TOPICAL REVIEW
Reproductive Ultrasound of the Dog and Tom
Autumn P. Davidson, DVM, MS, Dipl ACVIM,a and Tomas W. Baker, MSb
Ultrasonographic evaluation of the reproductive tract is an important component in the evaluation of the dog
and tom with reproductive disorders. Information is obtained confirming normal anatomy as well as patho-
logic conditions (eg, testicular neoplasia). Serial ultrasonographic evaluation of the diseased reproductive tract
can be very helpful in evaluating progression of disease (eg, testicular atrophy) and response to therapy (eg,
benign prostatic hyperplasia).
© 2009 Published by Elsevier Inc.
Keywords: reproduction, ultrasound, infertility, prostate, testes
P erforming ultrasound of the male reproductive tract re-
quires basic knowledge of the normal canine and feline
reproductive anatomy. The male canine reproductive tract
consists of the male genital organs including the scrotum, the
2 testes (normally located within the scrotum), the epididymi,
the deferent ducts (leading from the epididymis to the ure-
thra), the spermatic cords, the prostate, the penis, and the
urethra.
The canine scrotum is a pouch divided by a thin wall into
2 cavities, each of which is occupied by a testicle, an epidid-
ymis, 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 canine testicle is oval in shape
and thicker centrally. The testicles contain seminiferous tu-
bules. The epididymis is comparatively large in the dog and
consists of an elongated structure composed of a long and
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 3 layers.
The canine prostate gland surrounds the neck of the blad-
der, as well as the distal ductus deferens. A thin wall divides
the gland into 2 equal-sized, smooth, firm lobes. The prostate
has multiple openings into the urethra.
The canine 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 cop-
aSchool of Veterinary Medicine, Department of Medicine and Epidemiol-
ogy, University of California, Davis, Davis, CA, USA.
bSchool of Veterinary Medicine, Department of Radiology and Surgical
Sciences, University of California, Davis, Davis, CA, USA.
Address reprint requests to: Tomas W. Baker, MS, Chief Ultrasonogra-
pher, School of Veterinary Medicine, Department of Radiology and Surgi-
cal Sciences, VMTH/SAC, University of California, Davis, 1 Shields Ave,
Davis, CA 95616. E-mail: tbaker@vmth.ucdavis.edu
© 2009 Published by Elsevier Inc.
1527-3369/06/0604-0171\.00/0
doi:10.1053/j.tcam.2008.11.003
64
ulatory 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 nonerect penis.
The reproductive tract of the tom cat consists of the penis,
the scrotum, 2 testicles, the prostate gland, 2 bulbourethral
glands (Cowper’s glands), the epididymis, the ductus defer-
ens (also called the vas deferens), the spermatic cords, and the
urethra.
The feline 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 2 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 6 weeks after
castration. The feline 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 feline scrotum is located just ventral to the anus and
dorsal to the prepuce. It is visible when the tail is lifted up-
ward. The scrotum is covered with dense hair and is not
pendulous. The scrotum is a pouch divided by a thin wall into
2 cavities, each of which is occupied by a testicle, an epidid-
ymis, 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 feline 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 3 layers.
The ductus deferens or vas deferens begins at the tail of the
epididymis and runs along the border of the testicle, and then
toward the caudal aspect of the abdomen. It passes through
Volume 24, Number 2, May 2009
Figure 1. Normal canine testes. Using one testis as a “stand-
off” for the other facilitates evaluation by placing the testicle
in the center of the image.
the prostate and empties into the urethra. The 2 spermatic
cords are composed of the ductus deferens, and the vessels
and nerves of the testicles. They are covered by a thin mem-
brane. Each cord originates at the tail of the epididymis and
extends through the inguinal canal.
The feline 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 abdom-
inal cavity. The prostate gland surrounds the proximal por-
tion of the urethra and the termination of the ductus defer-
ens. The bulbourethral glands are situated on either side of
the urethra. The prostate gland surrounds the proximal ure-
thra, as well as the distal ductus deferens. The prostate has
