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EQUINE VETERINARY EDUCATION / AE / OCTOBER 2014


a)


b)


c)


d)


e)


Fig 3: Perineal incision into the corpus spongiosum penis: (a) perineal skin incision about 3 cm below the anus in the perineal raphe; (b) separated m. retractor penis (arrow) fascia overlying the bulbospongiosus muscle (asterisk); (c) paired bulbospongiosus muscle (arrow); (d) incision of the corpus spongiosum penis (arrow); (e) minimal amounts of blood running out from the freshly created corpus spongiosum penis incision.


Because PUH persisted, a perineal incision (PI) into the CSP


was performed on Day 14 after en bloc resection of the penis and prepuce (Fig 3). The procedure was originally described for the treatment of horses with terminal haematuria caused by a urethral rent (Schumacher et al. 1995). The pony was restrained in stocks and sedated with detomidine (Equisedan2, 0.03 mg/kg bwt, i.v.) and butorphanol (Morphasol2,25 μg/kg bwt, i.v.). Its perineum was desensitised by administering epidural anaesthesia using a combination of xylazine (0.22 mg/kg bwt) and lidocaine (0.17 mg/kg bwt). The tail was wrapped and secured dorsally to the stocks, the perineal area was prepared for aseptic surgery, and the bladder was catheterised through the urethral stoma with a 16-French Foley catheter. A 4 cm, vertical skin incision, beginning 3 cm ventral to the anus, was created on the perineal raphe. The incision was continued through the retractor penis and bulbospongiosus muscles using a scalpel and a pair of Metzenbaum scissors. The tunica albuginea surrounding the CSP was incised to expose corporeal tissue taking care not to penetrate the urethral lumen. The wound was left unsutured, and the skin ventral to the incision was covered with petroleum jelly.


Slight haemorrhage from the PI was observed immediately


after surgery but had ceased within an hour. Post urination haemorrhage, observed during the next day, occurred primarily at the PI and was reduced substantially at the permanent urethral stoma. Only a slight amount of blood dripped from the PI at the end of urination by the second day after surgery. PUH from the urethral stoma and from the PI had ceased by the third day after surgery. The pony’s PCV decreased from 19% before the PI to 12% by 2 days after the PI. Thereafter, it rose to 15% by Day 3. The pony was discharged from the hospital 8 days after surgery to create the PI. The pony was again presented to our hospital 6 weeks after undergoing partial phallectomy because of stranguria


© 2014 EVJ Ltd


due to a stricture at the urethral stoma. By this time, the PI had healed completely, and the pony’s PCV was 25%, and its total protein 65 g/l. The stoma was revised and reconstructed with the pony anaesthetised. Despite meticulously compressing the CSP, the pony again developed persistent PUH after surgery, and another PI into the CSP was performed 5 days after reconstruction of the stoma. Slight PUH from the PI persisted for one week, but haemorrhage from the urethral stoma reduced substantially after the PI and ceased completely within 4 days. The pony was discharged from the hospital 11 days after the second PI.


Outcome


The owner reported that the urethral stoma and the perineum had healed completely by 18 days after the second PI surgery. By the time of submission of this report, 4 months after the initial surgery, the pony was doing well, and was observed to have normal micturition and no signs indicative of tumour recurrence.


Discussion


Haemorrhage is a common complication of partial phallectomy regardless of the technique of amputation. Haemorrhage is expected during the first few days after surgery and usually resolves spontaneously (Schumacher 2012). In a study by Mair et al. (2000), intermittent PUH was observed in 32/41 horses after partial phallectomy, and even though it persisted for up to 5 weeks in some horses, no specific treatment to address PUH was elected. For 25 horses undergoing en bloc resection of the penis and prepuce, haemorrhage was considered mild in 15 and moderate in 9 (Doles et al. 2001). One horse had severe haemorrhage originating from the dorsal penile artery, and required a blood transfusion. Post operative bleeding from the other 24 horses


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