Penile Surgery

Question 1

Obj: What disease or injuries commonly effect the penis/prepuce of cattle?

Question 2

Obj: How to differentiate these various problems

Question 3

Obj: What surgical procedures are appropriate and how are they done?

Question 4

Obj: Understand the expectations and prognosis associated with these various conditions?

Question 5

Obj: Elective Surgeries

Question 6

What are some common injuries/conditions of the prepuce?

Answer 6

• Persistent frenulum
• Preputial prolapse
• Preputial lacerations

Question 7

What are the common injuries/conditions of the penis in cattle?

Answer 7

• Fibropapilloma
• Hematoma
• Vascular shunts
• Deviations

Question 8

What are other reproductive problems of importance in cattle (not penis/prepuce)

Answer 8

• Scrotum - inguinal hernia
• Testicular disease (lymphosarcoma, trauma, infection)
• Seminal Vesiculitis
• Musculoskeletal Disease

Question 9

How can the penis be extended/prepuce be exposed in cattle?

Answer 9

• Rectal massage (seminal vesicles)
• Electro-ejaculator (EEJ)
• Drugs:
  
  • Acepromazine - 0.03mg/kg
  • Xylazine - 0.05 mg/kg
• Manual extension
  
  • straighten sigmoid flexure
• Pudendal nerve block - not common
  
  • paralyses of retractor penis muscles

Question 10

What are the sites of swelling in the male repro tract?

Answer 10

• Diamond: Scrotal hernia/Orchitis
• Rectangle: Hematoma of the penis
• Oval: Preputial lacerations

Question 11

What animals are more prone to preputial lacerations and prolapse?

Answer 11

• More common in polled breeds and Zebu-type cattle
  
  • Angus, Polled Herefords have minimal or no retractor prepuce muscle
  • Zebu cattle (Brahman, Santa Gertrudis) have excessively loss sheath

Question 12

What is the treatment for preputial lacerations?

Answer 12

• Sexual rest
• Anti-inflammatory drugs
  
  • Flunixin, aspirin
  • phenylbutazone (drug residues)
• Antibiotics
  
  • PPG
• Hydrotherapy
• Topical antiseptics
  
  • lanolin/Petroleum base (lanolin/scarlet oil/penicillin)
• Penile/preputial retention
  
  • Purse string
  • retaining tube
• Re-check at 60+ days

Question 13

When is surgery for preputial lacerations (posthioplasty) indicated?

Answer 13

Compromised mobility of the penis or prepuce

Question 14

What is Posthioplasty? Indications? Prognosis?

Answer 14

• “Reefing” “Preputial Resection/Circumcision”
• Indications:
  
  • Prophylactic
    
    • repeated minor trauma
    • Bos indicus bulls
  • Restrictive adhesions
  • Circumferential scar
• Prognosis:
  
  • Able to extend penis for surgery
    
    • 75% breed at least 1 additional season
    • Reoccurrence uncommon if able to return to breeding
  • Compromise of elastic laminae important

Question 15

Pre-op, Intra-op evaluation of penis during psothioplasty

Question 16

What are important components of a psothioplasty?

Answer 16

• Alignment marker sutures
• circumferential incisions
• Establish Strict hemostasis
  
  • hematoma/seroma will dehisce sutures
• Suture closure - Appositional, interrupted, absorbable
• Preputial retainer for 10-14d

Question 17

What causes penile hematomas?

Answer 17

• Bending of the penis against escutcheon of cow
• Restraint by retractor penis muscle

Question 18

What happens during a penile hematoma?

Answer 18

• Rupture of CCP dorsal aspect of penis opposite Retractor penis muscle
  
  • rare to rupture ventral (urethra)
• Pressure can approach 1500psi
• Volume of blood is proportional to how many times bull tries to breed after injury

Question 19

How can a penile hematoma be diagnosed

Answer 19

• History
• PE
  
  • location:
    
    • base of scrotum → hematoma
    • preputial orifice → abscess
• Palpation
• Ultrasound
• Fine needle aspirate
  
  • Needs to be aseptic - otherwise will cause abscess
• Surgical exploration

Question 20

What determines Medical vs Surgical Management of a Penile hematoma?

Answer 20

• Size:
  
  • <20cm width
    
    • 75% success with medical or surgical treatment
      
      • so usually medically
  • >20cm width
    
    • 75% success with surgical treatment
    • 40% success with medical treatment

Question 21

What is the Prognosis for Penile hematomas?

Answer 21

75% of bulls return to breeding

Question 22

What is the medical management for penile hematomas?

Answer 22

• Sexual rest for 60 days
• NSAID’s
• Antibiotics
• Hydrotherapy / Therapeutic ultrasound
• Preputial retainer as needed

Question 23

What is the surgical management for penile hematomas?

Answer 23

• General anesthesia v Sedation and local anesthesia
• Evacuate Hematoma
  
  • must do aseptically
• +/- Reconstruct tunica
• One-layer closure
• Post-op
  
  • same as medical treatment

Question 24

What are common complications of Penile Injury?

Answer 24

• Vascular shunts
• Dorsal nerve penis dysfunction
• Adhesions → restriction of mobility
  
  • infection/abscess = adhesions

Question 25

What are some elective penile/preputial surgeries in cattle?

Answer 25

* Penopexy * ventral midline * sigmoid flexure tie-down * Preputial and penile diversion * Tunneling SQ * Transposition Flap * Epididymectomy * Vasectomy