Patient 1

Patient 1 presented for a three-day duration history of anorexia and apathy. Physical examination revealed severe dehydration, apathy, painful abdominal palpation, and empty urinary bladder. Hematology and protein electrophoresis were unremarkable. Blood chemistry showed hyperglycemia (183 mg/dl; reference range [RR] 74–148 mg/dl) and hypertriglyceridemia (225 mg/dl; RR 50–200 mg/dl).^10,11 Radiography showed signs of digestive hypomotility but was otherwise unremarkable. The rabbit was hospitalized, and strangury and vesical tenesmus were noted by attending staff. Urine was collected by urinary catheterization. Urinalysis revealed a urine specific gravity (USG) of 1.036 (RR 1.003–1.060), pH of 5 (RR 7.6–8.8), traces of blood and proteins, and scarce granular casts.^11,12 Ultrasound examination revealed a distended seminal vesicle protruding into the abdominal cavity and compressing the proximal urethra. The content was hypoechoic with multiple hyperechoic foci. The seminal vesicle measured 13.7 mm (RR 5.4–5.6 mm) in width, 5.7 mm (RR 4.5–4.6 mm) in depth, and at least 30.0 mm (RR 6.2–6.3 mm) in length (caudal limit was not clearly identified).¹³ Proprostate measured 17.7 mm (RR 10.7–16.7 mm) in width, 8.8 mm (RR 4.3–7.5 mm) in depth, and at least 17.8 mm (RR 6.4–19.8 mm) in length (caudal limit was not clearly identified), and had otherwise normal echographic appearance (Figure 1A).⁸ No clinical signs of cystitis or other pathologies that would explain the strangury were observed. Particularly, no inflammatory or epithelial cells were found in urine, as would be expected in case of cystitis or urethritis. Consequently, prostatic complex pathology was suspected, and presumptive diagnosis of proprostatitis and seminal vesiculitis with secondary strangury was established based on proprostate enlargement and abnormal seminal vesicle contents and size. Patient 1 was treated with marbofloxacin^a (5 mg/kg SC q 24 hr), hyoscine butylbromide (1 mg/kg SC q 8 hr) in combination with sodium metamizole^b (125 mg/kg SC q 8 hr), buprenorphine^c (0.05 mg/kg SC q 8 hr), ranitidine^d (4 mg/kg SC q 8 hr), metoclopramide^e (0.5 mg/kg SC q 8 hr), and intravenous fluid therapy.¹⁴ After 5 days, no significant improvement in strangury and vesical tenesmus was observed. Despite normalization of the hydration status and analgesic treatment, the rabbit remained apathetic, anorexic, and with signs of abdominal pain. Ultrasound follow-up examinations showed no changes in size or contents of the seminal vesicle. Because of the lack of improvement, laparotomy was performed, revealing a distended and congested seminal vesicle filled with whitish, thick fluid (Figure 1B). The fluid was aspirated using a 1 cc syringe and 25G needle (Figure 1C). Cytology of the fluid revealed inflammatory cells (mainly neutrophils) and gram-positive cocci. A sample for microbiological culture was submitted and later resulted in a pure culture of multidrug-resistant Staphylococcus sp. The seminal vesicle was incised and flushed with sterile saline. Vesiculectomy and bilateral orchiectomy were performed. A combination of benzylpenicillin G (80,000 UI/kg) and dihydrostreptomycin sulphate^f (100 mg/kg SC q 24 hr) were added to the treatment after the surgery. Patient 1 recovered uneventfully from the surgery and started eating the same day. This rabbit was discharged 2 wk later and had no recurrences for 11 mo.

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Histopathology of the seminal vesicle showed mild neutrophilic adenitis. Both testicles were histologically normal.

