Amputasi Penis Kelompok 5

TUGAS MATA KULIAH
ILMU BEDAH KHUSUS VETERINER
“TEKNIK OPERASI AMPUTASI PENIS”

Disusun Oleh :
Kelompok 5
KELAS C
1. Satria Aji Pratama 1609511087

2. Rani Utami Putri 1609511088
3. Ni Wayan Ayu Rukmini 1609511091
4. Aditya Try Mahindra 1609511093
5. Ni Kadek Chris Nariasih 1609511105
6. Rama Purnomo 1609511114
LABORATORIUM BEDAH VETERINER

FAKULTAS KEDOKTERAN HEWAN
UNIVERSITAS UDAYANA
TAHUN 2019
i
RINGKASAN
Ilmu bedah merupakan cabang ilmu dari kedokteran hewan yang masuk
ilmu klinik veteriner. Pembedahan biasanya dilakukan untuk penanganan penyakit
atau pengeluaran benda asing dalam tubuh. Salah satu contohnnya adalah bedah
amputasi penis. Bedah amputasi penis merupakan pembedahan dengan
mengeluarkan penis semaksimal mungkin preputium, posisi penis dipertahankan
dan dipasang tourniquet di sebelah kaudal penis yang akan diamputasi. Dalam
melakukan pembedahan perlu dilakukan persiapan meliputi, persiapan hewan,
tempat operasi, persiapan alat, bahan, dan juga obat.
SUMMARY
Surgery is a branch of veterinary medicine that has entered veterinary

clinical science. Surgery is usually done to treat illnesses or expel foreign bodies in
the body. One example is penile amputation surgery. An amputation enlargement
penis is surgically removed with the maximum possible prepuce, the penis is
approved and the tourniquet is placed on the right side of the penis to be amputated.
In carrying out surgery, preparations, animal preparations, operations preparations,
equipment, materials, and medicines are necessary.
ii
KATA PENGANTAR
Puji syukur penulis panjatkan kepada Tuhan Yang Maha Esa karena berkat
rahmat-Nya lah penulis dapat menyelesaikan paper pada mata kuliah Ilmu Bedah
Khusus Veteriner semester VII yang berjudul “ Teknik Operasi Amputasi Penis ”
dengan tepat waktu.
Tidak lupa penulis ucapkan terima kasih kepada pihak-pihak yang telah
turut membantu dalam penyelesaian paper ini. Penulis sadari pula bahwa paper ini
masih sangat jauh dari kesempurnaan, maka dari itu penulis mengharapkan kritik
dan saran yang membangun serta bantuan dari semua pihak demi tersusunnya paper
yang jauh lebih baik, akhir kata penulis ucapkan terima kasih.
Denpasar, 1 Oktober 2019

Hormat Kami,
Penulis
iii
DAFTAR ISI
HALAMAN JUDUL .............................................................................................. i

RINGKASAN / SUMMARY................................................................................ ii
KATA PENGANTAR......................................................................................... iii
DAFTAR ISI ....................................................................................................... iv
DAFTAR GAMBAR............................................................................................. v
DAFTAR LAMPIRAN ....................................................................................... vi
BAB I PENDAHULUAN
1.1 Latar belakang ............................................................................................ 1
1.2 Rumusan Masalah ...................................................................................... 1
1.3 Tujuan Penulisan ........................................................................................ 2
BAB II TINJAUAN PUSTAKA
2.1 Pengertian Amputasi Penis ......................................................................... 3
BAB III PEMBAHASAN
3.1 Persiapan Operasi........................................................................................ 4
3.2 Teknik Operasi ........................................................................................... 5
3.3 Pasca Operasi ............................................................................................... 7
BAB IV PENUTUP
4.1 Simpulan ..................................................................................................... 8
4.2 Saran............................................................................................................. 8
DAFTAR PUSTAKA .......................................................................................... 9
iv
DAFTAR GAMBAR
Gambar 1.a. ........................................................................................................... 6
Gambar 1.b. ........................................................................................................... 6
Gambar 2 ............................................................................................................... 6
Gambar 3 ............................................................................................................... 7
v
DAFTAR LAMPIRAN
Lampiran 1. A comparison of surgical Outcomes of Perineal Urethrostomy

Plus Penile Resection and Perineal Urethostomy in Twelve Calves with Perineal
or Prescrotal Urethral Dilatation.
Lampiran 2. Surgical Management of Penile and Preputial Neoplasms in
Equine with Special Reference to Partial Phallectomy.
Lampiran 3. Penile amputation and scrotal urethrostomy in 18 dogs.
vi
BAB I
PENDAHULUAN
1.1 Latar Belakang

Ilmu bedah merupakan cabang dari ilmu kedokteran hewan, termasuk ilmu-
ilmu klinik veteriner. Ilmu bedah ditujukan untuk meringankan,menyembuhkan,
membetulkan serta menghilangkan gejala penyakit, trauma dankelainan kongenital
dengan menggunakan alat, manual, mekanik atau pembedahan. Tujuan pokoknya
adalah memulihkan ke keadaan normal dari suatugangguan penyakit untuk
penyelamatan jiwa dan secara ekonomi untuk kepentingan tertinggi pemilik serta
membantu untuk penetapan suatu diagnosa. Salah satu pembedahan yang akan
dibahas berikut ini adalah Amputasi penis.
Amputasi berasal dari kata latin amputare yang erarti “pancung”. Dalam
ilmu kedokteran diartikan sebagai “membuang” sebagian atau seluruh anggota
gerak, sesuatu yang menonjol atau tonjolan (organ tubuh) (Reksoprodjo, 2002).
Amputasi pada ektremitas bawah sering diperlukan sebagai akibat penyakit
vaskuler perifer progresif (sering sebagai gejala sisa diabetes mellitus), gangren,
trauma (cederaremuk, luka bakar, luka bakar dingin, luka bakar listrik),
deformitas kongenital, atau tumor ganas (Brunner & Suddarth, 2002). Penyakit
Amputasi penis adalah tindakan pembedahan yang dilakukan untuk
memotong penis. Pemotongan penis dilakukan karena adanya trauma pada
preputium dan penis yang menyebabkan hematoma dan patah tulang penis,karena
adanya neoplasia seperti tumor veneral menular. Tumor ini adalah tumor yang
dapat menular melalui kontak seksual atau jilatan (Sudisma, 2016).
1.2 Rumusan Masalah

Berdasarkan permasalahan yang ada maka penulis merumuskan bagaimana
gambaran pre-operasi hingga pasca-operasi dalam penaganan kasus bedah amputasi
penis.
1
1.3 Tujuan Penulisan
1. Umum
Tujuan umum dari penulisan makalah ini adalah untuk dapat
memahami bagaimana teknik operasi amputasi penis dari pra-oerasi hingga
pre-operasi.
2. Khusus
Tujuan khususnya adalah untuk memahami secara betul bagaimana
melakukan implemetasi pada pasien yang mengalami kasus amputasi penis
dan memahami melakukan evaluasi dalam post amputasi penis.
2
BAB II
TINJAUAN PUSTAKA
2.1 Definisi Amputasi Penis

memotong penis. Amputasi penis biasanya dilakukan pada pasien dengan indikasi
perlukaan yang hebat disertai nekrosa pada penis, tumor pada ujung penis, paralysis
penis yang telah berlangsung lama, prolapsus penis, trauma pada preputium dan
penis yang menyebabkan hematoma dan patah tulang penis, karena adanya
neoplasia seperti tumor veneral menular (transmissible venereal tumor/TMT),
squamus sel karsinoma, hemangiosarkoma, dan papilloma. TMT adalah tumor yang
menular melalui kontak seksual atau jilatan.
Dalam melakukan operasi amputasi penis hal-hal yang harus dipersiapkan

adalah mulai dari persiapan preoperasi sampai dengan post operasi. Persiapan
preoperasi meliputi persiapan hewan/pasien, Persiapan Site Operasi, dan terakhir
hewan/pasien masuk ruang operasi. Sedangkan persiapan post operasi,
penyembuhan luka setelah operasi/pembedahan bisa diberikan penyuntikan
antibiotik oxytetracycline. Hewan yang habis melakukan operasi/pembedahan lebih
baik dikandangkan di kandang yang bersih dan kering agar kita bisa mengawasi
gerak-gerik pasien. Pemberian makanan dan vitamin yang tekontrol dengan baik
akan mempercepat penyembuhan pasien dari segi fisik. Bila kondisi pasien buruk
pada pasca operasi bisa diberikan infus larutan Dextrose 5% dalam Saline atau
larutan Laktat Ringer’s, atau pemberian tranfusi darah.
3
BAB III
PEMBAHASAN
3.1 Persiapan Operasi Amputasi Penis
 Persiapan Hewan / Pasien
1. Anamnesa
2. Pemeriksaan fisik
3. Persiapan Tempat Operasi
4. Pelaksanaan operasi
 Persiapan Tempat Operasi :
o Restrain
o Pencukuran bulu atau rambut di sekitar tempat operasi
o Setelah pencukuran bulu atau rambut, cuci tempat operasi dan beri
antiseptic ( povidoneiodin/yodium tincture )
 Pasien Masuk Ruang Operasi :
o Lakukan anastesi dengan anestesi regional atau anestesi umum
o Baringkan dengan posisi dorsal recumbency
o Pasang cateter pada uretra untuk orientasi dan melindungi terjadinya
trauma pada uretra.
 Persiapan Alat, Bahan, dan Obat
o Alat yang digunakan dalam melakukan pembedahan yaitu Pinset
anatomis, pinset sirorgis, towel
clamp, gunting bengkok, scalpel,needle holder, syiringe 1 cc,
tampon, kapas, kassa, plester, tang arteri, jarum bulat dan
penampang segitiga, cut gut chromic 3/0, silk 3/0, kain duk, tali
restrain,timbangan, lampu operasi, pencukur rambut, sarung tangan,
masker, penutup kepala, dan baju bedah.
o Bahan-bahan yang digunakan antara lain premedikasi, yaitu atropin
sulfat dengan dosis 0,25 mg/kg BB secara subkutan.
Bahan anasthetikum, yaitu xylazine2% dengan dosis 2 mg/kg BB
dan ketamine HCL 10% dengan dosis 10 mg/kg BB secara
intramuskular. Bahan antibiotik, yaitu oxytetracyclin (terramycin)
4
50% dengan dosis 14 mg/kg BB, Amocillin 25% dengan dosis 20
mg/kg BB, dan penicillin 50000 IU. Alkohol 70%, iodine tincture
3.2 Teknik Operasi

Amputasi penis adalah prosedur pembedahan yang jarang dilakukan pada
anjing dengan beberapa kasus yang dilaporkan dalam literatur kedokteran hewan.
Amputasi penis telah dilaporkan dan / atau disarankan untuk pengobatan trauma
penis termasuk pencekikan penis yang mengakibatkan gangren pada bagian distal
dan kerusakan parah pada uretra (Hobson 1990, Boothe 2003).
Berikut penjelasan mengenai prosedur amputasi penis, hewan dipersiapkan
seperti biasa untuk di operasi, dianestesi dan dibaringkan pada punggungnya (dorsal
recumbency). Dipasang cateter pada uretra untuk orientasi dan melindungi
terjadinya trauma pada uretra. Penis dikelurkan semaksimal mungkin dari
preputium, posisi penis dipertahankan dan dipasang tourniquet di sebelah kaudal
penis yang akan diamputasi. Dibuat insisi berbentuk “V” sepanjang tunica
albuginea dan jaringan kavernosus pada tulang penis dan uretra. Tulang penis
dipotong dengan pemotong tulang pada bagian paling kaudal dan hati-hati agar
tidak membuat trauma uretra (Gambar 12.7A). Uretra dipotong 1-2 cm di kranial
potongan penis. Diidentifikasi dan diligasi arteri di bagian dorsal penis untuk dapat
melepaskan tourniquet. Uretra yang telah dipotong di buka dan dilipat bagian
ujungnya diatas potongan penis. Dipertautkan mukosa uretra dengan tunika
albuginea dan jaringan kavernosus jahitan simple interrupted atau continuous.
Preputium di potong agar lebih pendek sesuai dengan sisa penis yang terpotong.
Insisi pada preputium dibuat berbentuk clip dan dilakukan penutupan kulit dengan
jahitan simple interrupted atau continuous dengan benang nonabsorbable (Gambar
12. 7B).
5
Gambar 1.a insisi berbentuk “V” pada tunika albuginea dan jaringan kavernosus, tulang penis
dipotong ; Gambar 1.b Uretra dipotong, dipertautkan uretra dengan tunika albuginea, preputium
diperpendek dan dijahit kulitnya dengan benang absorbable.
Gambar 2. Foto intraoperatif menunjukkan amputasi penis, pengebirian dan ablasi skrotum
6
Gambar 3. Penampilan luka operasi pasca operasi segera setelah amputasi penis, pengebirian dan
urethrostomy skrotum
3.3 Pasca Operasi
Perawatan Post operasi meliputi penyuntikan antibiotik oxytetracycline
14mg/kg BB secara intra muscular dan dilakukan monitoring terhadap kondisi
fisiologis hewan yang meliputi temperatur, frekuensi nafas, frekuensi jantung,
nafsu makan dan minum, feces, dan urine. Pengobatan dilakukan setiap hari
meliputi pemberian antibiotik, vitamin dan pembersihan pada luka jahitan.
Pemberian antibiotik amoxicillin (27.2 mg/ml) untuk mencegah infeksi selama 5
hari dilanjutkan dengan vitamin A ipi untuk regenerasi sel-sel epitel. Luka jahitan
tersebut dibersihkan dengan rivanol kemudian diberi betadine dan ditutup dengan
kassa. Kebersihan kandang untuk proses recovery juga perlu diperhatikan dan
dijaga kebersihannya.
7
BAB IV
PENUTUP
4.1 Simpulan

