81st Western Veterinary Conference

V256P
Reproductive Ultrasound in the Dog & Tom, with Case Studies
Tomas Baker, MS; Autumn Davidson, DVM, MS, DACVIM
University of California-Davis, Davis, CA, USA

OBJECTIVES OF THE PRESENTATION

This presentation will review normal male reproductive tract ultrasonography and give the clinician tools
for the evaluation of common male reproductive disorders.

KEY CLINICAL DIAGNOSTIC POINTS

Normal Male Reproductive Tract: Dog and Tom
Anatomy
The male canine reproductive tract consists of the male genital organs including the scrotum, the two
testes (normally located within the scrotum), the epididymides, the deferent ducts (leading from the
epididymis to the urethra), the spermatic cords, the prostate, the penis and the urethra. The scrotum is a
pouch divided by a thin wall into two cavities, each of which is occupied by a testicle, an epididymis, and
the tail end of the spermatic cord. The skin of the scrotum is covered with fine hairs. The dartos of the
scrotum is a layer of tissue that lies just under the skin and is made up of muscle and other tissue. Under
the dartos is connective tissue lining the scrotum. Each testicle is oval in shape and thicker centrally. The
testicles contain seminiferous tubules. The epididymis is comparatively large in the dog and consists of
an elongated structure composed of a long convoluted or twisted tube. It begins at the cranial aspect of
the testicle and is positioned along the edge. The deferent ducts are thin muscular tubes that are made up
of three layers. The prostate gland surrounds the neck of the bladder, as well as the distal ductus
deferens. A thin wall divides the gland into two equal-sized smooth, firm lobes. The prostate has multiple
openings into the urethra. The penis is a highly vascularized structure. It is composed of several parts,
including the root, body and distal portion or glans penis. The root and body are made up of a vascular
expansile tissue, the glans, and the os penis. During copulation, the glans penis swells permitting the
copulatory lock. The penis also surrounds the termination of the urethra and is important in directing the
stream of urine to the outside of the body. The prepuce is the tubular sheet of skin that covers the free
part of the non-erect penis.
The reproductive tract of the tom cat consists of the penis, the scrotum, two testicles, the prostate
gland, two bulbourethral glands (Cowper’s glands), the epididymis, the ductus deferens (also called the
vas deferens), the spermatic cords, and the urethra.
The penis is located within the prepuce. When the penis is not erect it is completely enclosed within
the prepuce, which is visible on the caudal aspect of the body between the two pelvic limbs. The penis is
covered by a protective sheath called the prepuce. The tip of the penis is called the glans, and it is covered
with 120 to 150 penile spines that are directed caudally, away from the end of the glans. These penile
spines start to appear at about 12 weeks of age and are fully developed at puberty. They are absent in
neutered male cats, disappearing by six weeks after castration. The penis is a highly vascularized
structure. It surrounds the termination of the urethra and is important in directing the stream of urine to
the outside of the body.
The scrotum is located just ventral to the anus and dorsal to the prepuce. It is visible when the tail is
lifted upwards. The scrotum is covered with dense hair and is not pendulous. The scrotum is a pouch
divided by a thin wall into two cavities, each of which is occupied by a testicle, an epididymis, and the
tail end of the spermatic cord. The dartos of the scrotum is a layer of tissue that lies just under the skin
and is made up of muscular tissue. Under the dartos is connective tissue that lines the scrotum.
The testes, or testicles, are normally located within the scrotum. Each testicle is round to oval in
shape. The testicles contain the seminiferous tubules. The epididymis is an enlarged tube positioned
along the edge of the testicle. Its beginning and end (head and tail) are located at the cranial and caudal
aspects of the testicle, respectively.
 The deferent ducts are thin muscular tubes that are made up of three layers. The ductus deferens or
vas deferens begins at the tail of the epididymis and runs along the border of the testicle, and then
towards the caudal aspect of the abdomen. It passes through the prostate and empties into the urethra.
The two spermatic cords are composed of the ductus deferens, and the vessels and nerves of the testicles.
They are covered by a thin membrane. Each cord originates at the tail of the epididymis and extends
through the inguinal canal.
The urethra extends from the urinary bladder to the very tip of the penis. The feline penile urethra
is very narrow and much shorter than the urethra of the dog. The prostate gland is very small in the cat.
It is normally located at the cranial aspect of the rim of the pelvis caudally in the abdominal cavity. The
prostate gland surrounds the proximal portion of the urethra and the termination of the ductus deferens.
The bulbourethral glands are situated on either side of the urethra. The prostate gland surrounds the
proximal urethra, as well as the distal ductus deferens. The prostate has multiple openings into the
urethra. It is very small, relatively unimportant organ in the male cat.
Ultrasonography
The testes are readily located within the scrotum in the normal dog and tom. Imaging each testis can be
facilitated by using the opposite as a standoff structure. The normal testis is uniform in texture with
echogenicity similar to the spleen. The mediastinum testis is a thin, centrally located, very hyperechoic
line. The epididymis (head, body, tail) is less echoic than the testis. The ductus deferens is difficult to
visualize. The spermatic cord is adjacent to the head of the epididymis and has obvious, tortuous, small
diameter veins.
The normal canine prostate gland, located in the pelvic canal, has fairly uniform echogenicity,
smooth stippled texture, and echogenicity similar to the spleen. Its shape is bi-lobed in the transverse
plane and oval in the longitudinal plane. A hyperechoic “butterfly” pattern may be noted in the
transverse image that corresponds to the distribution of ductal tissue, having more echogenic connective
tissue than the more hypoechoic glandular tissue. The length and height of the prostate gland ranges
from 1.3–3.3 cm in mature, 7–30 kg dogs. The lumen of the prostatic urethra is usually not visualized. The
periurethral connective tissue is variably imaged as a bright hilar echo. Caudally, the hilar echo may be
surrounded by the hypoechoic urethralis muscle. The normal prostatic capsule can be difficult to detect.
In the neutered male the prostate will be quite a bit smaller, in fact, it is usually just a pod, or ‘flair’
bulging out of the width of the urethra. The neutered male prostatic pod will appear isoechoic with the
urethra and be much more hypoechoic than the intact male prostate.
The feline prostate gland surrounds the proximal urethra within the pelvic canal, making
visualization difficult. Prostatic disorders are, fortunately, uncommon in the tom.

