Equine Male Repro Surgery

Question 1

Equine male surgical reproductive problems.

Answer 1

Penis and prepuce.
- Paraphimosis.
- Phimosis.
- Priapism.
- Trauma.
- Masses/lesions.
Urethra.
- Cystic calculi.
- Urethral rents.

Question 2

1. How is the equine prepuce different to that of other spp.?
2. Term for opening of equine prepuce?
3. Age of separation of internal and external laminae of the equine prepuce?

Answer 2

1. Formed by a double fold of preputial skin.
2. Preputial ring.
3. 1mth old.

Question 3

Specific CE of equine repro?

Answer 3

Hx and PE.
Assess urination.
- Stranguria/pollakiuria/distorted stream.
- Haematuria.
- Clean bed.
- Dipstick urine sample.
Palpate penis/prepuce/testicles.
Inspection.
- Extend penis (Don’t pull hard; use sedation if required).
- Evaluate penis including urethral fossa.
- Evaluate entire internal preputial lamina.
+/- Observe breeding/sexual arousal.
Semen evaluation.

Question 4

1. What sedative should not be used in intact stallions?
2. Diagnostics to use to evaluate male repro.
3. Why may a normal urine sample appear cloudy?

Answer 4

1. Acepromazine.
2. Urinalysis, semen evaluation, biopsy of mucosal lesions, catheterisation, endoscopy, ultrasound.
3. Calcium carbonate crystals / mucus.

Question 5

1. Corpus cavernosum penis during erection.
2. Corpus spongiosum penis during erection.

Answer 5

1. Closed system during erection.
2. Open system during erection.

Question 6

How do non-breeding injuries causing trauma occur?

Answer 6

• Ridden.
• Field.
• Travelling.
• Other!

Question 7

Neoplasia of the prepuce/penis.

Answer 7

Squamous cell carcinoma.
- Unpigmented skin.
- Locally invasive.
- May metastasise to local (inguinal) LNs.
Sarcoid.
- Space occupying lesions.
- Rarely metastasise.
Melanoma.
- Grey horses.
- Space occupying lesions.
- May metastasise.

Question 8

1. What are urethral rents?
2. How do urethral rents present?
3. What type of urethral crystal are horse predisposed to?

Answer 8

1. Lesions that extend from surface of urethra to surface of corpus spongiosum.
2. Blood in the urine and pain during ejaculation or erection.
3. CaCO3 (Calcium carbonate).

Question 9

Treatment indicated for uroliths?

Answer 9

Surgical removal (cystotomy).
- Rough surface, may be large, no ability to digest.
- Caudal midline ventral, paramedian, parainguinal, perineal.
- Lithotripsy/shockwave possible (non invasive).

Question 10

1. Treatments for penile lacerations.
2. Complications of penile lacerations.

Answer 10

1. Fresh - debride and primary closure.
   Infected - daily cleaning and topical and/or systemic antimicrobials.
   Extensive tissue trauma may require phallectomy.
2. • Urethral lacerations that heal as either fistulas or by cicatrix.
     - Shunt forming between CCP and superficial penile vasculature.

Question 11

Risk associated w/ preputial lacerations?

Answer 11

Severe swelling.
May cause penis to be trapped within the preputial orifice (phimosis).
OR may cause penis to be trapped outside swollen preputial orifice (paraphimosis).

Question 12

Penile haematoma.

Answer 12

Rapid development post trauma.
Likely superficial vessel rupture.
Occasionally from corporeal vessel.
- More difficult to manage and treat.
First aid: cold compression.
- Compression bandage (vetrap).
- Hydro therapy (cold hosing).

Question 13

Managing penile haematoma management.

Answer 13

• Box rest 5-6d.
• Followed by light exercise.
  – minimises sheath swelling.
• Keep away from sexual stimuli.

Question 14

Complications of penile haematomas and overcoming these.

Answer 14

Urethral obstruction.
- Catheterise.
Paraphimosis/phimosis.
- Acute – due to swelling and cellulitis.
- Chronic due to scar tissue formation.

Question 15

Paraphimosis aetiology.

Answer 15

Preputial or penile oedema.
- Trauma.
Damage to penile innervation.
- Spinal disease.
- Trauma.
- Infectious (EHV1).
Debilitation.
Phenothiazine tranquilisers.
- Idiosyncratic reaction.
- Will wear off but need support initially.