memotong penis. Amputasi penis biasanya dilakukan pada pasien dengan indikasi
perlukaan yang hebat disertai nekrosa pada penis, tumor pada ujung penis, paralysis
penis yang telah berlangsung lama, prolapsus penis, trauma pada preputium dan
penis yang menyebabkan hematoma dan patah tulang penis, karena adanya
neoplasia seperti tumor veneral menular (transmissible venereal tumor/TMT),
squamus sel karsinoma, hemangiosarkoma, dan papilloma.
Dalam melakukan operasi amputasi penis hal-hal yang harus dipersiapkan
adalah mulai dari persiapan preoperasi sampai dengan post operasi. Persiapan
preoperasi meliputi persiapan hewan/pasien, Persiapan Site Operasi, dan terakhir
hewan/pasien masuk ruang operasi. Sedangkan persiapan post operasi,
penyembuhan luka setelah operasi/pembedahan bisa diberikan penyuntikan
antibiotik oxytetracycline. Hewan yang habis melakukan operasi/pembedahan lebih
baik dikandangkan di kandang yang bersih dan kering agar kita bisa mengawasi
gerak-gerik pasien. Pemberian makanan dan vitamin yang tekontrol dengan baik
akan mempercepat penyembuhan pasien dari segi fisik. Bila kondisi pasien buruk
pada pasca operasi bisa diberikan infus larutan Dextrose 5% dalam Saline atau
larutan Laktat Ringer’s, atau pemberian tranfusi darah.
4.2 Saran
Harus diperlukan tenaga yang ahli dalam melakukan operasi ini dikarenakan
operasi ini sangat besar resiko kesalahannya. Dan diperlukan pengobatan yang rutin
supaya kesembuhannya terjamin.
8
DAFTAR PUSTAKA
HOBSON, H. P. (1990) Surgical procedures of the penis. In Current Techniques

in Small Animal Surgery. 3rd edn. Ed M. J. Bojrab. Lea & Febiger. pp
423-430
Marzok, M.A. dkk. 2013. A comparison of surgical Outcomes of Perineal

Urethrostomy Plus Penile Resection and Perineal Urethostomy in Twelve
Calves with Perineal or Prescrotal Urethral Dilatation. Open Veterinary
Journal Volume 3, halaman 106-113
R. D. Burrow. et al . (2014). Penile amputation and scrotal urethrostomy in 18

dogs. 10.1136/vr.100039 | Veterinary Record. Downloaded from
veterinaryrecord.bmj.com on October 9, 2014 - Published by
group.bmj.com
Rizk, Awad. dkk. 2013. Surgical Management of Penile and Preputial Neoplasms
in Equine with Special Reference to Partial Phallectomy. Hindawi
Publishing Comporation Journal of Veterinary Medicine Volume 2013.
Sudisma, I.G.N. dkk. 2006. Ilmu Bedah Veteriner dan Teknik Operasi. Udayana
University Press.
9
Downloaded from veterinaryrecord.bmj.com on October 9, 2014 - Published by group.bmj.com
Papers
Papers
Penile amputation and scrotal urethrostomy
in 18 dogs
R. D. Burrow, S. P. Gregory, A. A. Giejda, R. N. White
The objective of this study was to report the signalment, indications for surgery,
postoperative complications and outcome in dogs undergoing penile amputation and scrotal
urethrostomy. Medical records of three surgical referral facilities were reviewed for dogs
undergoing penile amputation and scrotal urethrostomy between January 2003 and July
2010. Data collected included signalment, presenting signs, indication for penile amputation,
surgical technique, postoperative complications and long-term outcome. Eighteen dogs
were included in the study. Indications for surgery were treatment of neoplasia (n=6),
external or unknown penile trauma (n=4), penile trauma or necrosis associated with urethral
obstruction with calculi (n=3), priapism (n=4) and balanoposthitis (n=1). All dogs suffered
mild postoperative haemorrhage (posturination and/or spontaneous) from the urethrostomy
stoma for up to 21 days (mean 5.5 days). Four dogs had minor complications recorded at
suture removal (minor dehiscence (n=1), mild bruising and swelling around the urethrostomy
site and mild haemorrhage at suture removal (n=2), and granulation at the edge of stoma
(n=1)). One dog had a major complication (wound dehiscence and subsequent stricture of
the stoma). Long-term outcome was excellent in all dogs with non-neoplastic disease. Local
tumour recurrence and/or metastatic disease occurred within five to 12 months of surgery
in two dogs undergoing penile amputation for the treatment of neoplasia. Both dogs were
euthanased.
THE surgical technique for penile amputation, ablation of the external The level at which penile amputation is actually performed (ie,
genitalia and urethrostomy in the dog have been described by Leighton partial or complete) and the site of the subsequent urethrostomy
(1976), Hobson (1990) and Boothe (2003). Penile amputation has been depends on the nature and location of the penile lesion and/or prepu-
reported and/or suggested for the treatment of penile trauma includ- tial lesion that is being treated. Distal penile lesions may be treated
ing strangulation of the penis resulting in gangrene of the distal por- by partial penile amputation alone, and if a large portion of the glans
tion and severe damage to the urethra (Hobson 1990, Boothe 2003) penis is removed, shortening of the prepuce has been recommended
and for the treatment of priapism (Martins-Bessa and others 2010), (Hayes and others 1994) to avoid the complications associated with
penile neoplasia (Michels and others 2001, Bleier and others 2003, urine being voided into the prepuce on urination. More extensive
Marolf and others 2006, Root Kustritz and Fick 2007, Peppler and penile lesions or extensive preputial disease (eg, trauma, neoplasia)
others 2009, Webb and others 2009), urethral neoplasia (Davis and may necessitate more aggressive penile amputation with excision of
Holt 2003), arteriovenous fistula of the prepuce (Trower and others the prepuce. The urethrostomy site may be prescrotal, scrotal or peri-
1997), hypospadias (Galanty and others 2008) and other conditions neal depending on the actual site at which penile amputation has been
where there is traumatic loss, acquired or congenital abnormalities of performed.
the prepuce leaving the distal portion of the penis exposed (Croshawe Urethral stricture is a possible complication of partial penile ampu-
and Brodey 1960, Hobson 1990, Soderbergh 1994, Papazoglou 2001, tation if healing is complicated (Boothe 2003). Other complications
Hedlund 2002, Papazoglou and Kazakos 2002, Boothe 2003). reported for penile amputation include early postoperative urine scald
and the inability to urinate due to suspected urethral sphincter hyper-
tonus (Michels and others 2001). Postoperative haemorrhage from the
Veterinary Record doi: 10.1136/vr.100039 urethrostomy site (Bilbrey and others 1991) and urine dribbling with
scalding of the medial surface of the hindlimbs are possible complica-
R. D. Burrow, BVetMed, CertSAS, R. N. White, BSc, BVetMed, CertVA, tions of urethrostomy performed alone without penile amputation
CertVR, DipECVS, MRCVS, DSAS (soft tissue), DipECVS, MRCVS, (Kyles and others 1996, Smeak 2000, Bjorling 2003). Despite the sur-
A. A. Giejda, DVM, MRCVS, Willows Veterinary Centre and Referral gical technique being well described, penile amputation is a procedure
The Royal Veterinary College, Service, Shirley, Solihull,West Midlands that is uncommonly performed and there are only individual cases of
University of London, B90 4NH, UK penile amputation reported in the English language veterinary litera-
London, UK ture. This retrospective study describes a further 18 cases and reviews
S. P. Gregory, BVetMed, PhD, DVR, E-mail for correspondence: the indications for surgery, postoperative complications and long-term
DSAS (soft tissue), MRCVS, [email protected] outcome.
Department of Veterinary
Clinical Sciences, Royal Veterinary Provenance: not commissioned; Materials and methods
College, North Mymms, externally peer reviewed The medical records of three referral facilities (The Small Animal
Hertfordshire Teaching Hospital, University of Liverpool; Queen Mother Hospital
AL9 7TA, UK Accepted August 31, 2011 for Small Animals, The Royal Veterinary College, and Robert N.
10.1136/vr.100039 | Veterinary Record | 1 of 8

Papers
TABLE 1: Clinical details of 18 dogs undergoing penile amputation and scrotal urethrostomy
Hosp. Late
Case Age Sex Breed Presenting signs Diagnosis (days) Urethrostomy closure Early complications complications Outcome
1 7y MN Labrador Preputial mass Intermediate grade 3 Continuous MIHSU for 5 days None Euthanased 1 year
mast cell tumour later, metastatic
disease
2 1y 6m M Bull dog Persistent erection Chronic priapism, 3 Continuous MIHSU for 3 days None Excellent
following coitus thrombus within corpus
cavernosum
3 6y M Golden Unseen trauma with Fracture of the os penis, 4 Continuous MIHSU for 3 days, None Excellent
retriever resulting chronic chronic balanoposthitis localised bruising and
penile engorgement spontaneous bleeding at
and irritation urethrostomy site on 5th
day postoperatively
4 12y 3m MN Cross bred Preputial mass Liposarcoma 4 Continuous MIHSU for 3 days None Excellent
5 5y 8m MN Dalmatian Dysuria, Obstruction of penile 4 Continuous MIHSU for 21 days None Excellent, dietary
traumatisation of urethra with urate control of urate
penis and prepuce calculi urolithiasis
6 5y 2m M Rottweiler Preputial mass Haemangiosarcoma 6 Continuous MIHSU for 1 day, localised None Euthanased 5
bruising and spontaneous months later,
haemorrhage from metastatic disease
urethrostomy at 5 days
postoperatively
7 7y 5m MN Cross bred Severe penile/ Fractured os penis, 7 Simple interrupted MIHSU for 1 day, localised None Excellent
preputial trauma penile urethral rupture bruising and spontaneous
associated with dog bleeding at urethrostomy at
fight 7 days postoperatively
8 4y 7m MN Yorkshire Protrusion and Chronic idiopathic 3 Simple interrupted MIHSU for 7 days None Excellent
terrier vascular engorgement priapism
of penis
9 7y M Golden Dysuria, stranguria, Severe 5 Simple interrupted MIHSU for 1 day, mild None Excellent
retriever penile swelling and thrombophlebitis, bruising and spontaneous
haemorrhage after cellulitis and penile bleeding at urethrostomy
dog fight 3 weeks haematoma at 11 days postoperatively,
previously urinary tract infection
10 11y MN Bassett Hound Profuse penile Balanoposthitis, 8 Simple interrupted MIHSU for 7 days None Excellent
haemorrhage lacerations of bulbus
glandis penis
11 4y M Swedish Dysuria swollen Balanitis, fracture of the 13 Simple interrupted MIHSU for 3 days None Excellent
Vallhund haemorrhagic penis os penis, urethral and
cystic calculi
12 10y M Sheltie Collapsed, dysuric Penile necrosis, orchitis, 62 Simple interrupted MIHSU for 1 day, complete Stricture of Excellent
swollen testicles, urethral and cystic dehiscence of skin and urethrostomy
swollen and calculi urethrostomy wounds site, urinary
discoloured penis tract infection
following prescrotal
urethrotomy
13 5y M Staffordshire Preputial mass Intermediate grade 10 Simple interrupted MIHSU for 7 days, None Excellent
bull terrier mast cell tumour dehiscence of cranial skin
wound allowed to heal by
second intention
14 3y MN Labrador Preputial mass Grade 1 mast cell 5 Simple interrupted MIHSU on days 4-6 None Excellent
tumour postoperatively, swelling/
reddening of skin wound
at 10 days postoperatively,
resolved after suture
removal
15 11y MN Affenpinscher Persistent Penile squamous cell 4 Simple interrupted Mild spontaneous None, Excellent, no gross
haemorrhagic carcinoma haemorrhage from stoma histology tumour recurrence
preputial/penile for 5 days postoperatively, report showed at 1 year
discharge, penile MIHSU for 10 days, swelling tumour postoperatively
swelling and irritation around stoma at suture invasion into
removal, mild granulation blood vessels
tissue at cranial aspect of and neoplastic
stoma,suspected urinary cells at margin
tract infection at 10 days of excision
postoperatively
16 7y 10m MN Miniature Dysuria, self-trauma/ Idiopathic priapism, 4 Simple interrupted MIHSU for 4 days None Excellent
longhaired laceration and necrosis with self-trauma
dachshund of proximal 3-4 cm of
persistently protruding
penis following
bilateral perineal
hernia repair
17 4y 3m MN Pug Persistent penile Idiopathic priapism 4 Simple interrupted MIHSU and spontaneous None Excellent
protrusion and with trauma secondary spontaneous haemorrhage
engorgement to exposure from stoma for 2 days
18 2y 10m MN Chihuahua Self-trauma, Self-trauma 5 Simple interrupted MIHSU and spontaneous None Excellent
amputation of distal 2 haemorrhage from stoma
cm of penis following for 3 days
coitus
Hosp Hospitalisation, M Male, N Neutered, MN Male neutered, y Year, m Month, MIHSU Mild intermittent haemorrhage from stoma on urination
2 of 8 | Veterinary Record | 10.1136/vr.100039

