Multiple skeletal metastases from a penile squamous cell carcinoma in a horse

A 21‐year‐old gelding with ventral abdominal and preputial oedema was evaluated for right hindlimb lameness. Partial phallectomy had been performed 3 years prior for treatment of squamous cell carcinoma. Regional analgesia did not localise the source of lameness and nuclear scintigraphy was recommended. The results of the scan revealed severe increased radiopharmaceutical uptake in the proximal femur. Radiographic and ultrasound examinations were inconclusive. The horse was discharged with recommendations of stall confinement and a 2 week course of nonsteroidal anti‐inflammatory drugs. Four weeks later the horse presented for an inability to elevate his neck and persistent hindlimb lameness. The owner elected humane euthanasia. Post mortem examination revealed metastatic squamous cell carcinoma in the proximal femur and fifth cervical vertebrae consistent with metastasis from the penile squamous cell carcinoma. To the authors’ knowledge, multiple site bone metastasis of squamous cell carcinoma has not been reported previously in the horse.     

Penile and preputial squamous cell carcinoma in the horse: a retrospective study of treatment of 77 affected horses

Reasons for performing study: The most common penile and preputial neoplasm in the horse is the squamous cell carcinoma (SCC), but no large surveys of treatment and effects of the grade of the tumour, based on the degree of differentiation, on outcome of affected horses are available. Objectives: Analysis of treatment of male horses affected with SCC of the external genitalia and long‐term results of treatment. Methods: Seventy‐seven cases of SCC were evaluated. Data recorded included treatment, outcome, post operative histopathology and retrospective tumour grading. Results: Treatments included: cryosurgery, excision, partial phallectomy, partial phallectomy and sheath ablation, and en bloc penile and preputial resection with penile retroversion and removal of inguinal lymph nodes. The incidence of recurrence after partial phallectomy was 25.6% (10/39) and following incomplete removal was 17.9% (7/39). The incidence of recurrence after en bloc resection with retroversion was 12.5% (1/8). In horses with confirmed inguinal lymph node metastasis, the incidence of recurrence was 25.0% (1/4). Poorly differentiated SCCs were more likely to metastasise than well differentiated SCCs, and there was a greater chance that the treatment would be unsuccessful. The success of treatment, complete removal and in preventing recurrence of the tumour, of male horses with SCC of the external genitalia was 55.7%. Conclusions: Horses that receive only partial phallectomy for treatment for SCC of the external genitalia have a high incidence of recurrence in contrast to horses that receive an en bloc resection. Tumour grading of SCC can help predict prognosis and guide selection of treatment.     

Penile and preputial tumours in the horse: a retrospective study of 114 affected horses

REASONS FOR PERFORMING STUDY: Preputial and penile tumours are more common in horses than in other domestic animals, but no large surveys of male horses with tumours of the external genitalia are available. OBJECTIVE: To present a retrospective analysis of male horses with neoplasms of the external genitalia. METHODS: The penile and preputial tumours of 114 horses were evaluated. Data recorded included age, gelding or stallion and breed; type and site of lesion; involvement of regional lymph nodes; histopathology (including grading of squamous cell carcinoma); and results of radiographic examination of the thorax. RESULTS: Mean age of horses was 19.5 years with no apparent breed predilection. Common presenting clinical signs were irregularities (e.g. the presence of a mass and/or ulceration) on the integument of the penis and prepuce, and purulent or sanguineous discharge from preputial orifice. Squamous cell carcinoma (SCC) was the most prevalent neoplasm followed by papillomas and melanomas. A basal cell carcinoma, neurofibrosarcoma, adenocarcinoma or fibrosarcoma were each found on single horses. Squamous cell carcinomas with poor differentiation had a higher tendency to metastasise than did more differentiated tumours. CONCLUSIONS: Squamous cell carcinoma is the most common urogenital tumour of the male horse and occurs primarily in old horses. Horses with poorly differentiated SCCs tend to have a higher incidence of regional metastases. Pathology of lymph nodes, even when not palpably enlarged, is a valuable diagnostic exercise. Radiology of the thorax to detect lung metastases is of little value.     

