Surgical correction of a congenital preputial and penile deformity in a dog

An 11-month-old, intact male Great Pyrenees was presented for recurrent, nonpainful accumulation of suppurative fluid within the prepuce. Surgical exploration revealed a continuation of the urethral mucosa with the cutaneous epidermis of the prepuce, thus creating a closed preputial cavity surrounding the penis where fluid could accumulate. A persistent frenulum and a previously undescribed tissue remnant connecting the dorsal and distal aspects of the penis to the dorsal wall of the prepuce were also present. Surgical correction of the preputial and penile deformity, along with correction of the resulting paraphimosis and pendulous prepuce that became apparent following the initial surgery, are discussed.     

Subtotal penile amputation and preputial urethrostomy in a dog

CASE DESCRIPTION: A 6-year-old castrated male Shih Tzu was evaluated because of intermittent bleeding during urination. CLINICAL FINDINGS: Necrosis of the cranial portion of the penile shaft extended distally from the preputial fornix. Penile necrosis secondary to strangulation from paraphimosis was diagnosed. TREATMENT AND OUTCOME: A midline preputiotomy incision was used to expose the penile shaft; amputation was performed caudal to the preputial fornix. The terminal portion of the urethra was anastomosed to the preputial mucosa, which allowed the dog to urinate through the preputial orifice. CLINICAL RELEVANCE: Unlike the more conventional urethrostomy procedures performed in dogs, preputial urethrostomy eliminates the potential for local skin irritation during urination. Preputial urethrostomy is also easier to perform in those dogs in which penile amputation is required adjacent to the preputial fornix. A release incision cranial to the prepuce can be used to facilitate caudal displacement of the preputial mucosa, which facilitates urethral anastomosis to this structure. A midline preputiotomy incision provided excellent exposure of the penile shaft for this surgical procedure.     

Preputial damage and lateral penile displacement during castration in a degu

CASE DESCRIPTION: A 2-month-old male degu was treated for preputial damage and lateral penile displacement that occurred during attempted castration. CLINICAL FINDINGS: Bruising and swelling of the prepuce and severe edema to the left of the prepuce were evident. The penis could not be extruded from the prepuce. Radiography revealed a large bladder. Contrast medium injected into the prepuce filled the peripreputial subcutaneous tissues. TREATMENT AND OUTCOME: During surgical exploration through a peripreputial approach, the penis was found to be completely separated from the prepuce and located in the adjacent subcutaneous tissue. The penis was repositioned in the prepuce and anchored with a suture at its base. The following day, the preputial orifice was crusted over, urine was leaking from the incision, and the penis could not be extruded from the prepuce. The anchoring suture was removed, and the tip of the penis was sutured to the preputial orifice so that the penis protruded slightly from the prepuce. Urination was normal after the second surgery. Two years later, the preputial orifice remained adhered to the distal portion of the penis and the exposed penile tissue was healthy. CLINICAL RELEVANCE: Penile displacement from the prepuce is an unusual complication of castration in degus. The surgical technique used in this animal may be an effective means of repair. Permanent exposure of the tip of the penis may be well-tolerated in degus.     

Reconstruction of the urethra by use of an inverse tubed bipedicled flap in a dog with hypospadias

CASE DESCRIPTION: A 1-year-old castrated male German Shepherd Dog was evaluated because of a history of hematuria and stranguria secondary to recurrent urinary tract infections. CLINICAL FINDINGS: Physical examination revealed hypospadias with penile and preputial aplasia. The urethral orifice was just ventral to the ventral aspect of the anocutaneous junction. Ascending urinary tract infections, secondary to fecal contamination of the urethral orifice, were the presumed source of recurrent bouts of cystitis that developed despite periodic antimicrobial treatment. TREATMENT AND OUTCOME: A 1-cm-diameter urethral extension was constructed from the urethral mucosal remnant located along the midline of the perineum (urethral trough). Two parallel 4-cm incisions (3 cm apart) were made lateral to that urethral trough. The borders were sutured to form an inverted, epithelium-lined tube (bipedicled flap) attached to the dorsal urethral orifice. The lateral skin margins were sutured over the reconstructed urethral extension, completing the procedure. Postoperative swelling necessitated temporary catheterization of the urinary bladder. After closure of a small fistula from the reconstructed urethral segment, the dog subsequently had only 2 episodes of cystitis during a 3-year period. To minimize skin irritation secondary to urine exposure, the dog's owner regularly trimmed the hair around the new urethral orifice. CLINICAL RELEVANCE: In dogs, correction of perineal (subanal) hypospadias via urethral reconstruction should be considered among treatment options. By use of an inverse tubed urethral extension, direct fecal contamination to the lower urinary tract may be effectively eliminated, dramatically reducing the incidence of ascending urinary tract infections in dogs with hypospadias.     