Papers
FIG 1: Preputial haemangiosarcoma (case 6) FIG 3: Devitalised distal penis and lacerated penile body (case 16)
FIG 2: Idiopathic priapism and devitalised penis (case 16)
White Surgical Consultancy Services) were reviewed for dogs under- FIG 4: Chronic idiopathic priapism. In this dog, priapism was
going penile amputation and scrotal urethrostomy between January secondary to thrombosis of the deep penile veins
2003 and August 2010. Data collected from the dogs’ medical records
included signalment, presenting signs, indication for penile amputa- [n=1], calcium oxalate [n=1], struvite [n=1]), priapism in four dogs
tion, surgical technique and method of urethrostomy closure, postop- (with self-trauma in two of these dogs, see Figs 2, 3 and 4) and balano-
erative complications and long-term outcome. posthitis with penile haemorrhage in one dog. One of the dogs (case
Dogs were excluded from the study if their medical records were 12) with urethral obstruction presented in a collapsed state and was
incomplete, a partial penile amputation had been performed or no uraemic with a calculus obstructing the penile urethra. The referring
long-term follow-up was available. veterinary surgeon had attempted a prescrotal urethrostomy but the
incision had been made into the penile body and had not entered the
Results urethra. At presentation, the penis was swollen, dark red in colour and
Nineteen dogs were identified that had undergone penile amputa- the prepuce and ventral abdominal tissues were oedematous. The scro-
tion and scrotal urethrostomy, and one dog was excluded because of tum was swollen, erythematous and exuding serosanguineous fluid.
incomplete records. The case details are listed in Table 1. A cystotomy tube was placed to allow urinary diversion while this
dog was stabilised. The decision to perform penile amputation was
Signalment and diagnosis delayed for 12 hours; despite improvement in the animal’s renal and
The dogs ranged in age between one year six months and 12 years cardiovascular parameters with intravenous fluid therapy, the penis
three months (mean six years six months). The mean age of dogs became cold and blackened (Fig 5), suggesting continued vascular
with neoplastic and non-neoplastic disease was six years six months interruption and necrosis. Priapism was considered to be idiopathic
in both groups. Fifteen pure breeds were recorded, both labrador and in three dogs and occurred following bilateral perineal hernia repair in
golden retriever were recorded twice and crossbreed was recorded three one of these dogs and following coitus in one dog.
times. Eleven dogs were neutered and seven dogs were entire.
The indication for surgery was neoplasia in six dogs (preputial Surgical technique
neoplasia, n=5 [mast cell tumour, n=3; liposarcoma, n=1; haeman- Eight male neutered dogs underwent penile amputation and scrotal
giosarcoma, n=1, see Fig 1] and penile/urethral neoplasia, n=1 [squa- urethrostomy, and 10 male entire dogs underwent castration and
mous cell carcinoma]). Preoperative haematology and biochemistry scrotal ablation in addition to the above. The surgical technique used
were performed and preoperative staging was done (two- or three-view was as described by Hobson (1990). In brief, an elliptical incision was
thoracic radiography performed under sedation or general anaesthesia, made around the base of the prepuce taking lateral and caudal margins
abdominal ultrasonography and aspiration of prominent or enlarged appropriate for the disease being treated. Entire male dogs then under-
local lymph nodes); no dogs had evidence of gross metastatic disease. went concurrent castration and scrotal ablation (see Fig 6). The penis
Other indications for surgery were penile trauma in four dogs (dog cranial to the scrotum was dissected free and a tourniquet was applied
fight injury [n=1], road traffic accident [n=1], self-trauma following to the body of the penis proximal to the proposed amputation site.
coitus [n=1] and unknown trauma [n=1]), penile trauma or necrosis The penis was excised distal to the tourniquet and the tunica albug-
associated with urethral obstruction with calculi in three dogs (urate inea was oversewn with monofilament absorbable suture material.

Papers
not cleaned until after suture

removal, which was performed
10 to 14 days postoperatively
in 17 of 18 dogs. The three
dogs undergoing penile ampu-
ta t i o n fo l l ow i n g u re t h ra l
obstruction for calculi received
dietary management appropri-
ate to their calculus type once
results of calculi analysis were
available.
Postoperative
complications
All dogs had intermittent haem-
FIG 5: Devitalised penis, swollen prepuce and testicles and area of skin necrosis around peputial/penile orrhage from the urethrostomy
incision immediately before penile amputation (case 12) site, either spontaneously or dur-
ing and/or immediately after uri-
nation for three to 21 days post-
operatively (mean 5.5 days). The duration of stomal bleeding was not
reported in one dog but had resolved by the time of discharge at five
days postoperatively. In five cases, intermittent postoperative haemor-
rhage at urination or excitement was managed during hospitalisation
by the application of cold compresses to the urethrostomy site. Mild
bruising around the urethrostomy site was recorded in four dogs.
Duration of postoperative hospitalisation ranged from three to 62
days (mean 8.6 days). Case 12 was hospitalised for 62 days; initially
this was to allow management of postoperative complications but was
extended at the owners’ request for their convenience rather than for rea-
sons related to the dog’s condition. Exclusion of this dog from the data
analysis for duration of hospitalisation reduced this mean to 5.4 days.
Minor complications were noted at the time of suture removal in
four dogs (n=1 mild dehiscence of the cranial aspect of the skin inci-
sion that subsequently healed by second intention, n=2 mild swell-
ing and bruising of the urethrostomy site with mild haemorrhage
at suture removal, n=1 granulation tissue at the cranial edge of the
stoma). No treatment was administered and all the above had resolved
on re-examination seven days later. Case 12 had major postoperative
complications. This dog developed wound dehiscence at the cranial
extent of the incision starting three days postoperatively, it extended
caudally to involve the entire wound and it was not secondary to sub-
cutaneous urine leakage as a cystotsomy tube was placed before penile
FIG 6: Intraoperative photograph showing penile amputation, amputation to allow urinary diversion. The sutures were removed
castration and scrotal ablation and the wound was allowed to heal by second intention. The scro-
tal urethrostomy site strictured and subsequently this dog underwent
perineal urethrostomy. The cystostomy tube was removed once the
The urethra was incised along the ventral midline, at least 1 cm from perineal urethrostomy had healed.
the amputation site and a scrotal urethrostomy was performed. In Two dogs had urinary tract infections (UTIs) based on positive
six cases, a simple continuous pattern with polypropylene was used bacterial cultures of urine samples obtained by cystocentesis. In one
to appose urothelium to skin and in 12 cases the urethrostomy was dog, a UTI was diagnosed at the time of penile amputation and in the
closed with a simple interrupted suture pattern using polypropylene second dog, case 12, which had a cystostomy tube, a UTI was diag-
or polyamide. The remaining skin incision was closed routinely and a nosed six weeks postoperatively. The cystostomy tube had been main-
closed suction drain was placed in one case (see Fig 7). tained until this animal’s other postoperative complications (wound
dehiscence and stricture of the scrotal urethrostomy) had been resolved
Histological diagnoses and UTI was confirmed at the time of cystostomy tube removal six
Five dogs were diagnosed with preputial neoplasia based on the results weeks later. Both dogs had a resolution of infection with appropriate
of preoperative incisional and postoperative excisional biopsies (n=3 antibacterial therapy. A UTI was suspected in one dog on the basis
mast cell tumours [MCTs]: grade 1, completely excised [n=2] and of foul-smelling urine at the time of suture removal although urine
grade 2, completely excised [n=1]; n=1 liposarcoma [completely culture was not performed. The signs resolved with empirical anti-
excised], n=1 haemangiosarcoma [completely excised]). One dog had bacterial therapy.
a penile/urethral squamous cell carcinoma (SCC); this was incom-
pletely excised with evidence of tumour emboli in local vasculature. Long-term follow-up
Long-term follow-up was by telephone report from the owner and/or
Postoperative treatment referring veterinary surgeon in all cases. Metastatic disease occurred
All dogs received NSAIDs and/or opioid drugs for two to 10 days within five and 12 months of surgery in the two dogs that under-
postoperatively. None of the dogs with neoplastic disease received went penile amputation for the treatment of a preputial haeman-
radiotherapy. The dog with the SCC received ongoing treatment with giosarcoma and intermediate grade MCT, respectively. These dogs
meloxicam and the other dogs with neoplastic disease did not receive were euthanased as a result of the neoplastic disease. In all other cases,
chemotherapy. long-term follow-up of six months to five years confirmed there were
All dogs received lead-restricted exercise for 10 to 14 days post- no complications associated with penile amputation and scrotal
operatively. All dogs wore Elizabethan collars and the stoma was urethrostomy.

Papers
postoperative haemorrhage from the urethrostomy site for up to 21

days postoperatively, regardless of the suture pattern used to appose
urothelium and skin. Haemorrhage was managed conservatively in
all cases. While postoperative haemorrhage has not been reported to
be a serious or life-threatening postoperative complication following
urethrostomy in the dog, requiring supportive or further surgical
intervention, it may however, increase the duration of postoperative
hospitalisation, or cause owner concern and/or inconvenience if it
happens after the animal is discharged from the hospital. Bruising of
the urethrostomy site was also a common complication, occurring
in 29 per cent of these cases. Similarly, Bilbrey and others (1991)
reported postoperative haemorrhage in 72.2 per cent of cases and
bruising or swelling of the surgical site in 41.2 per cent of cases
undergoing scrotal urethrostomy sutured using a simple interrupted
pattern.
The pattern used to suture the urethra to the skin may affect
the likelihood of postoperative haemorrhage. Newton and Smeak
(1996) reported reduced postoperative haemorrhage using a simple
continuous pattern and three-needle bite sequence for urethrostomy
closure, passing the suture needle via the urethral mucosa first. Using
this technique, Newton and Smeak (1996) reported a dramatic reduc-
tion in active bleeding, bleeding after micturition and bruising after
surgery, with no suture line breakdown or stricture. These modifica-
tions are suggested to produce a better tissue seal by more completely
apposing the tissues. Continuous patterns have fewer knots and
thus reduce tissue irritation, needle bites are placed closer together to
improve urethra to skin apposition and incorporation of the tunica
albugenia helps to seal the incised cavernous edges. All of these fac-
tors may reduce postoperative haemorrhage and this technique is
also faster to perform (Newton and Smeak 1996). In 12 of the 18
dogs, a simple interrupted pattern was used to close the urethros-
tomy stoma. The use of continuous or interrupted suture pattern
FIG 7: Immediate postoperative appearance of the surgical wound was dependent on the surgeon’s preference. Unfortunately, due to
following penile amputation, castration and scrotal urethrostomy differences in detail of data recording between clinicians, the authors
were sometimes unable to reliably differentiate between active/spon-
taneous haemorrhage and haemorrhage associated with urination so
Discussion cannot report on differences between these specific types of haemor-
Penile amputation and scrotal urethrostomy is an uncommonly rhage in relation to technique of stomal closure. However, postopera-
performed surgical procedure in dogs with few cases reported in tive haemorrhage was recorded in all cases, regardless of technique
the veterinary literature. Here, the authors report the signalment, of urethrostomy closure and no advantage of reduced haemorrhage
indications for surgery, postoperative complications and outcome associated with the use of a continuous pattern was recognised in
in 18 dogs undergoing penile amputation and scrotal urethrostomy. this study.
All dogs suffered minor postoperative haemorrhage from the ure- Non-absorbable suture material was used to appose the skin
throstomy stoma, however, complications of wound dehiscence and and urethra in all animals in this series. Sutures were removed 10
stomal stricture were rare. Other postoperative complications were to 14 days postoperatively under sedation or a short general anaes-
minor and of minimal clinical significance. The long-term outcome thesia; this also allowed for close inspection of the stoma. The use
was excellent in all dogs that had non-neoplastic disease, whereas of monofilament absorbable suture material eliminates the need for
for two of five dogs with a diagnosis of preputial neoplasia (hae- suture removal. Polydioxanone has been used for closure of perineal
mangiosarcoma and grade 2 MCT), metastatic disease resulted in urethrostomies in cats. In one study, leaving absorbable sutures in
euthanasia within one year after surgery. The postoperative com- place did not result in any more complications when compared with
plications seen in the present cases are those that have previously the use of non-absorbable sutures (Agrodnia and others 2004). The
been reported to accompany scrotal urethrostomy and the long-term mild haemorrhage that occurred in two dogs at suture removal in the
outcome following this surgery was dependent on the underlying present study was due to physical trauma to the stoma; this was not
disease. considered to be a significant problem but the use of monofilament
Penile necrosis secondary to penile urethral obstruction with absorbable suture would avoid the risk of traumatising the stoma in
calculi has not been reported previously, it was the reason for penile this way.
amputation in three dogs in this study. In these three dogs, the ure- Only one dog suffered major complications of surgery, experienc-
thral calculus had been causing obstruction for several days and the ing wound dehiscence, stricture of the urethrostomy site and UTI.
dogs were reported to have been straining unsuccessfully to urinate This association of urethrostomy stricture after stomal dehiscence
for 24 to 48 hours before referral. The cause of the necrosis in these has been suggested by Boothe (2003) although this appears to be an
cases is uncertain but is likely to be associated with disruption of the uncommon complication; no cases were reported by Bilbrey and oth-
penile blood supply. In one of these cases, penile necrosis may have ers (1991) in their study of the complications of scrotal urethrostomy
been secondary to attempted urethrotomy performed by the referring in dogs. In the dog suffering dehiscence and subsequent stricture in this
veterinary surgeon. The indications for penile amputation and scrotal series, a surgical intervention had been performed before referral that
urethrostomy in the other cases in this series included those that have appeared to have permanently interrupted the vascular supply of the
been previously reported. penis, prepuce, scrotum and ventral abdominal tissues. In retrospect,
Scrotal urethrostomy is the preferred urethrostomy site in dogs the level of penile amputation and urethrostomy in this dog should
because the membranous urethra is wider, more distensible and have been performed more proximally at a perineal location where
more superficial at this location, and is surrounded by less cavernous the tissues were normal. UTIs are a well-recognised potential compli-
tissue so incision at this location is associated with less haemor- cation of perineal urethrostomy in the cat (Smith and Schiller 1978,
rhage (Fossum 2007). All dogs in the present case series suffered mild Scavelli 1989, Griffin and Gregory 1992, Osborne and others 1996,