Perineal incision into the corpus spongiosum penis to resolve persistent post urination haemorrhage after partial phallectomy

Partial phallectomy or en bloc resection are surgical methods to address pathological conditions of the penis and/or prepuce including neoplasia, trauma, habronemiasis, chronic paraphimosis or permanent penile paralysis, and priapism. Haemorrhage associated with urination is a common complication observed after penile surgery but usually resolves spontaneously without specific treatment. This report describes a case of post urination haemorrhage (PUH) that recurred with each urination and persisted without significant improvement for a period of 2 weeks following en bloc resection of the penis and the prepuce. A perineal incision (PI) into the corpus spongiosum of the penis (CSP) resolved PUH by decreasing the blood pressure in the CSP distal to the PI. We propose that PI of the CSP can be an effective method to address PUH after penile surgery and may decrease time of hospitalisation for horses affected with PUH after phallectomy procedures.     

Alternative method to facilitate resolution of paraphimosis after penile trauma in the horse

Inflammation associated with traumatic injury to the penis is characterised by pain, heat and oedema. Ensuing penile swelling interferes with retraction of the penis into the prepuce, resulting in paraphimosis. This report describes the use of a 5 l capacity pressure infusion bag to reduce penile oedema in three horses. This technique provided complete resolution of oedema and associated paraphimosis in approximately 1 h. The use of the bag, along with an abdominoinguinal bandage, a plastic funnel suspensory device, or a penile repulsion device (Probang) to avoid recurrence, offers a novel treatment that may be performed with the horse sedated.     

Genital neoplasms treated by en bloc resection and penile retroversion in horses: 10 cases (1977-1986)

The medical records of 10 horses with invasive neoplasms of the penis, prepuce, and/or superficial inguinal lymph nodes in which treatment involved en bloc resection and penile retroversion were reviewed. All were geldings and ranged in age from 12 to 25 years (mean, 19 years). Evaluation of biopsy specimens obtained before surgery confirmed lymphosarcoma in 1 horse and squamous cell carcinoma in 9 horses. Typical history included swelling, ulceration, and abscessation of the penis and prepuce and large superficial inguinal lymph nodes. Complications after surgery included dehiscence of the urethrostomy site (4 horses), dehiscence of the ventral skin incision (1 horse), urine scalding of 1 hind limb (1 horse), cystitis (1 horse), severe hemorrhage (1 horse), and diarrhea (1 horse). One horse was euthanatized during hospitalization, because of severe dehydration secondary to diarrhea. At necropsy, firm nodules were scattered in the pulmonary parenchyma, myocardium, thyroid gland, parathyroid glands, cranial mediastinum, kidneys, and hilar lymph nodes. Microscopic examination of the nodules revealed undifferentiated carcinoma. Nine horses were discharged from the hospital between 1 and 5 weeks after surgery. The mean follow-up interval was 27 months (range, 6 to 96 months). Eight horses had no evidence of recurrence. One horse had recurrence of neoplasm at 6 months and was euthanatized 12 months later.     

Survey of equine cutaneous neoplasia in the Pacific Northwest.

A retrospective study examined data regarding equine cutaneous and mucocutaneous neoplasms submitted to the Veterinary Diagnostic Laboratory at Oregon State University in a 3.5-year period. A total of 536 neoplasms were identified, accounting for 30% of the total equine pathology submissions. Sarcoid, squamous cell carcinoma, melanocytic tumors, papillomas, and mast cell tumors were the most common neoplasms, constituting 87.5% of all cutaneous neoplasms. Sarcoids represented 51.4% of all neoplasms and 15.18% of total equine accessions. Sarcoid was most common in paints, quarter horses, and Arabians, and was the only common tumor in donkeys and mules. Mean age at diagnosis of equine sarcoid was 9 years. Squamous cell carcinoma constituted 18.3% of all neoplasms and 5.41% of total equine accessions. Ocular squamous cell carcinoma was most common in paints and quarter horses, and penile/preputial squamous cell carcinoma was most common in appaloosas and quarter horses. The mean age of horses with ocular squamous cell carcinoma (13 years) and squamous cell carcinoma of the skin (15 years) was significantly less (P < 0.5) than that of horses with squamous cell carcinoma of the penis and prepuce (21 years) or vulva, anal, and perianal skin (19 years). Findings suggest that equine sarcoid and squamous cell carcinoma occur more frequently in the Pacific Northwest than in the northeastern United States.     

