Penile amputation

Keywords: surgery, amputation, equine, stallion, penis

Penile amputation is used to treat penile neoplasia, especially squamous cell carcinoma. Numerous other indications for amputation exist, amoungst them, priapism. Priapism is morbid engorgement of the penis or penile "paralysis". In some cases, priapism may be an adverse side effect of phenothiazine-type tranquilizer but most often, the cause is unknown. This was such a case.  

The amputation operation is shown in the following images. All images measure 1239 x 847px; click to enlarge them.

Under general anesthesia, the site is surgically prepared, the urethra catheterized, and a tourniquet is placed around the base of the penis for hemostasis.

 The penis is then pulled caudally and a triangular incision is made on the ventral aspect of the penis. The  base of the triangle lies towards the glans penis.

The triangle of skin is removed and as shown below, dissection continues to the level of the  catheter in the urethra, exposing the urinary catheter.

An adequate amount of skin is retained and folded towards the base of the penis, to expose the corpus cavernosum penis surrounded by its tough, tunica albuginea. The next step is to appose the upper and lower sections of the tunica albuginea (seen below) to close the corpus cavernosum. Closure should be secure to afford excellent hemostasis. Absorbable suture material is used.

In the image below, the first step in closure of the corpus cavernosum has been completed.

Here, apposition has almost beencompleted. 

With the corpus cavernosum closed (see below), the skin of the penis and the urethral mucosa are apposed using non-capillary absorbable sutures. 

After starting apposition of the urethral mucosa and skin ventrally (at the apex of the original triangular incision) the circumference of the unattached skin is lifted as shown below. This causes that the corpus cavernosum penis to drops within the operative site and skin to be drawn upwards, towards the tip of the penis. This provide adequate skin for apposition to the urethral mucosa.

The urethral mucosa is then apposed to the skin on the dorsal surface of the penis. In the image below, only the first suture in this series is in place.

Below, circumferential apposition of the skin and urethra is almost complete.

A view of the new mucocutaneous junction at the end of the penis. The "V" shaped apposition on the ventral surface f the penis will help to prevent stranguria in the event of post-operative swelling in this area. The urethral catheter and tourniquet are still in place.

The completed phallectomy. Enough of the penis has been removed so that it is no longer visible on external inspection.

Scrotal hernia after castration

Keywords: castration, hernia, surgery, equine

The scrotum of a stallion that herniated an intestinal loop into its scrotum three weeks after an open-type castration.

Image size: 1540 x 1043px

The intestinal contents occupied the empty scrotum (red arrows). Fortunately the scrotal incision had healed sufficiently to prevented evisceration and probably, death. Herniorrhaphy was performed on this stallion.

Closed castration with double transfixing ligation of the inguinal canal will usually prevent this problem from occurring. When the inguinal canal is left open to the exterior, the risk of fatal evisceration always exists.

Congenital scrotal hernia

Keywords: hernia, foal, ultrasound, surgery

A foal, approximately 30 days old was presented with a scrotal hernia. Ultrasonography was used to verify the presence and severity of the hernia.

Image size: 1800 x 1130 px

When intestines become entrapped within the vaginal cavity, edema and peritoneal fluid usually accumulate around the herniated intestines.  Together with the movement of intestinal contents, the ultrasonographic contrast provided by this fluid facilitates a diagnosis of an intestinal hernia.

Although this initially appeared to be a left-sided hernia, intestines had actually herniated into the right vaginal cavity, displacing the left side of the scrotum far out to the left side. This had created the initial impression of a left-sided hernia.

Copyright: Dr N. J. Vos email: Klaas_Vos@Hotmail.com.

Image size: 1200 x 1156px

Herniorrhaphy was performed.  The head of the foal is at the top of the image above. The left testicle (green ring) was removed and the hernia on the right side was reduced via the abdominal route. A bizarre turn of events occurred during herniorrhaphy when the owner insisted that the testicle on that side not be removed! Despite warnings of potentially compromised blood supply and the heritability of scrotal hernias, the owners wishes were respected.

As reviewed by C.A. Ragle in Advances in Equine Laparoscopy (ISBN: 978-0-470-95877-3) scrotal hernias appear to be heritable in horses although a heritability coefficient has not been established as it has in pigs. This is complicated by the fact that scrotal hernias are more common in some breeds (Quarter horses and draft breeds) than others. That fact alone supports a heritable basis for the condition.