Papers
Agrodnia and others 2004, Bass and others 2005) and may be associ- will routinely include evaluation of mitotic index, Ki-67, PCNA,
ated with stoma formation and shortening of the urethra. Bilbrey and AgNOR, Kit mutational status and Kit localisation. Studies into the
others (1991) reported persistent clinically significant postoperative use of such panels have already been completed (Webster and others
UTIs in 15 per cent of dogs after scrotal urethrostomy. Two dogs in 2007, Thompson and others 2011a, b).
the present study had positive urine cultures but these were considered The dog with a grade 2 preputial MCT in the present study may
to be unrelated to the urethrostomy procedure and to be a consequence have benefited from adjunctive chemotherapy (Thamm and others
of the preexisting disease (balanoposthitis) or management of the 1999, London and Seguin 2003).
underlying problem (urinary diversion via cystostomy catheter). One Cutaneous haemangiosarcomas have a variable prognosis depend-
dog was suspected of having a UTI, which may have been associated ing on their site of origin and their depth of invasion. Tumours with
with the urethrostomy; this resolved after a 10-day course of antibac- hypodermal and underlying muscular involvement, as in the dog in
terial therapy. No other dogs in this case series showed clinical signs this study, tend to be larger in size, have a bruised appearance and
of UTI although urine cultures were not performed in any other dogs. shorter survival times (Ward and others 1994). Adjunctive chemo-
It is possible that subclinical UTIs occurred in some or all of the dogs therapy should be offered for these cases (Thamm 2007, Bulakowski
in this study but these were not identified because postoperative urine and others 2008).
cultures were not performed. Penile neoplasia is uncommon; the most common tumour of the
Other possible complications that can accompany urethrostomy penis in the dog is the transmissible venereal tumour (TVT), which is
in the dog are subcutaneous leakage of urine with resulting cellulitis rarely diagnosed in the UK. TVT is responsive to chemotherapy and
and urine staining of the hindlimbs or scald of the local tissues (Kyles radiotherapy so amputation of the penis should be considered rarely,
and others 1996, Bjorling 2003); these complications were not record- if ever, for treatment of this condition (Brown and others 1980, Thrall
ed in any of the present cases. 1982, Singh and others 1996). Other reported neoplasms of the penile
All of the dogs undergoing penile amputation and excision of the soft tissues include fibrosarcoma, lymphosarcoma, adenocarcinoma,
prepuce for the treatment of preputial tumours had complete excision mast cell tumour, haemangiosarcoma, squamous cell carcinoma
of the primary tumour. Depending on the size of the tumour, wide and idiopathic mucosal penile squamous papilloma (Hall and others
excision of preputial tumours with primary wound closure is often 1976, Ndiritu 1979, Herron 1983, Krishna and Gupta 1990, Wakui
possible. Preputial excision with amputation of the penis achieves a and others 1992, Michels and others 2001, Marolf and others 2006,
deep tissue plain in tumours of the prepuce and of the skin overlying Cornegliani and others 2007). Individual cases of neoplasia of the
the body of the penis. Of the three dogs that had preputial MCTs, os penis have been reported, including osteosarcoma, mesenchymal
the dog with the grade 2 tumour was euthanased for metastatic dis- chondrosarcoma, multilobular osteochondrosarcoma and ossifying
ease 12 months after surgery. The dogs with grade 1 tumours have fibroma (Patnaik and others 1988, Bleier and others 2003, Mirkovic
had no recurrence of disease currently either locally or at distant sites and others 2004, Root Kustritz and Fick 2007, Peppler and others
(36 months follow-up). 2009, Webb and others 2009). Squamous cell carcinoma (Patnaik and
The biological behaviour of MCTs ranges from benign, solitary others 1988), transitional cell carcinoma (Varshney and others 1986)
lesions that can be cured by surgical excision to aggressive, highly and lymphosarcoma of the penile urethra (Struble and others 1997)
metastatic neoplasms that lead to disseminated disease and death have also been reported.
(London and others 2009). Grade 2 MCTs in particular, have an unpre- The one dog in the present study that had a penile SCC had an
dictable behaviour (Bostock 1973, Patnaik and others 1984, Simoes incomplete excision of the tumour; a second surgical procedure to
and others 1994, London and Seguin 2003) and assigning the affected excise a wider margin of tissues together with a perineal urethrostomy
animal an accurate prognosis is challenging (Welle and others 2008) was offered which the owners declined. Meloxicam was prescribed
although a number of potential prognostic indicators have been iden- postoperatively for its possible antineoplastic effects (Knapp and oth-
tified. MCTs at inguinal, perineal and preputial locations have been ers 1992, 1994, Schmidt and others 2001). Despite the incomplete
correlated with a worse prognosis than those in other parts of the excision, this dog had no clinical signs of recurrence of disease in the
body (Tams and Macy 1981, Macy 1986, O’Keefe 1995, Thamm and nine months of follow-up.
Vail 2007), although this is not supported by all studies (Cahalane and Longer-term problems associated with recurrent urethral obstruc-
others 2004, Sfiligoi and others 2005) and definitive evidence for this tion by calculi following scrotal urethrostomy is unlikely. Bilbrey and
is lacking. others (1991) reported recurrence of calculi in two of 38 dogs that
Histological grading using the widely accepted Patnaik grading underwent scrotal urethrostomy for the treatment of urethral obstruc-
system has historically been and remains the most reliable predictor tion secondary to calculi and only one of these dogs had recurrent ure-
of the outcome of the tumour (Patnaik and others 1984, Murphy and thral obstruction secondary to calculi. In the present study, all cases in
others 2004, London and others 2009) although for grade 2 MCTs in which urolithiasis was the underlying disease which resulted in penile
particular, a wider range of biological behaviour is recognised (Bostock amputation, owners were given dietary and management recommen-
1973, Patnaik and others 1984, Simoes and others 1994, London dations to reduce the risk of urolith recurrence.
and Seguin 2003) making prognostication for an individual animal The only dog that suffered a serious complication of urethrostomy
more challenging (Welle and others 2008). To aid the ability to predict wound dehiscence subsequently developed a stricture. Boothe (2003)
outcome, advanced stains and certain molecular biology techniques suggested stricture as a complication following dehiscence; no cases
can be performed on tissue biopsy specimens; this can help to predict in the study of complications associated with scrotal urethrostomy
outcome with potentially greater accuracy. These include markers of reported by Bilbrey and others (1991) suffered either of these compli-
cell proliferation, AgNor count (silver staining chromosomal nucleo- cations. This complication appears to be uncommon.
lar organising region) (Bostock and others 1989, Simoes and others This study has several limitations. The case numbers presented
1994), PCNA (proliferating cell nuclear antigen) labelling fraction are relatively small, which reflects that penile amputation is per-
(Simoes and others 1994, Abadie and others 1999, Seguin and others formed uncommonly. The study is retrospective so the dogs’ records
2006), Ki-67 staining score (Abadie and others 1999, Scase and others may be incomplete and some details may have been omitted. In
2006) and mitotic index (Bostock and others 1989, Simoes and others addition, the surgeries were performed by four different surgeons.
1994, Romansik and others 2007), and investigation for gene muta- Histopathological analysis of excised tissue was not performed in all
tions in the proto-oncogene c-kit. This gene codes for the Kit receptor cases undergoing amputation following urethral obstruction with
protein and mutations in the gene result in dysregulated cellular pro- calculi and subsequent penile necrosis. This study does, however,
liferation and survival in canine mast cells (London and others 2009, suggest that penile amputation has few long-term complications
Downing and others 2002). Higher-grade MCTs are more likely to following wound healing. The complications accompanying penile
possess a mutation, the outcome being increased risk of local tumour amputation are those that are associated with scrotal urethrostomy.
recurrence and development of metastatic disease (Downing and oth- The long-term outcome depends on the underlying disease and is
ers 2002, London and others 2009). In future, therefore, together with excellent in animals that have undergone penile amputation for trau-
histological grade, it is likely that prognostic panels for MCT biopsies matic causes.

Papers
Acknowledgements Multi-center, placebo-controlled, double-blind, randomized study of oral toceranib

phosphate (SU11654), a receptor tyrosine kinase inhibitor, for the treatment of dogs
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Penile amputation and scrotal urethrostomy

in 18 dogs
R. D. Burrow, S. P. Gregory, A. A. Giejda, et al.
Veterinary Record published online October 2, 2011

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Open Veterinary Journal, (2013), Vol. 3(2): 106-113
ISSN: 2226-4485 (Print)
ISSN: 2218-6050 (Online) Original Article
_____________________________________________________________________________________
Submitted: 21/05/2013 Accepted: 14/09/2013 Published: 13/10/2013
A comparison of surgical outcomes of perineal urethrostomy plus penile

resection and perineal urethrostomy in twelve calves with perineal or
prescrotal urethral dilatation
M.A. Marzok1,2 and S.A. El-khodery3,4,*
1
Department of Veterinary Surgery, Faculty of Veterinary Medicine, Kafrelsheikh University , Kafr El-Sheikh
33516,Egypt
2
Department of Surgery and Gynecology, Faculty of Veterinary Medicine, University of Tripoli, Tripoli, Libya
3
Department of Internal Medicine and Infectious Diseases, faculty of Veterinary Medicine, Mansoura University,
Mansoura 35516, Egypt
4
Department of Internal Medicine, Faculty of Veterinary Medicine, University of Tripoli, Tripoli, Libya
____________________________________________________________________________________________
Abstract
The clinical diagnosis, ultrasonographic findings, surgical management, outcome, and survival rate of perineal or
prescrotal urethral dilatation in 12 male calves are described. All calves were crossbred and intact males. The most
noticeable clinical presentations were perineal (n= 10) or prescrotal (n= 2) swellings and micturition problems. The
main ultrasonographic findings were oval shaped dilatation of the urethra in all animals with dimensions of 40-75 X
30-62 mm. The calves with perineal urethral dilatation were treated by perineal urethrostomy (n= 4) and partial
penile transection including the dilated urethra and urethral fistulation (n= 6). Prescrotal urethral dilatations were
treated by penile transection proximal to the dilatation site (n= 2). Cystitis and stricture of the urethra were recorded
postoperatively for two of the calves that underwent perineal urethrostomy. Nine animals were slaughtered at
normal body weight approximately 6-8 months after the surgical treatment. Three animals were slaughtered after
approximately three to four months, two of them having gained insufficient body weight. Our study shows that
ultrasonography is a useful tool for the diagnosis of urethral dilatation in bovine calves. Our study also shows that
the partial penile transection may be a suitable and satisfactory choice of surgical treatment for correcting the
urethral dilatation in bovine calves.
Keywords: Male calves, Penile transaction, Perineal urethrostomy, Ultrasonography, Urethral dilatation.
_____________________________________________________________________________________________
Introduction Differential diagnoses include pathological perineal,