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.     

Equine penile squamous cell carcinomas are associated with the presence of equine papillomavirus type 2 DNA sequences

Forty cases of equine penile disease were screened with polymerase chain reaction for the presence of papillomaviral DNA. Cases consisted of 20 squamous cell carcinomas (average age of horse, 23.9 years) and 20 non-squamous cell carcinoma diseases (average age of horse, 13.3 years). All horses but one originated from the Northeastern United States. Breeds were not recorded. As based on MY09/MY11 consensus primers, DNA sequences from equine papillomavirus type 2 were amplified from 9 of 20 horses (45%) with penile squamous cell carcinoma and only 1 of 20 horses (5%) with non-squamous cell carcinoma penile disease. Equine papillomavirus type 2 DNA was the only papillomaviral DNA amplified from any of the 40 horses. Tissues from the 10 horses in which papillomaviral DNA was detected by polymerase chain reaction were also screened with in situ hybridization and immunohistochemistry. The presence of papillomavirus was demonstrated in a subset of these by in situ hybridization (6 of 10) and immunohistochemistry (1 of 10). This report describes a possible association between equine penile squamous cell carcinomas and equine papillomavirus type 2. This study is also the first report of equine papillomavirus type 2 infection in North American horses.     

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.     

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.     

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.     

Penile and preputial squamous cell carcinoma in the horse and proposal of a classification system

Squamous cell carcinoma (SCC) is the most common tumour of the penis and prepuce of the horse and is found mainly in older animals. Reports on breed predilection for penile tumour formation are equivocal but castration, coat colour, poor genital hygiene and various infectious agents have been suggested to predispose to the development of SCC. Careful assessment of the primary tumour is an important first step in the design of an optimal treatment protocol. Tumour size, invasiveness, differentiation grade and presence of metastases are relevant to the decision to pursue additional diagnostic procedures or specific treatment options. Complete elimination of the neoplasm and, therefore, risk of recurrence is highly dependent on the type of therapy chosen. However, the size and histopathological features of the primary tumour are also important factors with respect to prognosis. This review describes the clinical and pathological features of penile and preputial SCC in the horse and proposes a standard staging system.     

Causes of copulatory failure in beef bulls

A cow in full standing estrus is required to assess a bull's ability to copulate. Insufficient libido is not involved if the bull sniffs the cow's vulva and attempts to mount. Blood or pus exiting the penis or prepuce indicates penile or preputial lacerations or other lesions. Rear foot or stifle lesions, seminal vesiculitis, traumatic reticulitis or lumbar spinal injuries may prevent the bull from mounting. Preputial stenosis, penile adhesions, desensitization, hematomas or deviations, peripreputial abscess, cavernosal shunts, insufficient penile length and occlusions of the cavernosal canals may prevent intromission after mounting.     

