Dr. Douglas Brum
Antibiotics are very important in the treatment of the infection; however, their effect is limited since they do not penetrate well into the abscess cavity. Antibiotic treatment, alone, may improve the clinical signs in the short term, but rarely would they lead to a cure. For this reason, surgical drainage of the abscess is needed if a cure is to be obtained. Since the surgery is technically difficult and requires intensive care monitoring post-operatively, cases are often referred to specialty hospitals with 24 hour critical care. Dogs require aggressive therapy after surgery. Septicemia and shock are common complications immediately post-operatively. The mortality rate within the first few days may approach 25 percent. Specific treatment of a prostatic abscess includes: Intravenous fluids and intensive care support. Most dogs with prostatic abscesses are very ill and the risks of shock and septicemia are significant. Fluid therapy maintains tissue perfusion, blood pressure and circulatory status in the critical patient. Some animals might even require transfusions with blood or plasma products.
Intravenous antibiotics. The choice of specific antibiotics depends on the results of the cultures taken, and the ability of the antibiotic to penetrate the prostatic tissue. Not all antibiotics have an equal ability to enter the prostate (cross the blood-prostatic fluid barrier). Antibiotics that can cross the blood- prostatic fluid barrier include: erythromycin, clindamycin, chloramphenicol, trimethoprim/sulfonamide and the quinolones. In the acute condition, this choice is not as critical since the blood-prostatic barrier is not intact, and different antibiotics will penetrate effectively into the prostate. Antibiotics are initially given intravenously, and an oral form is continued long-term at home. Antibiotics may need to be changed based on the culture results.
Urinary bladder catheterization. In cases where the abscess causes compression of the urethra and a urinary obstruction, a catheter should be placed from the urethral orifice at the tip of the penis through the urethra and into the bladder. The goal is to by-pass the urethral blockage and allow for the normal flow of urine.
A prostatic abscess can be quite painful. Providing pain relief while a diagnosis is pending will allow the dog to be more comfortable and to be able to rest. Narcotics and nonsteroidal anti-inflammatory drugs are most commonly used. Usually, pain medications are only needed in the initial in hospital treatment of the patient.
Ultrasound-guided prostatic abscess aspiration. Removing all or most of the fluid within the abscess by fine needle aspiration may be attempted if surgical drainage is not an option. It is generally not recommended as the treatment of choice since recurrences are likely, and peritonitis is a significant complication.
Exploratory surgery for surgical drainage of the abscess. There are two surgical procedures for the drainage of a prostatic abscess. The procedure that is used depends on the size and location of the abscess and the surgeon's preference. The first procedure involves opening the abscess, removing the fluid and placing a rubber drain inside the cavity. The drain is placed so it exits the abdomen through the skin. The drain is left in place, usually for 3 weeks to allow for continued drainage and the flushing of fluid into the cavity. The second procedure, called marsupialization, involves opening the abscess and suturing it to the exterior of the body. A permanent communication of the abscess wall and body wall is thus created. If possible, smaller abscesses and abnormal tissue should be removed.
Castration. Dogs should be neutered at the time of the exploratory. Castration decreases the hormone levels that stimulate the prostate, thereby causing the amount of prostatic tissue to shrink. Neutering may also help in decreasing the potential of recurrence.
Optimal treatment for your pet requires a combination of home and professional veterinary care. Follow-up can be critical, especially if your pet does not improve rapidly.
Administer all medications as directed. Alert your veterinarian if you are experiencing problems treating your pet.
Warm water compresses should be placed on the drain sites several times a day. The skin around the area should be kept clean.
Close post-operative follow-up is important. Surgical sites need to be evaluated for appropriate healing. The amount and type of drainage should be recorded. The drainage should become clearer and the amount should decrease with time.
Urinalysis and culture of the urine should be repeated frequently. Recurrent infections are common.
Abdominal ultrasounds are periodically repeated. The ultrasound is used to assess the size of the prostate and it's texture. The general size of the prostate should decrease but recurrence of abscesses may be discovered.