The male urethra connects the urinary bladder to the retroflexion and hernia of the urinary bladder, rupture
glans of the penis and consists of pelvic and extra pelvic of the urethra and pathological urethral diverticulum
parts (Sisson and Grossman, 1975). Urethral dilatation is or dilatation (Weaver et al., 1992). The condition is
an uncommon clinical problem that is observed in male usually associated with urethritis and/or cystitis as a
animals and humans. result of accumulation of urine in the swelling for a
In calves, congenital urethral dilatation (megalourethra) prolonged period (Parsons et al., 1998).
and developmental urethral dilatation in the perineal Treatment of urethral dilatation is directed towards
region has been reported only in isolated cases (Tharp surgical correction, when possible. Surgical treatment
and Venzke, 1954; Johnson et al., 1980; Gasthyus et al., involves either perineal urethrostomy or excision of
1996; Geccelep and Alkan, 2000). The condition occurs the urethral dilatation (Tharp and Venzke, 1954;
sporadically and is observed during the first week to Gasthyus et al., 1996; Geccelep and Alkan, 2000;
several months of age (Anderson et al., 1993; Sedeek Sedeek and Bakr, 2009).
and Bakr, 2009). However, due to the rarity of the condition, clinical
The etiology of megalourethra is unknown in either reports on urethral dilatation in bovine calves are
animals or humans (Kester et al., 1990). Urethral scarcely reported in the literature. To our knowledge,
dilatation in juvenile male cattle is a rare phenomenon there are no reports describing urethral dilatation in
probably related to a transient urethral obstruction or the prescrotal region of bovine calves. Therefore, the
to a developmental abnormality (Gasthyus et al., purpose of this article is to describe the clinical
1996). diagnosis, ultrasonographic findings, surgical
Clinical signs of urethral dilatation include the management, outcome, and survival rate in 12 male
presence of a fluctuant, firm, irreducible and painless calves presented with urethral dilatation either in the
swelling in the perineal region with dysuria. perineal or the prescrotal regions.
________________________________________________________________________________________________________
*Corresponding Author: Prof. Sabry A. El-khodery. Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516,
106 Egypt. Email: [email protected]
http://www.openveterinaryjournal.com
M.A. Marzok and S.A. El-khodery Open Veterinary Journal, (2013), Vol. 3(2): 106-113
________________________________________________________________________________________________________
Materials and Methods ultrasonographic observations, surgical technique
Patient selection (duration, cost, severity of bleeding) and
Twelve calves were presented to the veterinary complications, body gain and surgical outcome.
teaching hospital of Kafrelsheikh University, Egypt, Clinical diagnosis
between 2006 and 2011 with the chief complaint of Ultrasound examination for the urinary bladder and
penile urethral dilatation. the urethra was carried out using a real time; B-mode
All cases were found to have the dilatation at the diagnostic ultrasound scanner (Pie-Data Medical
perineal region (n= 10) or the prescrotal region (n= 2) Company, Maastricht, The Netherlands, 100 LC)
(Figures 1 and 2). equipped with linear array 6/8 MHz transducer and
3.5/5.0 MHz sector transducers.
Transrectal examination of the urinary bladder and the
urethra was performed for all presented cases in a
standing position without sedation. The penile urethra
was also examined via transcutaneous ultrasonography
of the perineal and prescrotal areas. Transabdominal
ultrasound examination of the right kidney was also
performed (Braun, 1991), but no abnormal findings
were visualized.
Diagnosis was confirmed with aseptic fine needle
aspiration of the swellings using a 16 gauge
hypodermic needle attached to a 50 ml syringe. Blood
samples were collected from each animal for
haematology and biochemistry.
Fig. 1. (a) Caudal and (b) lateral view of the perineum of Surgical procedures
two animals, showing the clinical presentation of an urethral All animals were treated surgically while standing
dilatation in the perineal area (white arrows). (Figures 1, 2, 3, and 4). Epidural analgesia was
induced by injection of 2-3ml of lidocaine 2%
(Debocaine 2%; El-nasr pharm, Egypt) into the 1st
intercoccygeal vertebral spaces.
In 4 animals, 0.05 mg/kg xylazine hydrochloride
(Xylaject 2%; Adwia, Egypt), diluted in 5 ml of sterile
saline, was administered into the epidural space to
induce adequate analgesia of the perineal region.
Surgical repair was conducted after aseptic
preparation of the perineal area.
Fig. 2. Urethral dilatation in the prescrotal area (white

arrows).
Calves with perineal urethral dilatation were randomly

classified into two groups; group-I (n= 4) and group-II
(n= 6), which were then treated by perineal Fig. 3. (a) Intraoperative view of the dissected dilated
urethrostomy or partial penile transection (including urethra; (b) Identification of the retractor penis muscle.
the dilated urethra) and urethral fistulation,
respectively. While, calves in group-III (n= 2) with Group I
prescrotal urethral dilatation were treated by penile Urethrostomy was performed through a mid-line skin
transection (amputation). incision at the distal end of the swelling. The enlarged
Data collected included signalment, anamnesis, urethral cavity was exposed by blunt dissection. The
physical and clinical examination findings including wall of the urethra was incised and the mucosa of the
107
________________________________________________________________________________________________________
dilated urethra was sutured to the skin with single # 1 supramid, completing the perineal urethrostomy
interrupted sutures (Supramid #1 or 2). procedure.
Finally, the urethral cavity was flushed with A 10-12 gauge urinary catheter was passed into the
physiological saline to remove any debris. urinary bladder through this orifice and fixed laterally
Postoperative treatment included IM injection of 7 to skin in a single interrupted pattern using # 0
mg/kg long acting amoxicillin (Amoxinject LA, supramid. After emptying the urinary bladder it was
Bremer Pharma GMBH, Germany), and daily cleaning irrigated several times with a warm solution of 0.9%
and/or flushing of the urethral orifice with povidone saline. To obliterate the dead space below the
iodine solution. swelling, the perineal incision was closed using
subcutaneous appositional simple sutures of
#1chromic catgut and skin sutures of # 2supramid
placed in a simple pattern (Figure 4).
All animals were given ethamsylate 250 mg IV
(Dicynone®, Minapharm Pharmaceutical Co., Egypt)
20 minutes prior to the surgery to control bleeding
from the surgical site, Ringer’s solution (a total of 3 -
4 L IV) during surgery, and long acting amoxicillin 7
mg/kg IM (Amoxinject LA, Bremer Pharma GMBH,
Germany) and 2.2 mg/kg IV flunixin meglumine
(Flunixin Injection, Norbrook Laboratories Limited,
NEWRY, Co. down, Northen Ireland) after
completion of the surgery. The resected specimens
were fixed in 10% formalin and submitted for
histological examination. All calves were discharged
the same day with instructions to the owner to
continue anti-inflammatory treatment for a further 4
days and to have the sutures removed on day 14 under
veterinary supervision.
Group III
Fig. 4. One week post-operation in a calf which underwent
A midline incision, 10-15 cm long was made in the
partial penile transection.
perineal region ventral to the anus and extended
ventrally toward the scrotum. The incision was
Group II deepened through the subcutaneous and dense
A 25-30 cm vertical midline skin incision was made, connective tissue between the semimembranosus
extending from 5 cm ventral to the anus to 10 cm muscles until the paired retractor penis muscles and
proximal to the scrotum, after which blunt dissection penis were identified. The penis was then grasped,
was used to separate the firm fibrous walled and traced caudally and dorsally and dissected from the
hollow structures from the body wall. The retractor surrounding tissue.
penis muscles, identified caudal to the perineal sac Once the penis was exteriorized, the retractor penis
(Figure 3), were resected from the region over the muscles were ligated and transected as far proximally
perineal swelling. as possible. The dorsal vessels of the penis were also
The sac was firmly attached to the underlying bluntly dissected and preserved. The penis was
musculature cranially, and muscle fibers of the transected about 5 cm distal to the dorsal part of the
ischiocavernous were identified passing obliquely skin incision. The distal stump of the penis was
from the proximal part of the sac onto the caudal reduced with intact dorsal vessels, meanwhile the
ischial musculature and fascia. proximal penile stump was fixed to the skin using
The perineal sac was then transected at its origin and horizontal mattress suture surrounding and ligating the
termination, and dissection separated its attachments corpus cavernosum.
to the perineal raphè. The penis distal to and Finally the incision above and below the penile stump
contiguous with the sac was ligated with single was closed with continuous suture pattern using #
encircling suture of # 2 supramid at two points 2supramid. Aftercare was made in the same manner as
proximal to the sigmoid flexure and was transected in group (I).
between these sutures. The proximal attachment of the Follow-up
sac was transected 2-5 cm distal to the caudal portion Follow-up information was obtained via telephone
of the pelvic urethra. The edges of the sac were contact with veterinarians and owners at least 6
sutured to the skin in a single interrupted pattern using months after surgery.
108
________________________________________________________________________________________________________
Results The echogenic pattern of the urethra was interrupted
Animals by swirling points due to the presence of numerous
All the calves were crossbred intact males. The erythrocytes in the urine - salbuminous appearance of
average age at presentation was 9.1± 1.69 months urine - not caused by erythrocytes. Numerous irregular
(range: 7 months to 12 months). Average body weight hyperechoic masses, consistent with fibrin strands,
was 98.3± 21.46 kg (range, 70–130 kg). were visualized floating within the fluid in 4 cases
History and clinical evaluation (4/12) (Figure 7).
The history of 8 (66.6%) cases indicated that the
swellings were noticed by the owner for a period of 4
days to 6 weeks. The remaining cases (n= 4) were
recently purchased from the market; consequently, the
time of disease onset was unknown. Stranguria has
been observed in all cases.
Clinical examination revealed that all affected calves
were alert and with a fair body condition, with normal
rectal temperature, pulse, and respiration. Firm,
irreducible, and fluctuant swellings (10-20 cm in
diameter) were palpated either in the mid-perineal
region ventral to the anus extending ventrally to the
scrotum or in the ventral surface of the penile urethra
2 cm caudal to the preputial orifice and extending
caudally towards but not involving the scrotum.
The calves had no signs of discomfort during
micturition or palpation of the enlargement. Urine
dripped intermittently from the prepuce and palpation
of the swelling caused urine to dribble excessively Fig. 5. Ultrasound image of a calf with a dilated penile
from the preputial orifice. urethra containing anechoic and hypoechoic materials.
Stimulation of micturition caused an obvious Notice the thickened urethral wall.
distension of the swelling that was followed by
continuous passive dribbling of turbid white yellow
colored urine. In 4 (33.3%) cases, mucous strands
were seen mixed with the urine. Ultrasound
examination per rectum revealed moderate distension
of the urinary bladder.
The main hematological and biochemical values were
within normal physiological limits (despite masses of
white blood cells in the aspirated fluid). Aseptic fine
needle aspiration of the swellings yielded a large
volume (200-400 ml) of clear yellow fluid that had
ammoniacal or urineferous odor. Masses of white
blood cells, few red cells, a few cocci, calcium
phosphate crystals, and strands of mucous were
observed in the cytological examination of the urine. Fig. 6. Ultrasound image of a calf with a dilated penile
Ultrasonographic findings urethra. (A) The caudo-cranial diameter is 75 mm and (B)
Ultrasonography revealed that the urinary bladder was latero-lateral diameter is 32 mm. Notice the thickened
both intra-pelvic and intra-abdominal with the neck urethral wall.
being located at the caudal border of the ischium. In
eight cases, the bladder and bladder wall thickness A marked thickening of the urethral wall (urethritis)
were normal. was observed in all animals. The average urethral wall
Cystitis was diagnosed in 4 (33.3%) cases, in which thickness was 1.04±0.27 mm. In three animals (3/12),
the wall of the bladder was thickened, and the urine an irregular mucosal surface was also noted (Figure
was turbid. The main ultrasonographic findings were 8). In all cases, ultrasound examination of the right
oval shaped dilatation of the urethra in all animals kindney showed no abnormal findings.
with dimensions of 40-75 X 30-62 mm. The contents Surgical treatment
appeared anechoic and hypoechoic in every direction Primary repair of urethral dilatation was performed by
(Figures 5 and 6). perineal urethrostomy (n= 4), partial penile
109
________________________________________________________________________________________________________
transaction, including the dilated urethra and urethral Bleeding and disruption of the soft tissue were
fistulation (n= 6) and penile transaction distal to the extensive in the partial penile resection technique
dilatation site (n= 2). when compared to the other methods. With respect to
the cost of surgery and aftercare, it was found that the
cost of urethrostomy was less than the cost of penile
transection; meanwhile the cost of its aftercare was
twice that of the penile transection procedures.
Fig. 9. The resected penile urethra showing muscle and

adipose tissue adhered to the urethral wall.
Fig. 7. Dilated urethra containing hypoechoic and echoic

material consistent with fibrin strands.
Fig. 10. The excised penile urethra showing the narrow and
dilated segments of the urethra. Accumulation of mucous
threads were observed inside the urethral dilatation (white
arrow).
Fig. 8. Sonogram of dilated penile urethra (the caudo-cranial

diameter is 77 mm) obtained from a calf with necrotizing
urethritis. Notice the marked thickening of the urethral wall
and irregular mucosal surface.
Average duration of surgery was 31.75 ± 6.23 minutes