Persistent, widespread papilloma formation on the penis of a horse: a novel presentation of equine papillomavirus type 2 infection

A 9-year-old gelding presented with approximately 100 papillomas that covered about 75% of the distal penis. Biopsy was performed, and histology showed evidence of viral cytopathic change and koilocytosis. Polymerase chain reaction using DNA extracted from biopsied tissue amplified equine papillomavirus type 2 (EcPV-2) DNA sequences. Sixteen months later, the horse was re-examined and the appearance of the papillomas was unchanged. Equine papillomavirus type 2 DNA sequences were again amplified from both biopsied tissue and swabs of the penis. Papillomavirus was localized to the lesions by immunohistochemistry and in situ hybridization. An examination 2 years after the initial presentation revealed no detectable change in the appearance of the penis. The large number of papillomas and their failure to regress over an extended period support a clinical classification of papillomatosis. To the authors' knowledge, this is the first report of papillomatosis of the equine penis. This novel clinical manifestation suggests that persistent EcPV-2 infection is possible in horses. As there is evidence that EcPV-2 may promote development of equine penile squamous cell carcinoma, understanding the natural history of EcPV-2 infections may be important in preventing equine penile neoplasia.     

A modified surgical technique for penile amputation and preputial ablation in the horse

The aim of this study was to describe a modified surgical technique for treatment of severe penile pathology, and the long‐term outcome. The surgery consisted of subischial urethrostomy and penile amputation with preputial ablation, with the horse in dorsal recumbency. A redundant section of the penis root and body was left in situ, rather than being retroflexed as described elsewhere. Follow‐up was obtained using a structured owner telephone questionnaire. The 15 cases included: 11 squamous cell carcinomas (73.3%); 2 melanomas; one chronic preputial discharge with no associated neoplasia; and one paraphimosis following routine sedation. Length of survival ranged from 0.9 to 74.6 months (median 25.1 months). From the 14 horses with follow‐up, 9 survived >18 months (64.3%) [Correction added on 17 August 2015, after first online publication: The percentage in the preceding sentence was wrong and has been corrected to '64.3%' from '69.2%']. Four euthanasias were due to presenting or post operative complications, while 2 were unrelated to the procedure. This procedure presents a simplified, viable option for treatment of extensive mixed penile lesions; reducing surgical complexity and time in comparison to previously described techniques requiring retroversion.     

Penile and preputial tumours in the horse: literature review and proposal of a standardised approach

Penile and preputial tumours are not uncommon in the horse, but can cause discomfort and lead to serious complications. Several types of tumour of the male external genitalia have been described. The most common type is the squamous cell carcinoma (SCC), which is found mainly in older horses. Reports of a breed predilection for penile tumour formation are equivocal, but castration, coat colour, poor hygiene and various infectious agents have all been suggested to predispose to the development of some types of tumour (e.g. SCC, papilloma and melanoma). Careful assessment of the primary tumour is an important first step in the design of an optimal treatment protocol. Invasiveness, differentiation grade, tumour size and presence of metastases are all relevant to the decision to pursue additional diagnostic procedures or specific treatment options. To date, no standard protocol has been reported for the approach to penile tumours in the horse and treatments range from minimally invasive therapies (e.g. topical use of 5-fluorouracil) to radical surgical interventions (e.g. en bloc penile and preputial resection with penile retroversion). Completeness of removal of the neoplasm and therefore risk of recurrence is highly dependent on the type of therapy chosen. However, the size and histopathological features of the primary tumour are also important factors with respect to the likelihood of recurrence. This review describes the most common penile and preputial neoplasms in the horse, and outlines a standard protocol aimed at arriving at a specific diagnosis and tailoring the therapeutic approach accordingly.     

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.     

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.     

Use of a preputial circumferential mucosal flap for hypospadias management in a Boston terrier

An eight-week-old male Boston terrier presented for penile desiccation and urine pooling in the prepuce due to congenital hypospadias. An advancement flap was created from the dorsal mucosa of the incompletely formed prepuce and sutured circumferentially to construct a longer distal preputial mucosa. V- to Y-plasty of the ventral abdominal skin was utilised to create the preputial skin overlying the mucosal flap. Urethrostomy and partial penile amputation were also performed. Following surgery, the clinical signs of penile desiccation and preputial urine pooling resolved and acceptable cosmetic appearance was achieved. This technique may be considered for glandular or penile hypospadias or following resection of the ventral aspect of the distal prepuce when inadequate tissue is present for a simple two-layer closure of the preputial mucosa and skin.