Prostatic Omentalization in Dogs

Prostatic omentalization is a surgical procedure used in dogs which treats cysts and abscesses of the prostate. This involves draining the cyst before passing a section of the omentum – fatty tissue located in the abdomen – through two small incisions in the prostate. This is done to facilitate drainage, increase blood supply to the prostate, and prevent cyst recurrence. Prostatic omentalization is the preferred method for treating prostatic cysts that cannot be removed. Omentalization may also be recommended for treating cysts that were only partially removed.

The prostatic omentalization procedure proceeds as follows:

1. Blood work will be conducted to confirm anesthetization is safe for the dog.
2. General anesthesia, pain medications, and fluids are administered intravenously. 
3. Urinary and cephalic catheters are put into place.
4. An ultrasound may be conducted to locate cysts or abscesses before surgery begins.
5. The ventral abdomen is cleaned and clipped.
6. An incision is made into the abdomen, extending to just above the penis.
7. The abdominal wall is incised and the abdominal cavity opened.
8. Stay sutures are placed in the bladder.
9. The periprostatic fat is dissected, exposing the prostate. The surgeon will then locate the cysts.
10. An incision is made into the cysts, which are drained using suction. A culture is obtained from the contents of the cyst.
11. Small incisions are made on either side of the prostate, allowing the surgeon to access to parenchyma. Any cysts within the parenchyma are incised and drained.
12. The surgeon will take tissue samples for biopsy before flushing the surgical site with a saline solution.
13. A pair of forceps is passed through both of the smaller prostatic incisions. The surgeon will use the forceps to grasp a section of the omentum.
14. This section is passed into the prostate and around the urethra, and exits through the same incision.
15. The surgeon will then suture the omentum to itself.
16. A suction drain is placed into the prostate prior to wound closure.
17. The dog is hospitalized for up to five days.

The procedure steps will vary slightly for cysts which have been partially removed.

Prostatic omentalization is perhaps one of the most effective procedures for managing prostatic cysts that cannot be removed. The omentum is often used in surgery to promote healing, reconstruct tissue, and seal tissues connected via surgery. It also has a rich supply of blood vessels, as well as immune and inflammatory cells.

Antibiotics are administered for up to seven days after surgery. The suction drain is removed within four days of surgery, while the dog is still in the hospital. For dogs that experience severe urination problems, the urinary catheter may be left in place after surgery and connected to a closed collection system. This will be removed according to the surgeon’s instructions.

On the return home, exercise and activity should be restricted according to veterinary instructions. Pain medications will be prescribed as needed. Dogs will need to wear a bandage on the abdominal suture site or an Elizabethan collar to avoid irritating the sutures. The bandage should be changed daily, and needs to be kept clean and dry at all times. Owners should check the suture site each day to ensure draining, swelling, or bleeding does not occur. If any of these appear, immediate veterinary attention should be sought. The sutures will be removed within fourteen days of surgery.

The cost of prostatic omentalization will vary based on standards of living and additional costs incurred. The price of prostatic omentalization, including the cost of diagnostic imaging and postoperative medication, ranges from $1,000 to $5,000.

This procedure carries the lowest risk of postoperative complication, and the mortality rate is virtually nonexistent. However, the risk of mortality may increase to 50% for dogs diagnosed with septicemia. Complications are rare with prostatic omentalization. However, if the omentum is not handled properly, necrosis may occur and cause severe, potentially life-threatening complications. The cyst may also recur, although this is rare.

Prostatic cysts are difficult to prevent, as they often form before birth. Dogs treated for prostatic cysts should not be bred. Castration may aid in resolving underlying prostatic conditions.