multiple openings into the urethra. It is a very small, rela-
tively unimportant organ in the male cat.
Ultrasonography
As with the female reproductive patient, before performing a
specific evaluation of the male reproductive tract, the abdo-
men should be evaluated methodically with the animal in
dorsal recumbency.1 The discovery of abnormalities in other
systems can be relevant to reproductive disorders.
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 (Fig 1). The normal
testis is uniform in texture with echogenicity similar to the
spleen (Fig 2). The mediastinum testis is a thin, centrally
located, very hyperechoic line. The epididymis (head, body,
tail) is less echogenic 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 intact canine prostate gland, located in the
pelvic canal, has fairly uniform echogenicity, a smooth, stip-
65
pled texture, and echogenicity similar to that in the spleen. Its
shape is bilobed in the transverse plane and oval in the lon-
gitudinal plane (Fig 3, A and B). A hyperechoic “butterfly”
pattern may be noted in the transverse image that corre-
sponds to the distribution of ductal tissue, having more echo-
genic connective tissue than the more hypoechoic glandular
tissue. The length and height of the prostate gland range from
1.3 to 3.3 cm in mature, 7- to 30-kg dogs.2 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 hypo-
echoic 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 (Fig 4). 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. Pros-
tatic disorders are, fortunately, uncommon in the tom.
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. Ultrasono-
graphic 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 abnormal-
ities can assist in the diagnostic evaluation of infertility.
Infertility
Evaluation of the infertile (normal libido) stud dog’s gen-
eral and urogenital health by appropriate laboratory analysis
Figure 2. Normal canine testes. Note the uniform parenchy-
mal echotexture (similar to the spleen) and mediastinum tes-
tis (hyperechoic central linear structure or slash). This trans-
verse view allows for comparison of size and texture.
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Figure 3. (A) Normal intact canine prostate, transverse view. Note the symmetrical bilobed appearance and homogenous
parenchyma. (B) Normal intact canine prostate, sagittal view. The prostatic urethra is identified as a linear structure in the
center of the prostate.
of blood, urine, and both the sperm-rich and prostatic por-
tions of the ejaculate complements ultrasonography. Testic-
ular ultrasound should be performed in every patient with
unexplained infertility and abnormal sperm analysis. It al-
lows diagnosis of more pathologic conditions than physical ex-
amination. Subtle differences in testicular or epididymal size or
symmetry, or changes in testicular or epididymal consistency
warrant an ultrasonographic evaluation, which can disclose pa-
thology (ie, orchitis, epididymitis, testicular neoplasia) some-
times before reproductive performance has been irreversibly
affected. In human ultrasonography, color Doppler ultra-
sound allows rapid varicocele screening, which is not re-
ported in the dog. Recently, ultrasound-guided fine-needle
aspirates of the testes of dogs under evaluation for infertility
or subfertility has been described with good diagnostic re-
sults.3
The clinical evaluation of infertile tom cats is limited be-
cause semen is difficult to obtain without electroejaculation
Figure 4. Normal neutered canine prostate, sagittal view.
The prostate is small and homogenous, isoechoic to the ure-
thra.
Topics in Companion Animal Medicine
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 con-
firm normal morphology, provides an exact measure of tes-
ticular 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 because of the predisposition for
benign hyperplasia, cystic hyperplasia, and the potential for
prostatitis in intact males. When prostatic disease is sug-
gested by clinical evaluation (palpation, evaluation of the
third fraction of the ejaculate, urinary tract infection), ultra-
sonographic evaluation of the prostate gland is indicated.
Prostatic Disease
The use of ultrasound in the evaluation of prostatic disor-
ders permits prompt, accurate assessment of the gland for
Figure 5. Sagittal view of canine prostate. Arrows indicate
mineralization within the parenchyma.
Volume 24, Number 2, May 2009 67

