Day 8 - Surgery of the prepuce and penis

Question 1

Penile and preputial disorders

Answer 1

• Injuries
• Paraphymosis, penile paralysis
• Phimosis, Priapism
• Surgical interventions
  o Segmental posthectomy (circumcision or reefing)
  o Phallopexy (Bolz ́technique)
  o Phallectomy

Question 2

Vascular and nerve supply of the prepuce and penis

Answer 2

Artery and vein
- External pudendal a.v. (CCP- corpus cavernosum penis)
- Obturator a. (CCP)
- Internal pudendal a.v. (CSP – corpus spongiosum penis)

Nerves
- Pudendal n. – (Parasympathetic fibers)
- Pelvic plexus - (sympathetic nervous system)
- Deep perineal and caudal rectal nerves à m. bulbospongiosus, ischiocavernosus and
retractor penis

Question 3

Surgical interventions of penile and preputial disorders

Answer 3

o Segmental posthectomy
o Phallectomy

Question 4

Paraphimosis – Penile paralysis

Answer 4

= a inability to retract the penis back to the prepuce
- Cause
o Injury - oedema - paraphymosis
o Disease: EHV, Dourine, purpura haemorrhagica, rabies spinal disease
o Phenothiazine- derivates (ACP) NEVER use a high dose phenothiazines for castration etc.

CS:
- time is a big limit so should not wait or and do hydrotherapy, use creams etc. bc in a few hours there could be an elongation of the nerve supply to the penis

Tx:
o Treat edema, injury, prevent infection and further injuries
o In case of no success –> surgery

Question 5

Phimosis and Priapism

Answer 5

• Phimosis: Inability to protrude the penis from the prepuce due to congenital or acquired stricture
• Priapism: Persisten erection without sexual excitement due to:
• Phenotiazine-derivate tranquilizers (ACP): blocking alpha-adrenergic impulses that mediate detumescens of the penis
• (Less frequent: Neoplasia in the pelvic canal, GA, neomatodiasis of the spinal cord)

Question 6

Neoplasia

Answer 6

• Sarcoid, melanomas, squamous papillomas
• Squamous cell carcinomas
  o Non-pigmented genitalia, geriatric horses, geldings, stallions
  o Treatment: Laser exision, partial posthectomy, Penis amputation, “en bloc” resection
• Habronemiasis (Habronema muscae)

Question 7

Segmental posthectomy

Answer 7

• can take out circumforential fold, then suture - can do it at the preputial ring or fold etc.

Question 8

Phallectomy (william ́s technique)

Answer 8

• Caudal for preputial ring
• this is neoplasia removed
• Close the corpus cavernosum: suture well bc it can easily bleed a lot

Question 9

En Block resection

Answer 9

• Extensive neoplasia
• Extensive injury of the root penis
• Neoplasia is already at the lymph nodes
• Penis and prepuce is resected
• Make a soma to make the horse urinate in a stream and not to urinate down its legs