complications of a scrotal hematoma occurred. Upon his
physical exam, the prostate was examines\d. There was a significant decrease in size of the
prostate and no pain was palpated. Handler was advised for another exam in one month to ensure
the size of prostate continue to decrease.
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Busch, S. (2006). Small animal surgical nursing: Skills and concepts. St. Louis,
Mo.: Elsevier Mosby.
Plumb, D. (2008). Plumb's Veterinary Drug Handbook (6th ed.). Ames, Iowa: Blackwell.
Thomas, J., & Lerche, P. (2011). Anesthesia and Analgesia for Veterinary
Techinicans (4th ed.). St. Louis, Missouri: Elsevier Mosby.
Tilley, L., & Smith, F. (2011). Blackwell's five-minute veterinary consult (5th
ed.). Chichester, West Sussex: Wiley-Blackwell.