Patient 2

Patient 2 was presented with chronic pollakiuria. Owners reported a 6- to 7-mo history of strong urine smell, the rabbit's perianal and inguinal region being permanently wet, and several days of anorexia and apathy. Physical examination revealed severe dehydration, apathy, poor body condition, dermatitis of the perianal and inguinal regions, bilateral hind limbs pododermatitis and lameness, painful abdominal palpation, and distended urinary bladder (despite dehydration). Hematology revealed slight leucocytosis (11500 WBC/mcl; RR 5100–9700 WBC/mcl) with left shift (6% of band neutrophils; RR 0%–1%).^10,15 Protein electrophoresis showed normal total proteins (68 g/l; RR 55–72 g/l) with beta- (12.0 g/l and 17.6%; RR 9.5–11.5 g/l, 8.0%–14.8%) and relative gamma-globulinemia (7.7 g/l and 11.3%; RR 5.7–7.7 g/l, 8.6%–9.6%).^16,17 These results are consistent with chronic inflammation with infection as a most probable cause.^16–19 Infection by Encephalitozoon cuniculi was considered unlikely, since this patient presented undetectable immunoglobulin G titers (<1/80) against this microorganism 9 mo earlier and had no contact with other rabbits or rodents.¹⁷ Radiography revealed increased radiodensity in the caudal abdomen, an abnormal shape of the urinary bladder, and signs of digestive hypomotility. Urine was collected by cystocentesis. Urinalysis revealed a USG of 1.012 (RR 1.003–1.060), pH 8.0 (RR 7.6–8.8), moderate hematuria, pyuria and sporadic transition, and squamous epithelial cells.¹¹ Ultrasound examination revealed a noticeably enlarged seminal vesicle with hypoechoic content, thickening of the urinary bladder mucosa, and constriction of urinary bladder at the mid region (Figure 1D). The urinary bladder was displaced ventrally and laterally to the left by the dilated seminal vesicle. The seminal vesicle measured 15.7 mm (RR 5.4–5.6 mm) in width, 16.7 mm (RR 4.5–4.6 mm) in depth, and at least 34.6 mm (RR 6.2–6.3 mm) in length.¹³ Proprostate measured 10.7 mm (RR 10.7-16.7 mm) in width, 8.4 mm (RR 4.3-7.5 mm) in depth and 11.5 mm (RR 6.4-19.8 mm) in length.⁸ Contrast radiography was performed instilling 10 ml iohexol 300 mg I/ml solution^g through a tomcat catheter in the urethra. Radiography confirmed urinary bladder stricture and revealed unintentional placement of the urinary catheter in the seminal vesicle (Figure 2A, B). After injection of the contrast media, the maximum radiographic measurements of the seminal vesicle were 23 mm in width, 18 mm in depth and 46 mm in length.

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Diagnosis of cystitis and seminal vesiculitis was made. Patient 2 was hospitalized and treated with marbofloxacin^a (5 mg/kg SC q 24 hr), hyoscine butylbromide (1 mg/kg SC q 8 hr) in combination with sodium metamizole^b (125 mg/kg SC q 8 hr), fentanyl^h 12.5 mcg/h transdermal patch, intravenous fluid therapy and symptomatic treatment for digestive hypomotility for 4 days. The patient showed normalization of hydration status and general improvement, but the strangury persisted. Vesiculectomy, a biopsy of the urinary bladder, and bilateral orchiectomy were performed on day 4. Patient 2 recovered without incidence and was discharged after 7 days. This rabbit had no recurrences for 8 mo, and pollakiuria, strangury and urine scalding resolved completely.

Histopathology of the seminal vesicle showed mild acute multifocal erosive adenitis with multifocal hemorrhage and mucosal atrophy. Possible discrete hypertrophy of the muscular layer was also observed. The urinary bladder mucosa and the superficial part of the muscular layer presented occasional foci of hemorrhage associated to edema of the mucosa. Both testicles presented moderate atrophy of seminal tubules.