Surgical treatment of phimosis due to preputial stenosis in a Thoroughbred colt

A 6-month-old Thoroughbred colt was referred to Rossdales Equine Hospital with a recent history of discomfort and inability to protrude the penis whilst urinating, resulting in accumulation of urine within the prepuce. Careful examination and manual palpation revealed a constrictive ring of fibrous tissue at the level of the preputial orifice. With no evidence of trauma or a persistent penile frenulum, a tentative diagnosis of phimosis due to congenital preputial stenosis was made. Exploratory surgery confirmed the diagnosis and surgical transection and release of the fibromuscular ring at three sites allowed the colt to protrude the penis and urinate normally immediately post-operatively. At follow-up examination 11 months later, the colt continued to be able to extrude the penis and urinate conventionally. A slight excess of skin was present at the end of the prepuce but this was only of minor cosmetic concern.     

Direct preputial hernia associated with a ventral abdominal wall defect in a two‐year‐old gelding

The case of a 2‐year‐old gelding with acute onset of preputial swelling and prolapse is presented. After initiating conservative management using a penile repulsion device, the horse repeatedly displayed signs of mild abdominal discomfort with sudden deterioration to an episode of violent colic after 5 days of hospitalisation. Ultrasonographic examination of the preputial swelling at that time demonstrated the presence of small intestine between the internal and external laminae of the prepuce and led to the diagnosis of a direct preputial hernia. The contents of the hernia were readily reduced through a defect in the ventral abdominal wall after the anaesthetised horse was placed in dorsal recumbency. The historical information, clinical progression and surgical findings were supportive of an acquired ventral abdominal wall defect. To the authors' knowledge, this is the first reported case of a direct preputial hernia associated with an acquired ventral abdominal wall defect.     

Modified perineal urethrostomy using preputial mucosa in cats

A modified perineal urethrostomy was performed in 14 males cats with partial or complete urethral obstruction. Follow-up information was available for 2 to 18 months. By use of this method, the preputial tissues were preserved, and the penile urethra was anastomosed to the preputial mucosa to enlarge and lengthen the urethra. Urine flow was reestablished in all cats without evidence of urethral stenosis or other major complications. Appearance of the perineal region and prepuce was not substantially altered.     

Penile Amputation and Sheath Ablation in the Horse

OBJECTIVE: To report a surgical technique for penile amputation and sheath ablation in horses. Study Design-Retrospective study. Animals or Sample Population-Twenty-five adult geldings of various breeds with conditions requiring penile amputation and sheath ablation. METHODS: The medical records of horses that had penile amputation and sheath ablation were reviewed. Briefly, the technique involved en bloc resection of the skin and subcutaneous tissues of the inner and outer lamina of the prepuce and penile shaft. Resection of the penile shaft, proximal to diseased segments, and spatulation of the urethral mucosa was followed by fixation of the penis to the ventral abdomen and closure of the peripreputial skin over the ventral aspect of the penis and creation of a new mucocutaneous junction at the urethral orifice. RESULTS: Mild to moderate postoperative hemorrhage occurred in all horses. Partial dehiscence of the mucocutaneous junction occurred in 8 horses; all healed by second intention. Postoperative pain lasting 24 to 48 hours occurred in 7 horses; 1 required epidural analgesia for pain relief. Long-term follow-up was available for 8 horses; none had any long-term complications. CLINICAL RELEVANCE: Partial amputation of the penis with pexy to the ventral abdomen and revision of the peripreputial skin can be used as an alternative to en bloc resection and penile retroversion for lesions involving the free part of the penis and the prepuce. It requires smaller incisions and results in less alteration to the normal appearance of the external genitalia than retroversion techniques, while still allowing the surgeon to remove extensive portions of the penis and extirpate the regional lymph nodes.     

Creation of a Urethral Conduit from a Preputial Indirect Flap in a Dog with Perineal Hypospadias

Objective— To report a surgical technique for creation of a urethral conduit using a preputial indirect flap.
Study Design— Case report.
Animals— Male Doberman Pinscher (6 weeks old).
Methods— A urethral conduit was constructed using a multistage preputial indirect flap in a dog with severe perineal hypospadias.
Results— Successful transfer of a perineal located urethral meatus to a more anatomically normal inguinal location was achieved with a preputial flap. The procedure was performed to aid control of recurrent urinary tract infections after anal and urethral separation in a dog with imperforate anus, urethrorectal fistula, and proximal perineal hypospadias.
Conclusions— Creation of a urethral conduit from a tubed bipedicle flap using redundant preputial tissue eliminated fecal contamination of the urethral meatus, aiding control of urinary tract infection. A good functional and cosmetic outcome was achieved.
Clinical Relevance— This technique should be considered in aiding control and prevention of urinary tract infections in dogs with proximal perineal hypospadias where a preputial remnant exists.     

