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was observed at the mucocutaneous border of the urethral stoma and was thought to originate from the CSP (Doles et al. 2001). In the case of our report, PUH had not abated by 2 weeks
after surgery, and although the pony’s PCV had stabilised by then, it remained low, and the heart rate had increased to compensate for the low PCV. A perineal incision into the CSP was created, therefore, to resolve the PUH by diverting blood flow from the urethral stoma to the PI and allow the stoma to heal. Immediately after this procedure, the pony’s PUH subsided substantially, but did not cease entirely until Day 3 after PI. This is in contrast to a previous report by Schumacher et al. (1995), where 6 geldings underwent temporary perineal urethrostomy and another gelding was subjected to a PI into the CSP only, to address terminal haematuria resulting from urethral rents. In these 7 horses haemorrhage at the urethral orifice after urination was never observed after surgery. This difference may need to be considered when performing a PI to address PUH in cases where a penile amputation had been performed. In the case described here, the PCV was low but stable before the PI but decreased substantially after surgery, because the pony haemorrhaged from the PI. This potential (additional) drop in PCV should be taken into account prior to performing a PI into the CSP. Nonetheless, the PI healed without complication and PCV began to increase after 3 days. Castration at least 3 weeks before penile amputation is recommended to prevent haemorrhage caused by increased pressures within the erectile bodies during erection (Schumacher 2012). It may be argued that not having castrated the pony stallion prior to addressing the penile and preputial disease has placed our case at greater risk for post operative haemorrhage. However, it was elected to perform both surgeries under the same general anaesthesia, in order to no longer postpone treatment of the neoplasia and avoid costs and risks associated with a second general anaesthetic. The pony’s urethral stoma healed by second intention after
it dehisced, resulting in stricture of the urethra by 6 weeks. Doles et al. (2001) reported some degree of dehiscence in 8/25 horses that underwent en bloc resection of the penis and prepuce, which healed without further complications. Dehiscence at the stoma is most likely to be either the result of tension and/or infection at the reconstructed mucocutaneous junction, which may be aggravated or favoured by PUH. We suggest that a PI into the CSP has the potential to diminish these factors leading not only to a faster convalescence but also decreasing the likelihood of potential wound healing complications at the reconstructed urethral orifice.
Conclusions
The PIs were easily performed with the pony standing, proved effective in decreasing PUH at the urethral stoma and healed without complication. A PI can be performed after partial phallectomy to expedite healing of a urethral stoma from which PUH emanates and may decrease the time of hospitalisation for horses affected with persistent PUH after partial phallectomy.
Authors’ declaration of interests No conflicts of interest have been declared.
Acknowledgements
The authors would like to thank Drs Tom O’Brien and James Schumacher for their advice regarding case management and help with the preparation of the manuscript.
Manufacturers’ addresses
1Streuli Pharma, Uznach, Switzerland. 2Dr. E. Graeub AG, Bern, Switzerland. 3Boehringer Ingelheim GmbH, Basel, Switzerland. 4MSD Animal Health GmbH Luzern, Switzerland. 5Vétoquinol AG, Ittigen, Switzerland. 6Fresenius Kabi, Oberdorf, Switzerland. 7Johnson&Johnson AG, Zug, Switzerland. 8Merial, Lyon, France. 9Dr. Bichsel AG, Interlaken, Switzerland.
References
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