Penis and prepuce

Question 1

According to Bertran 2021 in Vet Surg, augmentation of a penile urethral resection and anastomosis with suturing of what structure resulted in increased maximal tensile strength?

Answer 1

Augmentation of the anastomosis with suturing of the tunica albuginea

Question 2

In a study by Vlaming 2019 in Vet Surg, what are the two described types of phimosis in kittens and what respective surgical treatments were used for correction?

Answer 2

Question 3

In a study by Ritson 2023 in JSAP, what was the outcome for nine dogs undergoing partial penile amputation? For what conditions was this procedure performed?

Answer 3

Good to excellent (2 dogs required revision surgery).

This procedure was performed for prepucial neoplasia, distal penile neoplasia, idiopathic paraphimosis, and chronic urethritis.

Question 4

What attaches the root of the penis to the ischial tuberosity?

Answer 4

The crura composed of the proximal corpora cavernosum and ischiocavernosus muscle.

Question 5

The corpora of the penis are comprised of what?

Answer 5

Enlarged venous spaces.

Question 6

The distal portion of the penis is divided into what two parts?

Answer 6

The proximal bulbus glandis, distal pars longa glandis separated by a fibrous septum.

Question 7

Describe the perineal musculature of the dog.

Answer 7

Question 8

What are the four extrinsic muscles of the penis?

Answer 8

The retractor penis, ischiocavernosus, bulbospongiosus, ischiourethralis.

Question 9

What is the vascular supply to the penis?

Answer 9

Three branches of the artery of the penis which is a continuation of the internal pudendal artery; the artery of the bulb of the penis, deep penile and dorsal penile arteries.

Venous drainage occurs via the internal and external pudendal veins.

Question 10

Where do penile lymphatics drain?

Answer 10

Superficial inguinal lymph nodes.

Question 11

In what percentage of male cats is the os penis visible radiographically?

Answer 11

40%

Question 12

At what age do spines appear on the feline penis?

Answer 12

12 weeks of age

Question 13

What is the blood supply to the prepuce?

Answer 13

The dorsal artery of the penis and the external pudendal artery. Venous drainage mirrors arterial supply + the deep veins of the glans.

Question 14

Which breed is most frequently affected by hypospadias?

Answer 14

Boston Terriers.

Question 15

What is the cause of hypospadias?

Answer 15

Failure of fusion of the urogenital folds. Urethral orifice can occur anywhere on the ventral aspect of the penis. Generally associated with failure of fusion of the prepuce and underdevelopment of the penis.

Question 16

What is the surgical treatment for hypospadias?

Answer 16

Reconstruction is not normally attempted due to a deficient cranial urethra. Excision of preputial and urethral remnants, bilateral orchiectomy and urethrostomy may be required.

Question 17

What is the surgical treatment of os penis deformity?

Answer 17

Fracture and straightening or partial penile amputation.

Question 18

What is the surgical treatment of os penis fracture?

Answer 18

Conservative management, immobilization with a urinary catheter, plating with a finger plate, partial penile amputation. Scrotal urethrostomy may be required if obstruction secondary to callus occurs.

Question 19

What are the treatment options for penile wounds?

Answer 19

Minor wounds: conservative topical treatment.

Major wounds: direct ligation of arterial bleeding or suturing of the tunica albuginea for cavernous bleeding.

Urethral damage: catheterization (5-7 days), if urethra is transected anastomosis should be performed (with catheterization for 10 days).

Severe wounds may require partial penile amputation and scrotal urethrostomy.

Question 20

What is the treatment for penile strangulation?

Answer 20

Minor: topical treatment +/- urinary catheterization.

Major: partial penile amputation +/- prepucial shortening.

Question 21

Describe the technique for partial penile amputation.

Answer 21

Question 22

What is the treatment for persistent penile frenulum?

Answer 22

The frenulum should rupture by puberty. If it remains intact it can be surgically severed.

Question 23

What are some tumours of the penis?

Answer 23

Transmissible venereal tumor (TVT), papilloma, squamous cell carcinoma, mastocytoma, hemangiosarcoma, and osteosarcoma of the os penis

Question 24

Describe the technique of penile amputation.

Answer 24

Question 25

What is paraphimosis?

Answer 25

When the penis protrudes from the preputial sheath and cannot be replaced.

Can be congenital (abnormally narrowed preputial orifice or shortened prepuce), or acquired (trauma, infection, priapism).

Question 26

What is the treatment for paraphimosis?

Answer 26

Mild: lubrication, application of hyperosmolar solutions and reduction.

Severe: urinary catheterization to allow bladder decompression. Surgical widening of the preputial orifice or phallopexy with or without preputial advancement. Partial penile amputation may be required in some instances.

Question 27

What is the prognosis for paraphimosis?

Answer 27

Guarded, recurrence is common.

Question 28

What is phimosis?

Answer 28

The inability to protrude the penis beyond the urethral orifice. Can be congenital or acquired (trauma, neoplasia).

Urine pooling typically results in balanoposthitis.

Question 29

What is the treatment for phimosis?

Answer 29

Widening of the preputial orifice using a dorsal (dogs) or ventral (cats) wedge incision.

The prognosis is typically good.

Question 30

What are causes of balanoposthitis?

Answer 30

Trauma, foreign body, phimosis, neoplasia.

Question 31

What is the treatment for balanoposthitis?

Answer 31

Lavage, removal of adhesions between the penis and prepuce, instillation of an iodine or cholorhexidine solution. Infusion of an antimicrobial ointment into the prepuce should be continued for several days.

Prognosis is guarded due to recurrence.

Question 32

What are the most common tumours of the prepuce?

Answer 32

Mast cell tumours and SCC.

Question 33

How can large defects of the prepuce be reconstructed?

Answer 33

Use of a caudal superficial epigastric flap and mucosal graft (multistage procedure usually required).

Question 34

How is preputial hypoplasia surgically treated?

Answer 34

Failure of fusion (in conjunction with hypospadias) is generally treated by removal of the open prepuce, partial penile amputation and scrotal or perineal urethrostomy.

A short prepuce can be corrected by preputial advancement or partial penile amputation.

Question 35

Preputial advancement is often unsuccessful if how much of the distal penis is exposed?

Answer 35

Greater than 1.5cm