Application of preputial tube-flap urethroplasty to establish a neourethra in a male dog with complications after preputial urethrostomy

A 14-year-old male poodle weighing 7.5 kg presented due to complications after preputial urethrostomy for management of preprostatic urethral rupture. Revision surgery was performed with preputial tube-flap urethroplasty via preputiotomy. A longitudinal flap was raised from the prepuce and anastomosed to the end of the previously cut urethra to create a neourethra and reduce tension at the urethrostomy site. Follow-up retrograde positive contrast urethrography performed 10 days and 6 months postoperatively showed no contrast leakage from either the neourethra tube flap or new preputial urethrostomy. A follow-up email questionnaire, based on the American Urological Association Symptom Index, was completed by the owner 6 months after surgery. The dog had excellent symptom scores, and urinated from the prepuce without difficulty in a manner resembling physiological urination.     

Metastatic transmissible venereal sarcoma in a dog

An adult male dog with large penile sheath and serosanguineous exudate from the preputial orifice and a cutaneous fistula in the right inguinal area was examined. Necropsy revealed tumor masses on the penis and prepuce, in superficial inguinal and external iliac lymph nodes, and in the liver. Histopathologic diagnosis of the tumor was confirmed by transplantation studies.     

Preputial urinary diversion to treat urine soaking during urination in a dog

A young dog was presented with a history of adopting an unusual posture to urinate, resulting in urine soaking of the ventral abdomen and caudal forelimbs. The dog was initially treated surgically with cranial advancement of the prepuce, which did not resolve the problem. Further surgery was then successfully carried out to create a more caudal preputial orifice, which angled the penis ventrally when extruded, directing urine away from the body. At follow-up clinical examination, the dog was clinically normal.     

Phimosis and paraphimosis in two ferrets (Mustela putorius furo)

Cases of paraphimosis are rarely described in ferrets. Phimosis has not been reported in the ferret. Two castrated ferrets with abnormalities of the prepuce were presented separately. Case 1 had a 4-month duration of a non-reducible paraphimosis. A shortening of the sheath prevented complete covering of the penis. Case 2 had dermatitis around the prepuce of a month's duration. The foreskin was distended by urine which could be eliminated through a barely visible opening by the application of manual pressure. The penis could not be extruded under general anesthesia. Surgery was performed in both cases. In case 1, parts of the skin of the prepuce, and mucosa of the sheath were resected to create an enlarged opening correcting the constriction of the penis. In case 2, a circular incision was made along the periphery of the skin with dermatitis, and the skin of the prepuce. The skin was resected to enlarge the preputial orifice. Surgical treatment was successful in both cases, did not present any technical difficulties, and was of a short duration. Surgical treatment of paraphimosis and phimosis have not been reported in ferrets and should be considered in cases of scalding of the prepuce not responding to medical treatments.     

Single stage urethroplasty for perineal hypospadias in a foal

The incidence of hypospadias is increasing in man, but the condition is rarely reported in horses. There are few available data regarding the surgical management of this disorder in horses, with no previous published report of urethral reconstructive surgery and only two reports documenting phallectomy procedures. This case report documents hypospadias repair, not previously reported in the horse, in a Thoroughbred foal with proximal hypospadias. The indication for surgery was contact dermatitis of the hind leg, which was impairing the foal's ambulation and had the potential to impair the foal's racing ability. Preoperative examination revealed a proximal hypospadias with a wide urethral plate. The anus was normal. The foal was otherwise thriving. A single stage urethroplasty was performed, during which the urethral plate was tubularised in two layers and the urethral meatus was successfully relocated distally to open upon the glans. The urethroplasty was covered with dartos fascia and the penile shaft skin and prepuce were reconstructed. Minor superficial dehiscence of the wound was successfully managed conservatively. Post‐operatively, urine was voided through the opening created on the glans penis, resolving the contact dermatitis. Follow‐up after 3 years confirmed that the horse continues to void through the re‐sited meatus without complication and had gone on to race successfully. In conclusion, we present the first report of reconstructive urethroplasty for the treatment of a horse for proximal hypospadias with good functionality and long‐term outcome.     

Preputial hematoma in a stallion

An 8-year-old Quarter Horse stallion was admitted with a swelling involving the prepuce, dorsal part of the scrotum, and root of the penis. The swelling was first noticed 10 days after breeding, with no evidence that it had resulted from a kick by the mare. The penis was retracted into the prepuce, except for a 10- to 15-cm protrusion of the glans penis. Treatment included warm hydrotherapy, massage, stockinette compression, antidiuretics, antibiotics, penile support, and exercise, without success. At necropsy, a massive preputial hematoma was found extending forward from the root of the penis to 12 cm proximal to the glans penis. The exact origin of the hematoma could not be determined. Most likely, bleeding had originated from the vascular plexus lying subfascially on the surface of the penis outside the intact tunica albuginea or from a branch of the external pudendal artery.     

