ADAIN Procedure

Prostatic abscess treated with abscess drainage antibiotic injection and neuter (ADAIN) procedure in a 9 year old MI Poodle dog

History
A 9-year-old MI poodle, with history of calcium oxalate crystalluria, presented for acting strangely. Per the owner, the patient was restless, had labored breathing, and was vomiting. There was a possibility of foreign body ingestion. On physical examination, the patient was depressed, quiet, and febrile, the mucous membranes were moist and pink, and the abdomen was non-painful on palpation. The only abnormality on blood chemistry was mild increase in ALT activity. The patient was treated with subcutaneous fluids, anti-emetics, and antibiotics. At recheck examination he was still doing poorly, had difficulty moving around, and his appetite was decreased.

Clinical Differential Diagnosis
Primary neurological disease, metabolic encephalopathy (renal/hepatic), infectious disease (bacterial/fungal/protozoal), immune-mediated disease, neoplasia, GI tract obstruction.

Image Interpretation
A large mildly echogenic fluid filled cystic structure is present within the prostatic parenchyma. Hyperechoic pericapsular inflammation and slight free fluid is noted suggestive for potential leakage into the abdomen and pelvic peritonitis.
Sonographic Differential Diagnosis
Prostatic abscess.

Sampling
US-guided fine needle drainage of the prostatic abscess was performed. Aerobic culture of an aspirate from the prostatic abscess yielded no growth, however the patient had been treated with antibiotics and an anaerobic culture was not performed.

DX
Prostatic abscess

Outcome
The patient was castrated, recovered uneventfully, and was placed on enrofloxacin and clindamycin for 4 weeks. Follow up ultrasound found that the prostatic abscess had resolved. The patient was doing well at that time; the owners were advised to continue with the antibiotics for further 3 weeks.

Comments
This procedure we call the “ADAIN” procedure: ultrasound-guided “Abscess Drainage Antibiotic Injection & Neuter.” In 18 cases to date, we have found near universal success with only occasional need to drain further post neuter in 2 cases. Studies are currently underway at SonoPath.com. This interventional ultrasonographic procedure avoids costly and invasive surgical prostatic marsupialization procedures.