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EQUINE VETERINARY EDUCATION / AE / OCTOBER 2014
Clinical Commentary Persistent post urination haemorrhage after partial phallectomy
J. Doles University of Nottingham, Sutton Bonington Campus, Leicestershire; and Oakham Veterinary Hospital, Rutland, UK. Corresponding author email:
james.doles@
nottingham.ac.uk
In the article entitled ‘Perineal incision into the corpus spongiosum penis to resolve persistent post urination haemorrhage after partial phallectomy’, Mählmann and Koch (2014) describe the use of a perineal incision to resolve haemorrhage post phallectomy. As the authors state, there is a high rate of complications
post operatively after phallectomy. Haemorrhage should be expected post operatively, and can last for several days (Schumacher 2012). If the source of the haemorrhage is the corpus spongiosum penis (CSP), the haemorrhage will usually resolve without further treatment as has been described in other case reports (Doles et al. 2001; Mair et al. 2000; Archer and Edwards 2004; Rizk et al. 2013). The haemorrhage may occur due to dehiscence of the incision, which usually heals with no complications (Schumacher 2012). The horse in the current case report had persistent haemorrhage that was severe enough to decrease the packed cell volume and cause tachycardia showing that the haemorrhage was significant. In the current case report, the authors performed a
technique that has been described to treat defects in the urethra causing post urination haemorrhage (Schumacher et al. 1995). This technique was selected to help resolve the post urination haemorrhage from the surgical site. The technique involves making a perineal incision into the CSP to reduce the pressure in the CSP. As a result of this incision the technique has been shown to resolve post urination haemorrhage and allow the urethral defects to heal. It would follow that the urethral defect, in this case created surgically, would also respond to an incision into the CSP. It has been reported that the pressure in the CSP increases during urination in both stallions and geldings. However, geldings have significantly higher pressures as compared to stallions during peak urination (Taintor et al. 2004). This increase in pressure is the likely cause of the post urination haemorrhage seen in the horse of the current report. The authors’ decision to incise into the CSP was a very viable option to address the persistent haemorrhage in this case. The reduction in pressure would allow the stoma to heal by resolving the haemorrhage. The haemorrhage did not resolve immediately as it did in the cases reported by Schumacher, which the authors comment may have to be taken into consideration as the patient will have continuing blood loses. This was especially important in this case as the packed cell volume was low after the first surgery. The haemorrhage may not have resolved immediately in this case as the location of the haemorrhage is more distal in the CSP and more dependent than the lesions described by Schumacher in his reported cases, which occurred in the area of the ischial arch. This may predispose to a longer period of haemorrhage post surgery that was not seen when the site of haemorrhage was more proximal.
© 2014 EVJ Ltd The fact that the horse of the case report was castrated
at the time the phallectomy was performed is of unknown significance. Castration has been recommended at least 3–4 weeks before penile amputation as the increased pressure present during erection may predispose to post operative haemorrhage and dehiscence of the suture lines (Schumacher 2012). It is unclear if that played any role in the case reported here. The horse in this report was not seen to be having any noticeable erections. The haemorrhage in this case was noted at the end of urination. It has been reported that stallions have a lower pressure in the CSP at peak urination as compared to geldings with the bleeding occurring following the decrease in urethral pressure at the end of urination while the corpus spongiosum pressure remains high (Taintor et al. 2004). It was felt that the pressure was higher in geldings due to the fact that the CSP was not as well developed in geldings (Taintor et al. 2004). The lower pressure in stallions may decrease the likelihood of bleeding at the end of urination; however, the effect of an erection could be very detrimental. It is very difficult to determine if earlier castration would have changed the course of this case. It is also important for veterinarians to realise that a purulent
or sanguineous discharge from the preputial orifice is one of the most common presenting clinical signs in horses with penile or preputial tumours (van den Top et al. 2008). The horse in this report was also aged 18 years. Penile and preputial tumours occur more commonly in older horses with it being reported that the average aged is 19.5 years in one retrospective study (van den Top et al. 2008). The horse in this report had been treated for approximately one year before referral. It may be with early recognition and diagnosis that a more conservative surgical option could have been used to treat these neoplasias. Any discharge from the preputial orifice that does not respond to treatment should be thoroughly investigated in a timely manner so that any underlying pathology can be promptly addressed. The authors of this case reported a procedure to address
post operative haemorrhage from the CSP following phallectomy. The procedure appeared to aid in resolution of the haemorrhage in this case and gives another treatment option in horses that have persistent haemorrhage post operatively.
Author’s declaration of interests No conflicts of interest have been declared.
References
Archer, D.C. and Edwards, G.B. (2004) En bloc resection of the penis in five geldings. Equine Vet. Educ. 16, 12-19.
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