Surgical affections of penis and sheath
Surgical affections of penis and sheath in animals are Hypospadias, Persistent penile frenulum, Fracture of os penis, Wounds of the penis, Strangulation of the penis, Paraphimosis, Phimosis, Prepucial hypoplasia, Posthitis, Prepucial tumors, Scrotal injuries, scrotal infection & scrotal tumors, Hypospadias, Penile tumors etc.
Surgical affections of penis and sheath are-
- Hypospadias
- Persistent penile frenulum
- Fracture of os penis
- Wounds of the penis
- Strangulation of the penis
- Paraphimosis
- Phimosis
- Prepucial hypoplasia
- Posthitis
- Prepucial tumors
- Scrotal injuries, scrotal infection & scrotal tumors
- Hypospadias
- Penile tumors
Surgical affections of penis and sheath
The genital system of male animals consists chiefly of the testicles or testes, accessory sex glands and the organ for copulation, the penis.
The tubular structures are the epididymus, vas deferens and urethra function as channels for the transport of the male gametes from the testicles into the female genital passage during coitus.
The testicles, normally present , are located within the scrotum as a pair in the inguinal region
In cats and pigs the scrotum is located in the perineal region below the anal opening.
The testicles produce male gametes and sex hormones -Leydig cells produce testosterone and Sertoli cells produce oestrogen. The accessory sex glands namely the prostate, the seminal vesicles and the bulbourethral or Cowper’s glands produce secretions that have a supportive role in the transport and well being of the male gametes as they are transferred from the male to the female animal.
The prostate is the only accessory sex gland in the male dog.
The urethra, extending from the neck of the urinary bladder to the tip of the penis, has the dual function of acting as a channel for the excretion of urine from the urinary bladder as well as the transfer of male gametes mixed with secretions of the accessory sex glands into the female genital tract.
Congenital or acquired conditions may affect the penis of companion animals.
Hypospadias
Hypospadias is a condition in which the failure of the urogenital folds to fuse ventrally resulting in an incomplete penile urethra. This is due to the fusion of the prepuce and underdevelopment of the penis. The urethra may open anywhere between the normal opening at the tip of the glans penis and the perineal region. Depending on the location of the urethral opening hypospadias may be glandular, penile, scrotal or perineal.
Surgical correction may not be required if there is free flow of urine But, if the urethral opening is not sufficiently large enough to allow free flow of urine the opening may be enlarged by suturing the urethral mucosa to the skin. Parts of the prepuce that interfere with the flow of urine may also be excised surgically.
Deformed or curved os penis may result in the inability of the dog to retract the penis into the prepuce because of the abnormal curvature. This can result in the exposed part of the penis becoming dry, injured and infected later. Treatment may be attempted by correcting the curvature of the bone by fracturing it and immobilizing it by passing a urethral catheter or fixed using a finger plate. Urethral obstruction by callus is a possible complication when treatment is attempted by fracture and fixation of the os penis. Such cases may have to be treated by performing a prescrotal urethrostomy. In severe cases of curvature, partial penile amputation may be recommended.
Persistent penile frenulum
Penile frenulum, the connective tissue band that joins the penis and the prepuce ventrally, may fail to rupture during puberty in some animals and may be a cause of pain during erection.
Treatment is by transecting the frenulum under general anaesthesia.
Acquired conditions
Fracture of os penis may rarely result from severe penile trauma. The condition may be characterized by dysuria, haematuria and abnormal mobility with crepitation when the os penis is palpated. Radiography may help to ascertain the type of fracture and decide the type of treatment. Minimally displaced fractures may be treated conservatively and need not be immobilized. Surgical or non surgical immobilization as mentioned above may be attempted in displaced fractures. Fractures associated with severe penile trauma may have to undergo partial penile amputation.
Wounds of the penis may result from fighting, jumping of fences, automobile accidents and mating. Penile wounds have a tendency to bleed profusely. Superficial wounds may be treated conservatively by cleaning with mild antiseptics and application of emollient antibacterial preparations followed by the use of systemic antibiotics. If bleeding is severe, arterial bleeding may be controlled by ligation and bleeding from the cavernous spaces may be controlled by suturing the tunica albugenia. The penis should be inspected carefully for urethral damage. Mild cases of urethral damage may be treated by catheterization for 7 days. In cases in which there is severe damage or transection of the urethra, urethral suturing followed by catheterization for 7 to 10 days may be done. Penile erection may have to be prevented by sedating the animal. A severely damaged penis should be partially amputated.
Strangulation of the penis may result from malicious or accidental application of rubber band on the penis of dogs or the accumulation of hair around the penis. The affected animal may show dysuria, pain, constant licking at the site and signs of necrosis of the cranial end of the penis. The penis may be saved in cases when the condition is diagnosed early and timely removal of the strangulating material is possible. In cases where strangulation was severe or prolonged enough to cause gangrene of the penis amputation of the affected part may be performed.
