Subtotal Prostatectomy in Dogs

Disease of the prostate gland in dogs often requires surgical intervention. Partial or subtotal prostatectomy to remove part of the prostate gland and resolve disease conditions can be performed by your veterinarian. Partial or subtotal prostatectomy is less invasive and leaves unaffected prostate tissue remaining as compared to total prostatectomy. The most common disease of the prostate requiring surgical intervention is neoplasia or abnormal cell growths. Abnormal growths of the prostate can be prevented with early castration in dogs, however when they occur in intact dogs, removal of the tumor or lesion with surr. Castration is recommended in conjunction with partial prostatectomy to avoid recurrence of neoplasia. Other conditions such as infections in the prostate can also cause disease requiring surgical intervention.

Prior to surgery your dog should be fasted for 12 hours. Blood work may be completed in the days prior to surgery to ensure that systemic infection or other disease that would compromise your dog during anesthesia and surgery are not present. On the day of surgery, your dog will be sedated and an intravenous line set up to provide fluids and intravenous anesthetic. When your dog is under IV anesthesia, a breathing tube will be inserted into their esophagus and gaseous general anesthetics set up to maintain anesthesia throughout the procedure. Your dog's lower abdomen and pelvic area will be shaved and cleaned antiseptically in preparation for surgery. 

The procedure is usually performed laparoscopically which will only necessitate a small incision or series of incisions to allow for laparoscopic instruments and camera to perform the procedure. An incision or incisions will be made in the caudoventral abdomen or perineal area, to access the prostate. Moist laparotomy sponges will be used to isolate the prostate from surrounding tissues. A drain may be put around the urethra to elevate the prostate if required to access diseased tissue. Abnormal tissues are dissected away from the prostate by sharp or blunt dissection. Electrocoagulation or laser instruments may be used to achieve this. Prostate tissues and fluids extracted are sent for examination by a veterinarian pathologist to determine nature of abnormal cells or bacteria present. If the dog has not previously been neutered, castration is usually performed at this time to prevent future disease of the prostate. If hemorrhage occurs, extracapsular ligation or a tourniquet applied to major blood vessels can be used to control bleeding. Damage to nerves and surrounding tissues such as the ureter and bladder will be avoided during the removal of prostate tissues. The incisions will be sutured shut and a catheter placed in the ureter during post surgery healing. A drain at the surgical site may also be placed, if required, to drain excess fluids. Your dog will be put into recovery and assisted with supportive care as required.

Partial or subtotal prostatectomy is associated with a lower rate of complications than total prostatectomy, as it is less invasive and impacts s a limited amount of tissues. For benign lesions it is extremely effective, although recurrence of growths can occur if prostate tissue remains and castration is not performed in conjunction with the procedure. For malignant growths, effectiveness may depend on early intervention. Used in conjunction with chemotherapy and radiation and caught at an early stage, success rates are more positive. Subtotal prostatectomy may be used as part of palliative care to remove diseased tissue and alleviate symptoms.

Post-surgery, analgesics, antibiotics and anti-inflammatories should be administered under the direction of your veterinarian. Restricting activity for your dog is advised for several days post-surgery to allow adequate healing of incisions. A temporary urinary catheter will be placed, and should be monitored and maintained to ensure it is kept clean and does not become dislodged. Your dog's fluid intake and output should be monitored and abnormalities reported immediately to your veterinarian. The catheter will usually be removed a few days after a subtotal prostatectomy. If a drain is present the drain will also need to be monitored to ensure it does not become dislodged and that the incision is intact and free from infection. All incisions should be checked for signs of redness or inflammation and discharge that would indicate infection may be present and incidence reported to your veterinarian. An e-collar may be required to make sure your dog does not interfere with catheter, drain or surgical incisions. Your dog may experience urinary incontinence post-surgery. This should resolve, but if it persists, follow up with your veterinarian, as medical treatment may be effective to treat persistent incontinence. Removal of sutures and follow-up should be conducted by your veterinarian at two weeks post-surgery and as recommended after that.

The cost of partial or subtotal prostatectomy varies depending on the degree of disease present and the amount of tissue being removed. An additional cost for examination of tissues removed post-surgery, to identify abnormal cells or bacteria will be incurred. The cost of the procedure, medications, and anesthesia, as well as testing of tissue, ranges from $500 to $2,000. Cost of living in your area will also impact total cost.

Damage to urinary structures and nerves in the area can occur. An experienced veterinary surgeon with a good understanding of urological function will avoid damage to these structures which could result in urinary incontinence, or other urinary dysfunction.

Recurrence of neoplasia is common and castration performed at the time of prostate tissue removal will minimize this. 

The presence of malignant growths is associated with guarded prognosis and the decision to proceed with treatment in these cases should be made in consideration of this.

Castration of dogs at an early age minimizes the likelihood of disease occurring in the prostate gland that requires surgical intervention. Early treatment of prostate disease also minimizes the requirement for surgery as treatment with more conservative medical therapy may be effective. Regular veterinary care and monitoring of your dog's health will help recognize symptoms of prostate disorder at an earlier stage, when other interventions may be effective.