Prostatic Marsupialization in Dogs

Prostatic marsupialization is a surgical procedure which involves incising a cyst or abscess of the prostate gland. The edges of the incision wall are then folded back and sutured to the cyst or abscess. This allows the abscess to drain freely. The cyst will continue to drain until all fluid has evacuated. Marsupialization may be recommended in addition to other treatment methods to fully treat the underlying condition.

The steps involved in prostatic marsupialization include:

1. A blood sample will be analyzed before surgery to ensure it is safe for the dog to undergo general anesthesia.
2. General anesthesia is administered intravenously.
3. The operative area is shaved and cleaned.
4. An ultrasound will be taken to locate the cyst or abscess.
5. The surgeon will perform a celiotomy – which involves incising the abdominal wall – to gain access to the abdominal cavity and prostate gland.
6. An incision is made into the cyst, and a culture is obtained.
7. The cyst is flushed with a sterile saline solution.
8. The wall of the cyst is sutured to the skin prior to closure of the celiotomy incision site.
9. The dog will be hospitalized.
10. Drainage is continuous, and will decrease over time. 

This procedure is permanent, meaning that a secondary procedure to suture the incision is not required. If marsupialization is ineffective or causes complications, another procedure may be required to remove the cyst.

The efficacy of prostatic marsupialization depends on the type and size of the cyst and the overall health of the dog. Because it allows for the continuous drainage, marsupialization is effective for cysts with dangerous levels of effusion, or fluid buildup. It is also effective for cysts that cannot be removed. Although it is less invasive compared to other surgical methods of cyst management, removal of prostatic cysts is almost always recommended over marsupialization. Excising the cyst will prevent future complications. If the cyst cannot be excised, other treatment methods may be recommended.

Dogs typically recover from this procedure within five weeks. The dog will be hospitalized according to the surgeon’s instructions to ensure no immediate postoperative complications occur. For up to two weeks after surgery – or per surgeon instructions – the dog should rest, not engaging in play or activity. Antibiotics and pain medications will be prescribed for up to two weeks after surgery. A follow-up appointment will be scheduled within ten to fourteen days to remove the sutures from the initial incision site. Until the sutures are removed, the dog should wear a bandage or Elizabethan collar to avoid irritating the sutures and causing wound rupture. Bandages should be changed each day and kept clean and dry at all times. The sutures should be checked daily for signs of swelling, bleeding, or drainage. If any of these occur, owners should seek immediate veterinary attention. 

The cost of prostatic marsupialization will vary based on standards of living and additional treatment costs. The price of prostatic marsupialization ranges from $500 to $3,500, with an average cost of $1,200.

Marsupialization has a lower morbidity rate compared to other prostatic surgical procedures, notably prostatectomy. It also allows the surgeon to directly visualize the cyst and flush fluid and bacteria out of it. However, this procedure can only be performed on certain types of cysts. The cyst wall must be strong enough to hold the sutures. Otherwise, the wall of the cyst will tear, rendering the procedure ineffective.

Complications associated with prostatic marsupialization include, but may not be limited to:

• Abscess recurrence
• Persistent draining of the cyst after the recovery period

The latter complication is perhaps the entire point of performing the procedure. However, this complication occurs when the cyst continues to fill with fluid. This may result in infection. If continuous drainage occurs, the cyst will need to be removed.

The veterinary surgeon will discuss all potential complications with the owner prior to surgery.

Prostatic cysts are difficult to prevent, since they often form while the dog is still in utero. Dogs that are diagnosed with and treated for prostatic cysts should not be bred. Castration may help treat non-cancerous prostatic conditions.