(range, 20–45 minutes), 88, 00 ± 13.03 (range, 70–100
minutes), and 45.00 ±7.07 (range, 40–50 minutes),
respectively. The resected specimens were dilated,
empty pouch, narrowing at both ends of its 25-30 cm Fig. 11. The excised penile urethra showing a necrotic
length (Figure 9). mucosal surface.
An accumulation of urine mixed with blood, debris,
mucous threads or pus was observed inside the Outcome
urethral dilatation during surgery and post resection Follow up of all cases was done via phone calls to the
(Figure 10). In three animals, the urethral mucosa was referred veterinarian. The recovery period ranged from
almost necrotic and a pseudodiphtheritic membrane 10 to 18 days (average, 12.9 ±3.2 days). The calves
was present (Figure 11). were discharged on the same day. No postoperative
From a technical point of view, the surgical complications were observed in groups II and III.
interventions were quickly and easily performed in Cystitis and stricture of the urethra were recorded for
both the urethrostomy and penile transection groups. two of the calves that underwent perineal
110
________________________________________________________________________________________________________
urethrostomy. These calves were readmitted to the ascending infections. Making a precise diagnosis in
clinic 2 months after discharge and recovered the field is of great interest as it permits rapid decision
following widening of the urethrostomy fistula. making regarding treatment options and avoids
Ten animals were slaughtered at normal body weights wasteful supportive treatments in the case of a low-
approximately 6-8 months later. Two animals (group value animal.
I) were slaughtered after approximately three to four Centesis of the dilated mass under aseptic conditions
months because of an inadequate weight gains. is often a simple but effective diagnostic aid. In this
Discussion study the material obtained by centesis of the urethral
Perineal urethral dilatations in calves encountered in swelling was urine, usually mixed with blood and
the current investigation were similar to those other debris. The debris indicated the presence of
described by previous workers (Johnson et al., 1980; inflammation and/or infection of the urinary tract.
Weaver et al., 1992; Anderson et al., 1993; Gasthyus Urinary tract diagnostic imaging techniques such as
et al., 1996; Geccelep and Alkan, 2000; Sedeek and plain radiography, contrast urethrogram, intravenous
Bakr, 2009). The occurrence of this lesion in the urogram and ultrasonography, can be used to confirm
prescrotal urethra appears to be the first report of this the involvement of the urinary tract (Karrass et al.,
case in calves. 1992).
Urethral dilatation is observed at the proximal The margins of the perineal swelling were easily
perineum in heifers and adults, and emerges as a result determined by ultrasonography, also enabling the
of transient urethral obstruction, or much less diagnosis of its contents.
frequently due to bacterial urethritis of the lower Braun (1993) mentioned that it is rarely necessary to
urinary tract (Karrass et al., 1992; Gasthyus et al., anaesthetize animals for ultrasound examination. The
1996). Congenital defects of the urinary tract are not findings of the present study match the previous
common in farm animals (Dennis and Leipold, 1979). suggestions because ultrasound examination was done
Urethral dilatation is a rare congenital or for all cases with the animals in standing position and
developmental malformation of the urethra in without sedation. Ultrasound measurements of the
domestic mammals. Megalourethra is uncommon in wall thickness of the urinary bladder and urethra were
male human neonates and is characterized by a claimed to be useful method to determine the increase
dilatation of the penile urethra, a poor urine stream, in the wall thickness in cases of cystitis and urethritis
and infection of the distal urethra without the evidence (Hoque et al., 2002).
of urethral stricture (Nesbitt, 1954; Schrom et al., In present study, ultrasound examination was helpful
1981). Megalourethra has been reported in a male in measuring the thickness of the urinary bladder and
Charolais calf (Weaver et al., 1992). the urethral wall in four cases of cystitis and in all
The etiology of megalourethra is currently unknown in cases of urethritis. Calves with urethral dilatation
both animals and human beings. Urethral dilatation frequently have common history and physical
related to transient urethral obstruction or examination findings. The clinical findings in the
developmental abnormality has been reported in 7 present study were in agreement with those of other
juvenile male cattle (Gasthyus et al., 1996). The later reports (Tharp and Venzke, 1954; Johnson et al.,
observation of urethral swelling by the owners in this 1980; Anderson et al., 1993; Gasthyus et al., 1996;
study, suggests that the condition was developmental. Sedeek and Bakr, 2009).
All the animals were crossbred bulls. The The main observation in all animals was a fluctuant
preponderance of this breed was probably due to the swelling in the perineal or prescrotal regions. The
popularity of these animals in Egypt. Urethral differential diagnoses of perineal and prescrotal
dilatation has been reported in Holstein-Friesian swelling include haematoma or abscess; retroflexion
(Tharp and Venzke, 1954), Hereford (Anderson et al., of the urinary bladder; congenital urethral
1993), Charolais (Weaver et al., 1992) and double- abnormality; pathological urethral diverticulum or
muscled Belgian blue bulls (Gasthyus et al., 1996). dilatation; and urethral rupture (Weaver et al., 1992).
Because most of the animals were reported to have Centesis of the fluctuant masses eliminated the first
had micturition problems and debris, mucous threads two possibilities. Retroflexion of the bladder was
and/or pus were often found during surgery, the considered unlikely for anatomical reasons and also
urethral dilatation might have been due to an earlier because it was likely to result in complete retention of
partial urethral obstruction distal to the dilated area. urine and severe tenesmus as seen in perineal hernia in
As a result of repetitive partial obstruction a gradual the canine males (Canfield and Bellinger, 1985).
increase in the pressure in the urethral canal can occur, Retroflexion was definitively eliminated as a
leading to a proximal dilatation (Gasthyus et al., differential diagnosis when tranrectal ultrasonography
1996). Dilatation of the urethra is accompanied by revealed the normal position of the urinary bladder in
urinary stasis which results in bacterial urethritis from the pelvic and abdominal cavities.
111
________________________________________________________________________________________________________
Ultrasonographic examination revealed an intact procedure, urethral scarring, and predisposition for re-
urethra in all cases, excluding urethral rupture. obstruction (Harari, 2003), pooling of urine
Although general anesthesia is commonly used in caudoventral to the ventral commisure of the
cattle in hospital settings, there are some risks urethrostomy with continuous irritation of the skin
associated with its use (Edmondson, 2008). Local or around the stoma and formation of granulation tissue;
regional anesthesia is safe and effective, and is still the and finally the direct contact of the two edges of the
most desirable procedure in many situations. In the wound via pressure of the medial aspect of the thighs.
present study, all the surgical interventions were On the contrary, partial penile transaction was not
performed in the standing animal under the influence associated with stenosis despite being more invasive.
of epidural analgesia. Decreased stenosis may be due to the higher position
The epidural administration of alpha-2 agonists such of the created stoma (directly under anus) and the
as xylazine hydrochloride (St Jean et al., 1990) was an fixation of a urinary catheter at this position that
effective analgesic technique for the surgeries prevented direct contact of wound edges and
described. Surgery has been suggested by many accumulation of urine at the ventral commisure.
authors as the standard treatment for urethral dilatation Conclusions
in calves (Karrass et al., 1992; Gasthyus et al., 1996). Ultrasound examination was found to be a useful non-
Conservative treatment described in one report invasive diagnostic technique for cases of urethral
(Anderson et al., 1993) was hard to justify in this dilatation in bovine calves. This is the first report that
study because of the problems with micturition. describes the prescrotal urethral dilatations in calves.
Different surgical techniques including urethrotomy or Partial penile transection can be an effective and
partial penile transection have been reported to be satisfactory surgical treatment for urethral dilatation in
successful in the management of urethral dilatation in bovine calves. Generally this technique minimizes the
calves. The reported success rate of surgical treatment risk of postoperative complications and yields
by urethrostomy varied from 37.5 to 100% (Tharp and improved outcomes, compared with urethrostomy.
Venzke, 1954; Gasthyus et al., 1996; Sedeek and ___________________________________________
Bakr, 2009). Whereas the reported success rate of References
partial penile transection was 100% (Weaver et al., Anderson, E.A., Wallace, C.E., Williamson, L. and
1992; Sedeek and Bakr, 2009). Similar findings were Mahaffey, M.B. 1993. Urethral recess dilatation in
shown in this investigation where the success rates of a Charolais-cross bull calf. Can. Vet. J. 34, 234-
urethrostomy and partial penile transection was 50% 235.
and 100%, respectively. Braun, U. 1991. Ultrasonographic examination of the
Our study suggests that the urethrostomy technique right kidney in cows. Am. J. Vet. Res. 52, 1933-
takes shorter time than the partial penile amputation 1939.
technique. This is likely to be related to the Braun, U. 1993. Ultrasonographic examination of the
complexity of the different surgical procedures. left kidney, the urinary bladder, and the urethra in
Severe bleeding in partial penile transaction, cows. Zentralblatt für Veterinärmedizin. 40, 1-9.
haemorrhage control may explain the prolonged Canfield, R.B. and Bellinger, C.R., 1985. Perineal
surgical times, despite pre-surgical injection of a hernia. In: Slatter, D.H. (Eds ), Textbook of Small
haemostatic drug. Subsequently, this technique is Animal Surgery. Saunders, Philadelphia,
potentially more expensive than urethrostomy, Pennsylvania.
although at our clinic the price for each surgery was Dennis, S.M. and Leipold, H.W. 1979. Ovine
similar. The observed complications in the congenital defects. Vet. Bull. 49, 233-239.
urethrostomy group agree with that reported Edmondson, M.A. 2008. Local and regional
previously (Anderson et al., 1993; Gasthyus et al., anesthesia in cattle. Vet. Clin. North Am. Food
1996). However, no complications were observed in Anim. Pract. 24, 211-226.
the penile transection groups. Gasthyus, F., Martens, A. and De Moor, A. 1996.
The higher incidence of cystitis in urethrostomy group Surgical treatment of urethral dilatation in seven
might be related to pooling of urine caudoventral to male cattle. Vet. Rec. 138, 17-19.
the ventral commisure of the urethrostomy opening. Geccelep, M. and Alkan, I. 2000. Congenital urethral
Stricture of the urethrostomy opening is a common dilatation in a male montaphon calf Case report.
complication of urethrostomy that may require re- Israel J. Vet. Med. 55, 243-246.
widening multiple times for establishment of a stoma, Harari, O. 2003. Tube cystotomy for treatment of
but generally it has limited success rate (Haven et al., urethral calculi and obstruction in pet pigs. Israel J.
1993; Van Metre et al., 1996). In the present study, Vet. Med. 58, 109-111.
stricture was recorded in two calves and may be due to Haven, M.L., Bowman, K.F., Engelbert, T.A. and
many factors including: the invasive nature of the Blikslager, A.T. 1993. Surgical management of
112
________________________________________________________________________________________________________
urolithiasis in small ruminants. Cornell Vet. 83, J.F. and Hague, B.A. 1998. Incomplete urethral
47-55. obstruction associated with dilatation of the
Hoque, M., Somvannnshi, R., Singh, G.R. and Mogha, urethra, cystitis, and pyelonephritis in a
I.V. 2002. Ultrasonographic evaluation of urinary Vietnamese pot-bellied pig. J. Am. Vet. Med.
bladder in normal, fern fed and enzootic bovine Assoc. 212, 262-264.
haematuria-affected cattle. J. Vet. Med. A. Physiol. Schrom, S.H., Cromie, W.J. and Duckett, J.W. 1981.
Clin. Med. 49, 403-407. Megalourethra. Urol. 17, 152-156.
Johnson, E.H., Nyack, B. and Johnson, R. 1980. Sisson, S. and Grossman, J.D. 1975. Equine urogenital
Urethral dilatation in a steer: a case report. Vet. system. In: Getty, R. (Eds.), The anatomy of the
Med. Small Anim. Clin. 75, 1429-1431. domestic animals. 5th edn. Saunders, Philadelphia.
Karrass, S., Modransky, P. and Welker, B. 1992. pp: 524-533.
Surgical correction of urethral dilatation in an St Jean, G., Skarda, R.T., Muir, W. and Hoffsis, G.F.
intersex goat. J. Am. Vet. Med. Assoc. 201, 1990. Caudal analgesia induced by xylazine
1584- 1586. administration in cows. Am. J. Vet. Res. 51, 1232-
Kester, R.R., Mooppan, U.M., Ohm, H.K. and Kim, 1236.
H. 1990. Congenital megalourethra. J. Urol. 143, Tharp, V.L. and Venzke, W.G. 1954. Dilatation of
1213-1215. the urethra in a bull. J. Am. Vet .Med. Assoc. 124,
Nesbitt, T.E. 1954. Congenital megalo-urethra. 269.
Postgrad. Semin. Am. Urol. Assoc. North Cent. Van Metre, D., Fecteau, G., House, J.K. and George,
117-119. L.W. 1996. Obstructive urolithiasis in ruminants:
Sedeek, A.M. and Bakr, H.A. 2009. Comparison surgical management and prevention. Compend.
between urethrostomy and penile resection for Cont. Educ. Pract. Vet. 18, 275-289.
treatment of congenital penile urethral dilatation in Weaver, A.D., Johnson, G.C. and Hill, J. 1992.
calves. Beni-Suef Vet. Med. J. 190, 1-6. Congenital megalourethra in a male Charolais calf.
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113
Hindawi Publishing Corporation
Journal of Veterinary Medicine
Volume 2013, Article ID 891413, 8 pages
http://dx.doi.org/10.1155/2013/891413
Research Article
Surgical Management of Penile and Preputial Neoplasms in
Equine with Special Reference to Partial Phallectomy
Awad Rizk,1 Esam Mosbah,1 Gamal Karrouf,1,2 and Mohamed Abou Alsoud3
1
Surgery, Anaesthesiology and Radiology Department, Faculty of Veterinary Medicine, Mansoura University,
Mansoura, 35516 Dakahlia, Egypt
2
King Fahd Medical Research Center, King Abdulaziz University, 21589 Jeddah, Saudi Arabia
3
Biology Science Department, King Abdulaziz University, 21589 Jeddah, Saudi Arabia
Correspondence should be addressed to Awad Rizk; awad [email protected]
Received 18 May 2013; Revised 28 July 2013; Accepted 29 July 2013
Academic Editor: Masanori Tohno
Copyright © 2013 Awad Rizk et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Penile and preputial neoplasia in horses occurs infrequently and represents diagnostic and therapeutic challenges. The present study
was carried out on a total number of 21 equids (14 stallions and 7 donkeys) suffered from different penile and preputial neoplasia.
Diagnosis of neoplasms was based up on history of the case, clinical examination as well as histopathological evaluation. Animals
with penile and preputial neoplasms were underwent local excision and partial phallectomy with a slightly modified version of the
techniques described by William’s. The diagnosed neoplasms were penile and preputial squamous cell carcinomas (SCCs; 𝑛 = 15);
sarcoid (𝑛 = 4); a-fibrosarcoma; and a melanoma. Local excision was curative in all cases except 5 stallions with SCCs. These stallions
had extensive damage of the glans penis, free part of the penis and the inner lamina of the internal fold of the prepuce, and they
underwent a partial phallectomy with successful outcome. Follow-up information was obtained by visit and telephone inquiries.
In conclusion, penile and preputial neoplasms are commonly encountered in elderly male horses and SCCs are the most common
type affecting male external genitalia. Partial phallectomy is effective for management of equine neoplasia if they are confined to
the glans and body of the penis and there is no proximal spread or involvement to regional lymph nodes.
1. Introduction metastasize to regional lymph nodes if not treated aggres-