Surgical treatment of 45 horses affected by squamous cell carcinoma of the penis and prepuce

The medical records of 45 horses treated for suspected squamous cell carcinoma of the penis and/or prepuce were reviewed. The age of 40 horses was known, and these had a mean age of 17.4 years. The duration of neoplasia was known for only 3 of the 45 horses. The results of histological evaluation of lesions, available for 35 horses, confirmed that the diseased tissue was squamous cell carcinoma. The location of gross neoplastic lesions was recorded for 43 horses; the glans penis was involved in 24 horses, the body of the penis or the inner lamina of the preputial fold in 27 horses, and the external fold of the prepuce in 10 horses. Surgical treatments of these horses included phallectomy (penile amputation) in 35 horses, segmental posthectomy in 4 horses, phallectomy plus segmental posthectomy in 2 horses, and en bloc resection of the penis, prepuce and superficial inguinal lymph nodes with penile retroversion in 4 cases. Short-term complications in the immediate postoperative period included preputial oedema and haemorrhage at the end of urination. One horse developed acute urinary retention because of severe urethral oedema. Long-term (>1 year) follow-up information was obtained for 31 horses. Neoplasia of the penis and/or prepuce recurred in 6 of these 31 horses (19%), and in 5 of these the recurrence necessitated euthanasia of the horse.     

Combined preputial advancement and phallopexy as a revision technique for treating paraphimosis in a dog

A 7‐year‐old neutered male Jack Russell terrier‐cross was presented for signs of recurrent paraphimosis, despite previous surgical enlargement of the preputial ostium. Revision surgery was performed using a combination of preputial advancement and phallopexy, which resulted in complete and permanent coverage of the glans penis by the prepuce, and at 1 year postoperatively, no recurrence of paraphimosis had been observed. The combined techniques allow preservation of the normal penile anatomy, are relatively simple to perform and provide a cosmetic result. We recommend this combination for the treatment of paraphimosis in the dog, particularly when other techniques have failed.     

Hypospadias in a Himalayan cat

A one-year-old male Himalayan cat was presented with a history of chronic cystitis. Physical examination revealed that the cat had hypospadias. It was postulated that the abnormal urethral opening on the ventral aspect of the penis permitted faecal contamination of the preputial area and gave rise to the ascending infection. The hypospadias was surgically corrected and a complete recovery was achieved.     

Preputial foreign body in a bull

A preputial foreign body caused severe preputial swelling and depression in a 4-year-old Shorthorn bull. Disruption of the preputial epithelium by the foreign body resulted in abscess formation lateral to the prepuce. A patent urethral fistula, probably a complication of prior fibropapilloma excisional surgery, was also detected on the distal portion of the glans penis. Foreign body removal, antimicrobial administration, and warm hydrotherapy resolved the swelling and abscess. Electroejaculation was used to extend the penis and to minimize preputial adhesions. Breeding soundness examinations were used to evaluate breeding potential.     

Investigation and clinical application of a novel axial pattern flap for nasal and facial reconstruction in the dog

OBJECTIVE: To describe the vascular supply to a facial skin flap based at the commissure of the lip in the dog and report on its use in four dogs. STUDY DESIGN: Experimental and prospective clinical study. Animals Five canine cadavers and four client-owned dogs. METHODS: In the cadavers, the ventral aspect of the zygomatic arch, the ventral margin of the caudal mandible and the wing of the atlas were marked as anatomical boundaries of a skin flap that was elevated from the subcutaneous tissues to the level of the medial canthus of the eye. Methylene blue dye and barium sulphate solution were independently infused through a common carotid (three dogs) or facial artery (two dogs) catheter. Distribution of dye throughout the harvested skin was assessed subjectively. After contrast infusion the flap was excised and radiographed. The technique was used to reconstruct large facial or nasal defects in four dogs after tumour or skin lesion excision. RESULTS: Cadaver dissections and contrast studies clearly demonstrated three direct cutaneous arteries, the superior and inferior labial arteries and the angularis oris artery, arborising within the base of the flap. A separate direct cutaneous branch of the angularis oris artery was identified. An arterial plexus was identified within the distal flap, within which this artery communicates with the transverse facial artery and a cutaneous branch of the masseteric artery. Dye infusion caused discolouration of the elevated skin and vasculature within the flap. The flap survived in all clinical cases with marginal distal necrosis in one dog. CONCLUSIONS: The complex facial flap described is perfused by three direct cutaneous arteries and functions reliably in clinical cases.