KEY ETIOLOGIC AND PATHOPHYSIOLOGIC POINTS

Ultrasonographic Evaluation of Disorders of the Male Reproductive Tract
Generally, any evidence of genitourinary disorders detected on physical examination or laboratory
analysis indicate the need for ultrasound evaluation in the male dog. Ultrasonographic examination of
the testes, epididymi and prostate gland can demonstrate lesions too small or inaccessible for detection
via palpation, and permits differentiation of soft tissue details not recognized with radiography. In the
tom cat, ultrasound evaluation of the testes for morphologic abnormalities can assist in the diagnostic
evaluation of infertility.
Infertility
Evaluation of the infertile (normal libido) stud dog’s general and urogenital health by appropriate
laboratory analysis of blood, urine and both the sperm rich and prostatic portions of the ejaculate
complements ultrasonography. Testicular ultrasound should be performed in every patient with
unexplained infertility and abnormal sperm analysis. It allows diagnosis of more pathologic conditions
than physical examination. Subtle differences in testicular or epididymal size or symmetry, or changes in
testicular or epididymal consistency warrant an ultrasonographic evaluation which can disclose
pathology (i.e., orchitis, epididymitis, testicular neoplasia) sometimes before reproductive performance
has been irreversibly affected. In human ultrasonography, color Doppler ultrasound allows rapid
varicocele screening, not reported in the dog.
The clinical evaluation of infertile tom cats is limited as semen is difficult to obtain without
electroejaculation or special training. Observation of sperm in the urine of the tom, or in the
vestibule/vagina of queens recently bred can confirm spermatogenesis. Ultrasound of the testes can
confirm normal morphology, provides an exact measure of testicular volume, and allows the detection of
the presence of dystrophic changes in the testicle, as well as anomalies of the epididymis and vas
deferens, such as cystic dilations.
The prostate should be evaluated ultrasonographically in every stud dog periodically, due to the
predisposition for benign hyperplasia, cystic hyperplasia and potential for prostatitis in intact males.
When prostatic disease is suggested by clinical evaluation (palpation, evaluation of the third fraction of
the ejaculate, urinary tract infection) ultrasonographic evaluation of the prostate gland is indicated.
Prostatic Disease
The use of ultrasound in the evaluation of prostatic disorders permits prompt, accurate assessment of the
gland for internal cavitations and changes in its normal parenchyma, symmetry, position or shape. In
combination with cytologic and microbiologic evaluation of prostatic fluid, this information permits
accurate and noninvasive information important to the evaluation of abnormal preputial discharge,
change in the color or volume of ejaculate, and urogenital pain or urinary habits. Ultrasound guided
prostatic aspirate or biopsy has greatly facilitated the differentiation of benign hyperplasia,
infection/inflammation, and neoplasia and is minimally invasive. Ultrasound guided drainage of
intraprostatic abscesses may hasten recovery. Sequential prostatic ultrasonography provides valuable
information on the efficacy of therapy.
Mineralization within the prostate will appear as highly echogenic slashes with attenuating
shadows. Mineralization can be seen in both the intact and neutered male prostate. Mineralization in any
prostate or prostatic pod is an abnormal finding, and should help define clinical findings (hematuria,
stranguria). Mineralization can be associated with chronic prostatitis or prostatic neoplasia.
Prostatic hyperplasia causes symmetric, mild enlargement of the gland with mildly increased
echogenicity which may progress to become patchy. The shape of the gland may change from bi-lobed to
circular in the transverse plane. Prostatic cysts, being fluid filled, will be easily seen as hypoechoic
structures within the prostate. Many times prostatic cysts will produce an enhanced (white shadow)
artifact. Fluid cavitations are seen with cystic prostatic hyperplasia and are difficult to differentiate from
early abscessation associated with prostatitis, clinical differentiation is indicated.
Mild early septic prostatitis may be difficult to differentiate from benign cystic hyperplasia, clinical
testing of urine, semen and prostatic fluid may be necessary. Chronic, severe prostatis can cause the
appearance of poorly marginated multifocal mixed echogenicity with infrequent mineralization.
Sublumbar lymphadenomegaly may be present.
Unlike true prostatic cysts, which are often seen in association with benign hyperplasia,
paraprostatic cysts are located adjacent to the prostate, not within it, and sometimes but not necessarily
contiguous with the prostate. The origin of these cysts is not understood, they may be remnants of the
müllerian duct system (i.e., uterus masculinus). Paraprostatic cysts resemble a second urinary bladder,
with variable wall thickness and fluid echogenicity. They are usually thin walled and contain sterile fluid
that may have necrotic debris. They do not interfere with function unless they become so large that they
obstruct flow of urine, but they should be surgically addressed by marsupialization to prevent
complications such as infection.
Neoplasia
Testicular neoplasms appear as variably circumscribed masses, hypo to hyperechoic, which may obscure
the mediastinum testis. The appearance is not specific for tumor type; masses tend to change from
hypoechoic to mixed echogenicity with growth likely due to necrosis and hemorrhage. Fine needle
aspirate of testicular masses can be helpful in differentiating tumor type (seminoma, interstitial cell,
Sertoli).
 Because neutering does not have a preventative effect on prostatic neoplasia, both intact and
neutered dogs are at risk; ultrasonography provides evaluation of the prostatic parenchyma and capsule,
and can guide appropriate, minimally invasive biopsy. Prostatic neoplasia is typically multifocal,
hyperechoic, poorly marginated and mineralized. The bladder neck, urethra and regional lymph nodes
may be affected. Tumor type is not usually distinguishable (adenocarcinoma vs transitional cell)
ultrasonographically. It is important to realize that all three pathologic prostatic conditions can occur
simultaneously (benign hyperplasia, septic prostatitis and neoplasia), making histopathologic
differentiation important.
Testicular Infection/Torsion
Orchitis and epididymitis can occur separately or concurrently. Acute infection is characterized by
generalized enlargement with a patchy hypoechoic appearance, abscessation may be evident. Extra-
testicular fluid may be present. With chronicity, mixed hyperechogenicity with atrophy is possible.
Testicular torsion can appear similar to orchitis with diffuse hypoechoic appearance to the testis.
Doppler examination reveals aberrant blood flow.