sively. Recurrence after surgical excision can be expected in
Penile and preputial neoplasia is more prevalent in equine 17–25% of cases [2, 4, 5]. Long-standing SCCs can interfere
than in other domestic animals; they occupied about 6 and with coitus or normal protrusion and retraction of the penis
10% of all neoplasms in equine [1, 2]. Squamous cell car- and most penile SCCs involve the glans penis (53–80%) [4, 11,
cinomas (SCCs) are the most common form of penile and 12].
preputial neoplasia [3–5]; however sarcoids, squamous cell Fibrosarcoma is a malignant tumor derived from fibrous
papillomas, melanomas, fibromas, fibrosarcoma, and hae- connective tissue and characterized by immature proliferat-
mangiomas have been reported [3, 4, 6, 7]. Penile and/or pre- ing fibroblasts or undifferentiated anaplastic spindle cells. It
putial neoplasia can cause discomfort and in advanced cases is unusual mesenchymal tumor in male genitalia of man [13],
can result in systemic disease [8–10]. horse [4], and cattle [14].
SCCs are the commonest neoplasm involving the penis, Equine sarcoid is a locally aggressive, fibroblastic skin
prepuce, or both [6]. It represents 20% of all equine tumours, tumour, which can appear as a flat or cauliflower-like growth
making it the second most common tumour in horses. It is a either singularly or multiple growths, usually in young horses
malignant tumour mainly affecting adult horses [5, 6, 11, 12]. [15]. Sarcoids have been clinically categorized into several
SCCs of the penis and prepuce are locally invasive but usually groups including verrucous, fibroblastic, mixed verrucous
show only low-grade malignancy [2]. These tumours may and fibroblastic, occult, nodular, and malevolent. Some of
2 Journal of Veterinary Medicine
Table 1: Showing type, breed, number, and percentage of penile (𝑛 = examination of each mass including location, size, age as well
11) and preputial (𝑛 = 10) neoplasms in stallion (𝑛 = 14) and Jack as histopathological examinations.
donkey (𝑛 = 7).
Penis Prepuce 2.1. Clinical Examination. Clinical examination was per-

Types Total % formed of the penis and prepuce. Examination of the penis
Stallion Jack Stallion Jack
SCCs 6 3 4 2 15 71.4
itself and the internal fold of the prepuce required sedation
with intravenous detomidine 1% (Domosedan, Pfizer) in a
Fibrosarcoma 1 — — — 1 4.7
dose of 0.01 mg/kg. body weight. Superficial inguinal lymph
Sarcoid 1 — 1 2 4 19.2 nodes were examined.
Melanoma — — 1 — 1 4.7
Total number 8 3 6 4 21 100
2.2. Surgical Intervention. Each animal was held off feed
for 12 hrs preoperatively and received procaine penicillin
(22,000 IU/kg, IM) and phenylbutazone (2.2 mg/kg, IV;
Phenyloject, Adwia, Egypt) prior to general anesthesia.
these subtypes can occur with any frequency on the equine Anesthesia was induced and maintained by infusion of a
penis and prepuce [15–17]. freshly prepared mixture of 3 mg medetomidine (3 𝜇g/mL),
Melanocytic tumours have been reported to affect all 40 mg midazolam (0.04 mg/mL) and 2 gm ketamine
parts of the penis and prepuce other than the glans [4, 9, (2 mg/mL) dissolved in 1 liter of dextrose 5% in animals
16]. Malignant melanomas were seen predominantly in older either underwent local excision or partial phallectomy.
nongrey horses and melanocytic nevi occurred in young
horses of all coat colours [7, 16].
2.3. Local Excision. The observed lesions were surgically
Recently, a standard protocol has been proposed to aid
resected through a wide surgical excision in the surrounding
treatment selection of horses with penile and preputial tum-
healthy tissues by 1-2 cm. Two Penrose drains were placed,
ours. Treatments were ranged from minimally invasive inter-
exiting the incision laterally. Primary closure of the incision
ventions (e.g., topical use of 5-fluorouracil) to radical surgery
was accomplished using a series of interrupted vertical mat-
[2]. Surgical modalities include local excision, segmental
tress sutures using prolene (Braun-Aesculap, Tuttlingen, Ger-
posthioplasty, partial phallectomy, partial phallectomy and
many) no. 0 and appositional sutures (simple interrupted).
sheath ablation, and en bloc penile and preputial resection
with penile retroversion [2, 18–21].
Local excision is indicated to remove small, solitary 2.4. Partial Phallectomy with a Modified Williams’s [24]
tumours, such as focal SCCs, squamous papilloma, and Technique. This modified technique was performed in five
sarcoid, where there is no evidence of metastasis to regional stallions diagnosed SCCs at the glans penis (3 horses), free
lymph nodes or invasion to deeper structures. Local excision part of the penis, and the inner lamina of the internal fold of
is usually curative for horses with melanocytic nevi and the prepuce (2 horses).
solitary dermal melanomas [22, 23]. Horses were positioned in dorsal recumbency. A catheter
Partial phallectomy, such as Scott’s, Williams’, or Vinsot’s was placed in the urethra and advanced into the bladder as a
techniques, is indicated only if the distal portion of the penis guide to aid in dissection of the urethra and to evacuate urine
(the glans and shaft of the penis) is involved and there is no at the end of the procedure. Soft-roll gauze was used to tie the
proximal spread and without involvement of the prepuce and free part of the penis to an overhead support to facilitate asep-
regional lymph nodes [4, 5]. Involvement of prepuce, urethra, tic preparation. The glans and proximal free part of the penis
and cavernous tissue are indications for performing more were covered in a sterile bandage. A latex tourniquet was
radical surgery [21]. placed proximal to preputial ring. The penis, prepuce, and the
The present study aimed to examine various types of surrounding ventral abdomen were aseptically prepared and
penile and preputial neoplasia in horses and donkeys in our the area was draped.
region and investigate the results of the surgical intervention A triangular incision (base 3 cms and sides 5 cms) was
using a modified version of Williams’s technique for partial made through the penile skin on the ventral midline of the
phallectomy. penis, with the apex pointing in a proximal direction. The
base of the triangle was proximal to corona glandis and it
was the site of penile transection. This triangle was bluntly
2. Materials and Methods dissected. A longitudinal incision was made into the urethra
from the apex to the base of the triangle. The incised edges of
The present study was carried out on a total number of 21 the urethral mucosa were opposed to the epithelial edges of
equids (14 horses and 7 donkeys) and diagnosed different the sides of the triangle with simple continuous sutures (Fig-
penile and preputial neoplasia (Tables 1 and 2). These animals ure 1(b)) using polydiaxanone no. 0 (PDS, Braun-Aesculap,
were admitted to Mansoura Veterinary Teaching Hospital Tuttlingen, Germany). The base of the triangle was left unsu-
of the Faculty of Veterinary Medicine, Mansoura University, tured. The urethral catheter was removed, and the penis was
Mansoura, Egypt. The age was ranged from 4 to 12 years obliquely transected at the base of the triangle in a craniodor-
old for horses and 2 to 10 years old for donkeys (Table 2). sal direction (Figure 1(c)). The tunica albuginea of the dorsum
Diagnosis was based on history of the case and clinical of the corpus cavernosum penis was sutured to the tunical
Journal of Veterinary Medicine 3
Table 2: Showing a patient data including animal species, age, tumour types, treatment, recurrence, followup, second treatment, second
recurrence, and followup of penile (𝑛 = 11) and preputial (𝑛 = 10) neoplasms in stallion (𝑛 = 14) and Jack donkey (𝑛 = 7).
Animal Age Penile or Tumor Second