Patient 3

Patient 3 was presented with acute anorexia, priapism, and hematuria. During the anamnesis, the owners reported a history of chronic difficulty in urination. Physical examination revealed mild dehydration, painful abdominal palpation, and a moderately dilated urinary bladder. Complete blood analysis showed no remarkable findings, except for the pronounced hyperglycemia (339 mg/dl; RR 74–148 mg/dl).^10,11 Urine was collected by manual extrusion of the urinary bladder. Urinalysis revealed transparent mucus in urine, a USG of 1.008 (RR 1.003–1.060), pH of 7.5 (RR 7.6–8.8), traces of blood and proteins, and occasional squamous epithelial cells.¹¹ Radiography revealed a moderate amount of sludge in the urinary bladder and was unremarkable otherwise. Ultrasound examination revealed a distended seminal vesicle with hypoechoic contents protruding into the abdominal cavity. The seminal vesicle measured 13.3 mm (RR 5.4–5.6 mm) in width, 7.3 mm (RR 4.5–4.6 mm) in depth, and at least 23.0 mm (RR 6.2–6.3 mm) in length.¹³ Proprostate measured 13.8 mm (RR 10.7–16.7 mm) in width, 8.8 mm (RR 4.3–7.5 mm) in depth, and 17.6 mm (RR 6.4–19.8 mm) in length, and prostate measured 7.2 mm (RR 3.2–7.8 mm) in depth and 14.1 mm (RR 8.4–15.2 mm) in width.⁸ Proprostate and prostate had normal ultrasonographic appearance. The urinary bladder did not present ultrasonography signs of cystitis. Prostatic complex pathology was suspected based on clinical signs, the absence of signs of cystitis, and abnormal contents of the seminal vesicle and proprostate enlargement detected ultrasonographically. A presumptive diagnosis of seminal vesiculitis and proprostatitis was made, and the patient was treated with a single injection of buprenorphine at 0.05 mg/kg SC, trimethoprim/sulfamethoxazoleⁱ (40 mg/kg PO q 12 hr), and meloxicam^j (0.3 mg/kg PO q 12 hr) for 7 days.¹⁴

After initial improvement and complete resolution of the clinical signs, Patient 3 relapsed 1 month after discharge with identical clinical signs and findings. Complete blood analysis was again unremarkable except for marked hyperglycemia (399 mg/dl; RR 74–148 mg/dl).^10,11 Ultrasound revealed hypoechoic content and hyperechoic wall of the seminal vesicle, prostate measurements of 8.8 mm (RR 3.5–7.9 mm) in depth and 15.3 mm (RR 8.4-–5.2 mm) in width. Proprostate and urinary bladder had normal ultrasonographic appearance. Urinalysis revealed few inflammatory cells in this occasion. The patient was treated with trimethoprim/sulfamethoxazole and meloxicam with the same protocol and improved noticeably in 24 hrs. Bilateral orchiectomy was performed 4 days later. The rabbit recovered uneventfully and did not present recurrences for 3 years. However, the owners reported lately that a slight difficulty in urination persisted.

Patient 3 showed three more episodes of exacerbated strangury in 4 yrs. The owners reported that the animal was repeatedly adopting posture to urinate without voiding urine and was anorexic and apathetic. Clinical and laboratory findings were similar to the previously described, but radiography and ultrasound revealed lithiasis and hyperechogenicity of the wall of the seminal vesicle (Figure 2C, D). Ultrasonographic appearance of the prostate was normal in these occasions. Only in one occasion, fever (rectal temperature 40.5°C; RR 38.5°C–40°C), abnormal urinalysis findings (presence of significant amount of transition epithelium cells, leucocytes and erythrocytes in urinary sediment), and ultrasonographically detected slight hypertrophy of urinary bladder mucosa were interpreted as signs of cystitis concurrent to vesicle lithiasis.¹⁴ The rabbit was treated with meloxicam^j (0.3 mg/kg PO q 12 hr) and presented rapid improvement in all occasions. Cystitis was treated with marbofloxacin^k (5 mg/kg PO q 24 hr) for 7 days. Surgical treatment of seminal vesicle lithiasis was rejected by the owners.