Question 16

Outcomes of paraphimosis.

Answer 16

Prolonged protrusion of penis itself causes oedema, swelling, stretching of nerves and retractor penis muscles.
If no treatment, vicious cycle.
In chronic cases:
- Penis points caudoventrally.
- Urination remains normal.
- Erectile function lost.

Question 17

Managing paraphimosis.

Answer 17

Goals.
- Control oedema.
- Prevent trauma.
- Reduce weight on muscle and nerves.
Options.
- Retain penis in sheath.
– Purse string sutures.
– Towel clamps.
– Reefing surgery.
- Support in sling.

Question 18

1. What is priapism?
2. Most common causes of priapism.
3. Risk associated w/ priapism?

Answer 18

1. Persistent erection of the penis in absence of sexual excitement.
2. Phenothiazine (ACP).
   Mechanism unclear.
   High flow - increase arterial flow.
   Low flow - reduced venous flow.
3. Penile trauma.

Question 19

Treatment options for acute priapism.

Answer 19

Medical:
- Phenylephrine / adrenaline into CCP.
- Massage.
- Support.
- Compression.
- Cold therapy.
Surgical.
- Irrigate CCP w/ heparinised saline.
- Create shunt between CCP and CSP.
– cannot get erection so care in case breeding stallion.

Question 20

Penile and preputial tumour treatment.

Answer 20

All need surgical excision plus adjunctive treatment:
- Local excision.
- Reefing.
- Phallectomy.

Question 21

1. Indications for reefing.
2. Goal of reefing.

Answer 21

1. Neoplasia.
   Granuloma.
   Phimosis.
   Paraphimosis.
2. Resection of circumferential segment of internal preputial lamina +/- preputial ring.

Question 22

1. What is a phallectomy?
2. What should be done w/ an entire male before phallectomy?
3. Most common technique for phallectomy?

Answer 22

1. Penile amputation.
2. Castrate several week before if possible.
   Avoids erection post op.
3. Williams.

Question 23

Complications of phallectomy.

Answer 23

Haemorrhage.
- Expect mild bleeding from stump for several days during urination.
- Stallions > geldings.
Haematoma.
Dehiscence.
Infection.
Oedema.
Urethral obstruction.
Pain.
Regrowth of neoplasia.

Question 24

1. What is phimosis.
2. What does it cause?
3. When is phimosis normal?

Answer 24

1. Inability to protrude penis from prepuce by stricture of preputial ring or preputial orifice.
2. Causes urine scalding w/in sheath.
3. Foals <1mth old.

Question 25

Phimosis treatment options.

Answer 25

For constrictive preputial orifice.
- Wedge resection external preputial lamina.
For constrictive preputial ring.
- Wedge resection internal preputial lamina to expose penis, followed by segmental posthectomy (‘reefing’).

Question 26

1. Presentation of urethral rent.
2. Dx of urethral rents.

Answer 26

1. Haemospermia (infertility).
   Haematuria (end of micturition).
   Multiple mounting attempts.
   - pain during erection/ejaculation.
2. Urethroscopy.
   - usually at level of ischial arch.
   Semen cytology.
   - ddx septic seminal vesiculitis.
   – WBC on semen cytology.

Question 27

Urethral rents treatment options.

Answer 27

Surgery.
- perineal urethrotomy.
- perineal opening of CSP.
– Approach as PU then divert around urethra into CSP.
– Decreases pressure in CSP.
Pain relief.
May heal spontaneously.
Sexual rest.

Question 28

Presentation of uroliths.

Answer 28

Behaviour changes.
Haematuria.
Bleeding from urethra.
Dysuria / stranguria / pollakiuria.
Urine scalding.
Colic.
Hindlimbs gait changes.

Question 29

1. Dx uroliths.
2. Where are most uroliths located?
3. Calcium carbonate urolith characteristics.
4. Phosphate urolith characteristics.

Answer 29

1. Catheter obstructed.
   Urethroscopy.
   Urine cytology (Increased WBC and RBC).
   Rectal exam (+/- US).
2. Bladder.
3. Spiculated.
4. Smooth.

Question 30

Urolith treatment.

Answer 30

Standing perineal urethrotomy w/ crushing of stone and flushing.
Before surgical treatment:
- US kidneys to check for more.
- Recurrence rate of up to 50% (inform O).
- No proven method of prevention.