Subject Treatment Recurrence Followup Recurrence Followup
type (year) preputial type treatment
1 H 6 Pre Me Loc No 12 Mo — — —
2 D 4 Pe SCC Loc No 12 Mo — — —
3 H 6 Pe SCC Wil Yes 5 Mo Loc No 12 Mo
5 H 10 Pe SCC Wil Yes 7 Mo Loc No 12 Mo
6 D 5 pr Sarcoid Loc No 8 Mo — — —
7 H 11 Pr SCC Wil No 12 Mo — — —
8 H 11 Pr SCC Loc No 12 Mo — — —
9 H 9 Pe Fib Loc No 13 Mo — — —
11 H 11 Pr SCC Loc No 10 Mo — — —
12 D 2 Pr Sarcoid Loc Yes 3 Mo Loc No 9 Mo
13 H 12 Pr SCC Loc Yes 3 Mo Loc No 16 Mo
14 H 8 Pr SCC Wil No 14 Mo — — —
15 H 9 Pe SCC Loc No 16 Mo — — —
16 H 12 Pe SCC Wil No 8 Mo — — —
18 H 11 Pe SCC Loc Yes 3 Mo Loc No 9 Mo
19 H 4 Pe Sarcoid Loc No 6 Mo — — —
21 H 3 Pr Sarcoid Loc No 12 Mo — — —
H: horse, D: donkey, Loc: local excision, Wil: Williams, Pe: penile, Pr: preputial, Fib: fibrosarcoma, Me: melanoma, Mo: Month.
(a) (b)
(c) (d)
Figure 1: Cauliflower-like SCC at the glans penis of horse (white arrow). The incised edges of the urethral mucosa were opposed to the
epithelial edges of the sides of the triangle with simple continuous suture (white arrow; b). Stroma of partial phallectomy (c). Histological
structure of SCCs showing small aggregates, irregular islands, and nests of neoplastic keratinocytes (black arrow) that proliferate downward
from the epidermis and invade the subepithelial stroma of the dermis (H & E ×400).
albuginea of the urethral groove with equidistant simple months after surgery. Surgical excision was performed in the
interrupted sutures using PDS no 0. The urethral mucosa two cases for a second time with successful recovery without
was sutured to the penile epithelium with simple interrupted recurrence 9 months and 16 months after surgery.
sutures using the same suture material. Open covered castra- Penile fibrosarcoma was diagnosed in a stallion repre-
tion was performed in these 5 stallions at the same time of senting 4.7% of the total neoplastic cases. Examination of the
surgery. penis revealed a large ulcerated soft tissue mass on the shaft of
the penis. Microscopically, tumor cells showed mesenchymal
2.5. Postoperative Care. The preoperative antibiotic and anti- origin characterized by spindle cells in nodular whorls or
inflammatory were continued for 5 days. A prophylactic dose streams and bundles, high nuclear to cytoplasm ratio, and
of antitetanic serum was injected. Wound dressing using oddly shaped large nuclei, without inflammatory component
povidone iodine was performed twice daily. Animals were and necrosis. Successful outcome was obtained after local
confined to a stall without exercise for 5 days after surgery. excision without recurrence 13 months after surgery. Penile
and preputial sarcoids were detected in 2 donkeys and 2
horses with an average age (2–5 years) and representing
2.6. Histopathological Examination. Samples of the excised
19.2% of the total neoplastic cases. They appeared singular
masses were fixed in neutral buffered formalin 10%. The
or multiple cauliflower like growths (Figures 2(a), 2(b) and
specimens were sectioned at 5 microns, stained with hema-
2(c)). Microscopically, there was a classical streaming and
toxylene and eosine according to Bancroft et al. [25].
interlacing spindle cell population, and “picketfence” appear-
ance, at the epithelial interface, and long, thin, dissecting rete
2.7. Long-Term Followup. Follow-up information was ridges are typical characteristic features to equine sarcoids
obtained by visit and telephone inquiries. Owners were (Figure 2(d)). Three operated animals showed no recurrence
questioned as to the horse’s general health status, recurrence of the masses after local excision while one donkey showed
of masses, complications from the surgical procedure, and recurrence 3 months after surgery which appeared smaller in
the ability of the operated animals to urinate freely. size than the former one. Surgical excision was performed for
a second time with successful recovery without recurrence 9
3. Results months after surgery.
A case of melanoma was detected in one stallion with SCC
In the present study, 21 equids (14 horses and 7 donkeys) (the 2 neoplasms were in the same animal) who underwent
showed various types of penile and preputial neoplasms partial amputation of the penis. It appeared as a solitary, firm,
(Table 1). The diagnosed neoplasms were penile (𝑛 = 9) nodular, and hairless mass with intact skin at the prepuce
and preputial (𝑛 = 6) SCCs, penile fibrosarcoma (𝑛 = 1), (Figure 3(a)). The mass was surgically excised with successful
penile (𝑛 = 1) and preputial (𝑛 = 3) sarcoid, and preputial outcome without recurrence one year after surgery (Figures
melanoma (𝑛 = 1) which was detected in a stallion with SCCs 3(b) and 3(c)). Microscopically, the tumor characterized by
(the 2 neoplasms in the same animal) who underwent partial a variety of cell patterns ranging from sheets to streams
phallectomy (Table 2). and nests of melanocytes shifts the diagnosis to a melanotic
SCCs were detected in 15 equids representing 71.4% of the melanoma. Cell morphology varies from being epithelioid to
total recorded cases (Tables 1 and 2). The animals suffered spindle-shaped. Melanin pigmentation was mild and it was
nonhealing erosions and granulation tissue of the penile and seen interspersed between the tumour cells (Figure 3(d)).
preputial surfaces. The tumour appeared as a proliferative Postoperative oedema was observed in 3 animals oper-
cauliflower-like or solid mass (Figure 1(a)). Microscopically ated via partial phallectomy. It receded after 4 days and urina-
SCCs consisted of small aggregates, irregular islands, and tion was not impeded. Intermittent haemorrhage associated
nests of neoplastic keratinocytes that proliferate downward with urination was observed frequently 2 weeks after partial
from the epidermis and invade the subepithelial stroma of the phallectomy in one stallion, but it stopped spontaneously
dermis. Frequent findings include keratin formation, horn without the need for further surgery or any other specific
pearls, mitoses, and cellular atypia (Figure 1(d)). therapy.
Local excision was curative in 10 cases with SCCs. The
other five stallions showed 5-7 mm pedunculated masses
present on glans penis, 4 mm friable mass within the urethral 4. Discussion
fossa, and 5 mm mass located on the free part of the penis.
Preputial bleeding and an intense, pungent odour were found. Partial phallectomy is generally regarded as a salvage pro-
These 5 stallions underwent partial phallectomy with A mod- cedure in stallions for purposes other than breeding [26].
ified Williams technique. Good recovery without recurrence Various techniques of phallectomy have been described [24,
was obtained in three horses one year after surgery, while the 27–29]. With all of these cases a Williams’ technique was
other 2 horses showed regrowth of the neoplasia at the stump employed by creating a triangular rather than linear incision,
of the penis 5 and 7 months after surgery. Surgical excision and, positioning the base of the triangle distally, the risk of
was performed in the two cases for a second time with urethral stricture is reduced [24, 30]. The technique of partial
successful recovery without recurrence one year after surgery. phallectomy which is performed in this study was similar to
Two horses and one donkey had been treated by local that described by Williams [24], but, instead of apposing the
excision of the SCCs and showed regrowth of the neoplasia 3 incised edges of the urethral mucosa to the epithelial edges of
(a) (b)
(c) (d)
Figure 2: Fibroblastic sarcoid on the prepuce of a donkey (a & b). The mass after surgical excision (c). Micrograph for sarcoids in donkeys
showing hyperplasia of the epithelium, elongation of rete pegs, ulceration of the epithelium, inflammatory cell infiltration, and thrombosis
and fibromatous growth in the dermis (d) H & E., original magnification ×400.
(a) (b)
(c) (d)
Figure 3: Solitary, firm, nodular, and hairless melanotic melanoma (white arrow) at the prepuce of horse (a). The mass was surgically excised
(white arrow; b). The mass after surgical excision (c). Melanotic melanoma showing intracytoplasmic dense brownish black pigment (melanin)
which obscures the cellular details; besides, fibrous tissue trabeculae were seen among them (d) H & E, original magnification ×520.
the sides of the triangle with simple interrupted sutures, sim- interfere with coitus or normal protrusion and retraction of
ple continuous sutures were performed which incorporate the penis, and most penile SCCs involve the glans penis (53–
and compress the cavernous tissue of the corpus cavernosum 80%) [4, 11, 12]. Horses that present with penile or preputial
penis. In addition, instead of transection of the penis in a SCCs tend to be older, pony breeds [11, 12, 35].
craino-distal direction, the penis was obliquely transected at In this study, three horses that operated via a slightly mod-
the base of the triangle in a craniodorsal direction, so that the ified phallectomy were cured without incidence of recurrence
dorsum of the penile stump was longer than the ventrum. one year after surgery. While two cases showed a local recur-
Surgical intervention aims to remove lesions and ade- rence of the masses at the stump of the penis and tunica albu-
quate margins to reduce the risk of recurrence [2]. Partial genia, this may be due to that those horses were affected by a
phallectomy with or without retroversion has been described more advanced stage of disease at the time of surgery than
in the standing horse [29, 31] and avoids the costs and risks that was appreciated. This might have involved spread to
involved with general anesthesia [31]. It was not deemed inguinal lymph nodes or the presence of tumour in the penile
suitable for partial phallectomies in this study, due to the size or preputial tissues remaining after surgery. In none of these
and temperament of the horses, and the increased risk to the horses, the superficial lymph nodes were palpably enlarged at
surgeon and assistant. the time of surgery, suggesting that palpation of the lymph
Unsuccessful outcome (i.e., recurrence or incomplete nodes may not be effective in identifying early metastasis
removal) of SCCs treated by partial phallectomy is not [4, 5, 12]. These results were in agreement with that reported
uncommon (43.5%). This was possibly as a result of the limi- by [4, 5, 11, 12].
tation to the amount of tissue that can be removed combined Haemorrhage is frequently observed after phallectomy
with the frequent presence of the more proximal part of the especially during and immediately after urination [12, 37].
penis or the prepuce of premalignant tumors, such as papillo- The prevention of haemorrhage is important to reduce
mas that may subsequently transform to SCCs [5]. The annu- postoperative swelling and the risk of wound dehiscence. In
lus of the inner preputial fold is generally given as the anatom- this study, haemostasis was achieved by placing simple con-
ical border up to which phallectomy can be performed tinuous sutures through the tunica albuginea of the dorsum of
because of the risk of suture failure if more extensive tissue the corpus cavernosum penis and the tunica albuginea of the
removal is attempted. However, in some cases the primary urethral groove, for compressing the erectile bodies. The use
tumor may be too close to this anatomical landmark to allow of an elastrator and specialised latex tubing at the site of pro-
excision of an adequate margin [4, 5]. posed amputation was described [29], and it was left in situ
Two horses and one donkey treated via local excision of postoperatively, to prevent haemorrhage and produce necro-
the SCCs underwent a second surgery three months after the sis of the distal penis. This is likely to be an extremely painful
first surgery due to the regrowth of the mass. This was consis- procedure. Although haemorrhage may increase the risk of
tent with the finding of [4, 5]. Tumour recurrence is possible dehiscence, it is usually of minor significance [12, 37, 38].
when the surgeon fails to remove all neoplastic cells from the In this study, local excision of the smaller penile and
surgical site; therefore, wide surgical excision is recom- preputial neoplasms which are not invading the tunica albu-
mended. Primary closure is indicated, if possible. The prog- genia was considered the radical method of treatment. It is
nosis for complete recovery after local excision is excellent if economic, fast, and mostly curative. However, this sort of
adequate tissue margins are obtained [30]. treatment has a high risk of incomplete removal followed by
Castration of stallions several weeks before phallectomy is recurrence [4]. If the operation is performed earlier with a
advisable to help in modification of behavior [4, 16, 30, 32, 33]. wide safety margin, treatment may be satisfactory with good
In this study, animals that had been treated with partial prognosis; however, when the action happens later, the prog-
amputation of penis underwent open covered castration at nosis becomes poor due to large capacity of metastatic tumor
the same time of surgery. Penile and preputial neoplasia in and recurrence [4, 5].
horses occur infrequently, but they represent diagnostic and In this study, a case of fibrosarcoma was recorded on
therapeutic challenges because lesions can be present for a the body of the penis which is an uncommon tumor of the
considerable period before clinical signs are noted by owners external genitalia of male horses [4]. Van Den Top et al. [4]
[11]. The clinical signs of various types of penile tumours recorded such neoplasm on the external fold of the prepuce
are not specific and can result from the primary tumor of a horse.
or secondary inflammatory processes. Symptoms commonly Four animals in this study showed penile and preputial
include irregularities of the penile surface, sanguineous or sarcoids. In the surgically treated cases, 75% of the treated sar-
purulent discharge followed by disturbed micturition and coids (3 cases) did not recur throughout the time of followup.
edema of the prepuce. Other signs include skin excoriation, This was considered a satisfactory success rate. However,
frequent protrusion of the penis, and lameness assuming a this success rate could probably be due to the seat of the
wide-based stance [4, 25, 34, 35]. sarcoid on prepuce and removal of a wide margin of normal
SCCs appear as single or multiple, raised and ulcerated. tissues around the sarcoid to avoid the recurrence of the
Advanced lesions often appear as florid, cauliflower-like lesion. This was in agreement with previous results obtained
masses with areas of necrosis, ulceration, and hemorrhage. by [15, 39–41].
They are the most common form of penile and preputial Melanoma is a common, generally slow growing, locally
neoplasms in horses [36]. Recurrence of SCCs in the present invasive tumour, estimated to occur in approximately 80%
study after surgical excision is 20%. Long-standing SCCs can of ageing grey horses [9, 23]. Garvican et al. [9] reported a
series of cases of penile or preputial melanomas resulting in cell carcinoma in a gelding,” Equine Veterinary Education, vol.
systemic metastasis. There were metastases of other equine 20, no. 3, pp. 135–139, 2008.
penile neoplasia [12]. Our case appeared as solitary, firm, [11] S. Howarth, V. M. Lucke, and H. Pearson, “Squamous cell car-
nodular, and hairless mass with intact skin at the prepuce. cinoma of the equine external genitalia: a review and assessment
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report indicated a good recovery and the horse was in a good Equine Veterinary Journal, vol. 23, no. 1, pp. 53–58, 1991.
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TUGAS MATA KULIAH

ILMU BEDAH KHUSUS VETERINER

“TEKNIK OPERASI AMPUTASI PENIS”

1. Satria Aji Pratama 1609511087

LABORATORIUM BEDAH VETERINER

Surgery is a branch of veterinary medicine that has entered veterinary

Denpasar, 1 Oktober 2019

HALAMAN JUDUL .............................................................................................. i

Lampiran 1. A comparison of surgical Outcomes of Perineal Urethrostomy

1.1 Latar Belakang

1.2 Rumusan Masalah

2.1 Definisi Amputasi Penis

Dalam melakukan operasi amputasi penis hal-hal yang harus dipersiapkan

3.2 Teknik Operasi

Amputasi penis adalah tindakan pembedahan yang dilakukan untuk

HOBSON, H. P. (1990) Surgical procedures of the penis. In Current Techniques

Marzok, M.A. dkk. 2013. A comparison of surgical Outcomes of Perineal

R. D. Burrow. et al . (2014). Penile amputation and scrotal urethrostomy in 18

10.1136/vr.100039 | Veterinary Record | 1 of 8

2 of 8 | Veterinary Record | 10.1136/vr.100039

FIG 2: Idiopathic priapism and devitalised penis (case 16)

10.1136/vr.100039 | Veterinary Record | 3 of 8

not cleaned until after suture

4 of 8 | Veterinary Record | 10.1136/vr.100039

postoperative haemorrhage from the urethrostomy site for up to 21

10.1136/vr.100039 | Veterinary Record | 5 of 8

6 of 8 | Veterinary Record | 10.1136/vr.100039

Acknowledgements Multi-center, placebo-controlled, double-blind, randomized study of oral toceranib

10.1136/vr.100039 | Veterinary Record | 7 of 8

8 of 8 | Veterinary Record | 10.1136/vr.100039

Penile amputation and scrotal urethrostomy

Veterinary Record published online October 2, 2011

Updated information and services can be found at:

P<P Published online October 2, 2011 in advance of the print journal.

To request permissions go to:

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A comparison of surgical outcomes of perineal urethrostomy plus penile

Introduction Differential diagnoses include pathological perineal,

Fig. 2. Urethral dilatation in the prescrotal area (white

Calves with perineal urethral dilatation were randomly

Fig. 9. The resected penile urethra showing muscle and

Fig. 7. Dilated urethra containing hypoechoic and echoic

Fig. 8. Sonogram of dilated penile urethra (the caudo-cranial

Average duration of surgery was 31.75 ± 6.23 minutes

Correspondence should be addressed to Awad Rizk; awad [email protected]

Received 18 May 2013; Revised 28 July 2013; Accepted 29 July 2013

Academic Editor: Masanori Tohno

1. Introduction metastasize to regional lymph nodes if not treated aggres-

Penis Prepuce 2.1. Clinical Examination. Clinical examination was per-

Animal Age Penile or Tumor Second

standing horses,” Journal of the American Veterinary Medical

Veterinary Medicine The Scientific

International Journal of Journal of

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