Paraphimosis is a condition in which the penis fails to return into the prepuce following protrusion.
The Paraphimosis condition may occur congenitally or be acquired. Congenital -narrowness of the prepucial orifice or shortened prepucial sheath may cause the condition. Acquired – conditions like trauma and infection may cause paraphimosis. The condition may follow coitus or masturbation. Clinical signs vary depending on the extent of constriction of the penis by the prepucial orifice and the duration of the condition. Penile desiccation, inflammation, trauma, infection, necrosis and urethral obstruction may result in protracted cases. Treatment involves cleaning of the penis with a mild antiseptic, application of hyperosmolal preparations and cold pack to shrink the swollen penis, application of an emollient lubricant and repositioning the penis into the prepucial sheath. following this , a purse string suture may be applied at the prepucial orifice to prevent recurrence and kept in place for 7 to 10 days. Sometimes the prepucial orifice may have to be surgically enlarged to allow return of the protruded penis. In cases where the prepuce is congenitally short or when the exposed part of the penis is irreparably damaged partial penile amputation may have to be performed.
Phimosis is a inability to protrude the penis out through the prepucial orifice, may occur congenitally or may be acquired. A congenitally narrow prepucial orifice may prevent the protrusion of the penis. Acquired conditions like stricture of the prepucial orifice following trauma or due to the presence of prepucial tumours also cause phimosis. In cases in which the prepucial orifice is severely narrowed urine may be voided in a thin stream or in drops. Urine may get retained in the prepucial sheath and cause necrosis of the inner lining of the prepuce and the surface of the penis. Treatment involves surgical enlargement of the prepucial opening and suturing the prepucial mucosa to the skin all around the prepucial opening using fine monofilament suture material like nylon. The penis, if necrotic, may be cleaned with mild antiseptic solution and emollient antibacterial preparations administered.
Prepucial abnormalities like hypoplasia, agenesis or failure to fuse ventrally may also be seen congenitally or defects may arise following trauma. Cases of incomplete fusion of the prepucial folds may be treated by scarification of the edges and suturing when the defect is small. In cases where the prepuce is not sufficiently developed/remaining to allow reconstruction, amputation of the exposed part of the penis may help. Orchiectomy, scrotal ablation and urethrostomy may have to be performed in cases in which the prepuce is extensively affected.
Inflammation of prepuce is called posthitis.
Prepucial tumors include all type of tumours that affect the skin. TVT, melanomas, mast cell tumours and perianal gland tumours have been reported from the prepuce. Surgical treatment includes excision followed by suturing the skin and mucosa separately or partial penile amputation also in cases where extensive prepucial involvement is seen.
Scrotal injuries, scrotal infection and scrotal tumors may be managed conservatively in mild cases by medical management or surgical excision followed by routine suturing. However, severe cases may warrant orchiectomy and scrotal ablation.
Hypospadias
Hypospadias is a condition resulting from the failure of the urogenital folds to fuse ventrally resulting in the penile urethra being incomplete.
The condition is usually associated with the fusion of the prepuce and underdevelopment of the penis. The urethra may open anywhere between the normal opening at the tip of the glans penis and the perineal region. Depending on the location of the urethral opening hypospadias may be glandular, penile, scrotal or perineal.
Surgical correction may not be required if there free flow of urine through the urethral orifice irrespective of its location as the urethra cranial to the defect will not be usually developed. However, if the urethral opening is not sufficiently large enough to allow free flow of urine the opening may be enlarged and the urethral mucosa sutured to the skin. Parts of the prepuce that interfere with the flow of urine may also be excised surgically.
Deformed or curved os penis may result in the inability of the dog to retract the penis into the prepuce because of the abnormal curvature. This can result in the exposed part of the penis becoming dry, injured and infected later.
Treatment may be attempted by correcting the curvature of the bone by fracturing it and immobilising it by passing a urethral catheter or fixed using a finger plate. Urethral obstruction by callus is a possible complication when treatment is attempted by fracture and fixation of the os penis. Such cases may have to be treated by performing a prescrotal urethrostomy. In severe cases of curvature, partial penile amputation may be recommended.
Penile tumors
Penile tumours are rare in cats but transmissible venereal tumour (TVT), papilloma and squamous cell carcinoma are common in dogs. Clinial signs and treatment vary depending on the location, extent and type of tumour.
TVT is never treated surgically. Even extensive cases of TVT respond favourably to appropriate chemotherapy. Other types of tumours may have to be excised when small or require penile amputation when the penis is extensively involved.
Destruction of papillomas by electrocautery may provide complete cure. It has been found that cauterisation of a few papilloma nodules can cause the destruction of the remaining in a few days or weeks due to a possible immune mediated response.