OVERVIEW OF THE ISSUE

Diagnostic ultrasonography has become an important component of small animal theriogenology since
its introduction to practice in 1978. The use of ultrasound as a tool in small animal reproduction has
expanded from its initial role in the evaluation of canine prostatic disease to its current use in the
approach to clinical reproduction (infertility, urogenital disorders and pediatrics). The availability of
ultrasonography in veterinary practice increased as reasonably priced, better quality diagnostic
ultrasound equipment became commercially available to veterinarians. Ultrasonography has become a
standard of practice in many communities, with diagnostic ultrasound available at primary private
practices, via readily accessible referral centers or from mobile specialty practices. Veterinary school
curricula and continuing education courses now commonly include ultrasonography, providing students
and graduates with the training to perform and interpret diagnostic ultrasound. Recent developments in
scanhead technology have allowed improved visualization of reproductive anatomy

SUMMARY
Ultrasonographic evaluation of the reproductive tract is a helpful diagnostic tool for investigation of
breeding soundness and any disorders of the reproductive organs.

REFERENCES
1. Baker TW. Diagnostic imaging of the reproductive tract and adnexa in cats and dogs. Proceedings, Norwegian
Annual Congress in Small Animal Reproduction. June 2007.
2. Nyland TG, Mattoon JS, Herrgesell EJ, Wisner ER. Urinary tract. In: Nyland TG, Mattoon JS. Small Animal
Diagnostic Ultrasound, 2nd edition. Philadelphia: WB Saunders, 2002, p.158–195.
3. Lamb CR. Ultrasonography of the ureters. In: Vet Clin North Am Small Anim Pract 1998; 28:823–848.
4. Eilts BE, Pechman RD, Hedlund CS. Use of ultrasonography to diagnose Sertoli cell neoplasia and
cryptorchidism in a dog. J Am Vet Med Assoc 1988; 192:533–534.