Figure 9. Sagittal image of the urinary bladder. A parapros-

tatic cyst is present dorsal to the urethra, extending cranially
Figure 6. Transverse view of canine benign prostatic hyper-
from the prostate.
plasia. Note the striations extending centrifugally in the pa-
renchyma.

Figure 10. Intratesticular neoplasia: seminoma. The well-cir-

cumscribed, round mass within the testicular parenchyma is
homogenous with a single cystic region.
Figure 7. Chronic canine prostatitis, sagittal view.

Figure 11. Prostatic neoplasia: transitional cell carcinoma.

Figure 8. Sublumbar lymphadenomegaly. Transverse image The prostatic parenchyma has been replaced by an irregu-
of the urinary bladder; a markedly enlarged lymph node is larly outlined, coarse mass with multifocal mineralization
evident dorsal to the urinary bladder. (cursors).
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Figure 12. Hydronephrosis. Note the dilated renal pelvis;
this resulted from partial obstruction of the ipsilateral ureter
at its insertion into the urinary bladder, secondary to a car-
cinoma of the prostate and bladder neck.
internal cavitations and changes in its normal parenchyma,
symmetry, position, or shape. In combination with cytologic
and microbiologic evaluation of prostatic fluid, this informa-
tion permits accurate and noninvasive information impor-
tant 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 intra-
prostatic abscesses can hasten recovery. Sequential prostatic
ultrasonography provides valuable information on the effi-
cacy of a selected therapy.
Mineralization within the prostate will appear as highly
echogenic slashes with attenuating shadows (Fig 5). Miner-
alization 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
Figure 13. (A) Epididymitis. Note the hypoechoic parenchymal change (cursors). (B) Image of the testis and epididymis. Free
fluid is present within the scrotal sac (arrow).
Topics in Companion Animal Medicine
(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 bilobed to circular in the transverse plane. The
parenchyma can have a striated appearance (Fig 6). 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 cav-
itations seen with cystic prostatic hyperplasia are sometimes
difficult to differentiate from early abscessation associated
with prostatitis; clinical differentiation is indicated.
Mild, early septic prostatitis may be difficult to differenti-
ate from benign cystic hyperplasia, and clinical testing of
urine, semen, and prostatic fluid may be necessary. Chronic,
severe prostatitis has poorly marginated, multifocal, mixed
echogenicity with infrequent mineralization (Fig 7). Sublum-
bar lymphadenomegaly may be present (Fig 8).
Unlike true prostatic cysts, which are often seen in associ-
ation with benign hyperplasia, paraprostatic cysts are located
adjacent to the prostate, not within it, and sometimes are
contiguous with the prostate (Fig 9). The origin of these cysts
is not understood; they may be remnants of the Müllerian
duct system (ie, uterus masculinus). Paraprostatic cysts can
resemble a second urinary bladder, with variable wall thick-
ness 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, hypoechoic to hyperechoic, which may obscure the
mediastinum testis. The appearance is not specific for tumor
type; masses tend to change from hypoechoic to mixed echo-
Volume 24, Number 2, May 2009
Figure 14. Sagittal image of a cryptorchid, abdominal testis
(cursors). The mediastinum testis is visible.
genicity with growth likely due to necrosis and hemorrhage
(Fig 10). Fine-needle aspirate of testicular masses can be help-
ful in differentiating tumor type (seminoma, interstitial cell,
Sertoli).4 These tumors are late to metastasize, and castration
usually proves curative. Histopathologic evaluation of the
local lymphatics is helpful in identifying local metastasis.
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 paren-
chyma and capsule and can guide appropriate, minimally
invasive biopsy. Prostatic neoplasia is typically multifocal,
hyperechoic, poorly marginated, and mineralized (Fig 11).
The bladder neck, ureters, urethra, and regional lymph nodes
may be affected. Hydronephrosis can result from ureteral
compression (Fig 12).5,6 Tumor type is not usually distin-
guishable (adenocarcinoma vs transitional cell) ultrasono-
graphically. It is important to realize that all 3 pathologic
prostatic conditions can occur simultaneously (benign hyper-
Figure 15. Intraabdominal testicular torsion. (A) A midabdominal mass (cursors) with little recognizable anatomy. (B) A
Sertoli cell tumor was identified within this testis after castration.
69
plasia, septic prostatitis, and neoplasia), making histopatho-
logic differentiation important.2
Testicular Infection/Torsion
Orchitis and epididymitis can occur separately or concur-
rently. Acute testicular infection is characterized by general-
ized enlargement of the testis with a patchy hypoechoic ap-
pearance, and focal abscessation may be evident. Ultrasound
permits differentiation of testicular versus epididymal en-
largement. Epididymitis is characterized by focal parenchy-
mal changes (Fig 13, A). With chronicity, mixed hyperecho-
genicity with atrophy is possible.
The epididymis, when infected, can appear hypoechoic and
enlarged. Extra-testicular fluid may be present (Fig 13, B). An
epididymal granuloma can result from the acute inflamma-
tory phase.
Testicular torsion can appear similar to orchitis with dif-
fuse hypoechoic appearance to the testis. The torsed testicle is
commonly abdominal and infiltrated by neoplasia. Cryp-
torchid testes can be positioned anywhere between the ipsi-
lateral kidney and the inguinal canal, and can be recognized
by the presence of the mediastinum testis (Fig 14). The torsed
testicle can be markedly altered in appearance from the pres-
ence of an intratesticular tumor and the vascular conse-
quences of torsion (Fig 15). Doppler examination reveals
aberrant blood flow.
Penile Disorders
Ultrasound evaluation of the prepuce and penis can be
contributory in the evaluation of priapism, posthitis, and
balanoposthitis, as well as penile trauma (eg, fractured os
penis, penile hematoma). Priapism (ischemic or nonischemic)
can be associated with vascular disorders (efferent or affer-
ent), neuropathy, masses, or thrombi, or can be idiopathic
(Fig 16). Trauma to the penis can result in a fractured os.
70
Figure 16. Transverse image of the canine penis at the level of the bulbus glandis. The os penis produces a hard shadow
dorsally. (A) Detumescence. (B) Tumesence.
Penile neoplasia is an uncommon disorder with some geo-
graphic predisposition (transmissible venereal tumor). Eval-
uation of the sublumbar lymphatics can identify enlargement
likely associated with metastasis.
References
1. Baker TW: Performing the complete abdominal ultrasound eval-
uation, in Proceedings of the Swedish Annual Course in Small
Animal Reproduction, Uppsala, Sweden, 2004
2. Baker TW: Diagnostic imaging of the reproductive tract and
adnexa in cats and dogs, in Proceedings of the Norwegian An-
nual Congress in Small Animal Reproduction, 2007
Topics in Companion Animal Medicine
3. Romagnoli S, Bonaccini P, Stelletta C, et al: Clinical use of testicular
fine needle aspiration cytology in oligospermic and azoospermic
dogs, in Proceedings of International Symposium on Canine and
Feline Reproduction, 2008
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 192:533-534, 1988
5. Nyland TG, Mattoon JS, Herrgesell EJ, et al: Urinary
tract, in Nyland TG, Mattoon JS (eds): Small Animal Diag-
nostic Ultrasound, ed 2. Philadelphia, WB Saunders, 2002, pp
158-195
6. Lamb CR: Ultrasonography of the ureters. Vet Clin North Am
Small Anim Pract 28:823-848, 1998