Large Ani. Sx- Equine Male Urogenital 3

wilsbach's version from 2015-11-09 03:00

Sx conditions of the penis

Question Answer
CQ: (T/F) Phenothiazine derived tranquilizers sometimes cause penile paralysis.T
CQ: (T/F) When the penis is traumatized horses usually develop phimosisF (paraphimosis)
CQ: (T/F) The Boltz Technique involves amputation of a portion of the penis.F (this is a penile retraction technique)
CQ: (T/F) Reefing is a surgical technique that involves surgically modifying a stallion so that he can’t breed.F (reefing is circumcision)
what is paraphimosis?Swelling of the penis and prepuce which causes the penis to be retained outside the preputial orifice
paraphimosis usually occurs in which two sp?bulls and stallions (only gonna talk about stallions here)
what are some manual treatments to help with paraphimosis?A support can be manufactured from a nylon mesh laundry bag and latex tubing to hold the penis against the ventral abdomen . Can also do Massage aided by ointments and or lubricants As well as mild exercise
what are some drugs you can give to help with paraphymosis?NSAIDs, diuretics, Abx (if infxn present)
Paraphimosis--> If attended promptly and treated aggressively, it is usually possible to manipulate the penis back into the prepuce within ____(time)24 hours.
paraphimosis--> the penis can usually be kept in place by inserting a probang into the preputial orifice-- when dont you do this? Why? HOW do you do this?If there are no lacerations you can do this. (don't use this technique if there are breaks in the preputial skin (an abscess may develop). Pad the end of a plastic vaginal speculum with cotton--> Apply tape over the cotton--> Place a plastic sleeve over the tape --> Insert the padded end into the prepuce --> Hold in place with adhesive tape encircling the abdomen --> After several days, the penis usually stays in place .........An alternative method is this:
what do you think of using a purse string around the prepuce to keep the penis in the sheath as a tx for paraphimosis?he doesnt recc- leads to extensive scar tissue -->
what is phimosis?Swelling of the penis and prepuce which causes the penis to be retained inside the preputial orifice
who is phimosis most common in?Condition seldom occurs in stallions and is fairly common in bulls
what is penile paralysis? Waht two major things cause penile paralysis?Animal looses the ability to retract the penis into the prepuce (dysfunction/paralysis of retractor penis mm)... this is usually due to (1) Phenothiazine derived tranquilizers used in stallions (2) Failure to adequately treat paraphimosis
I say phenothiazines, you say...penile paralysis (ace!)
how do you tx penial paralysis?Replacement of the penis in the prepuce and retention as described under paraphimosis. Occasionally retention for a prolonged time will allow return to function. Surgery to retract the penis is indicated if prolonged retention is not effective
what is reefing?This is The term commonly used for circumcision in the stallion
when is reefing indicated?Remove abnormal growths or scar tissue that do not extend deeper than the dermis
how does position/anesthesia differ depending on the situation when reefing?Sedation and local anesthesia in the standing animal when the lesions are small and do not require removal of a large amount of tissue (Small lesions that do not require circumferential incision). General anesthesia with the animal in dorsal recumbency for extensive lesions
what is the surgical procedure for reefing?Preparation for aseptic surgery--> Pass catheter for identification of the urethra--> Tourniquet is used by some (not required)--> Pull penis anterior - umbilical tape snare is suggested--> Circumferential skin incisions anterior and posterior to the lesion--> Establish a dissection plane--> Dissect skin from the deeper tissues--> Remove the ring of diseased tissue--> Then close in TWO layers: 1) Superficial fascia - simple interrupted pattern with absorbable suture. 2) Skin - with non absorbable suture or monofilament absorbable suture
what post-op precautions should you take after a reefing procedure?Limit erection in stallions for 3 to 4 weeks but applying a breeding ring (If non absorbable skin sutures are used they should be removed in 10 days)
what is a possible post-op complication of reefing and how do you tx it?If hemostasis is less than ideal, a hematoma may develop at the surgical site (drainage is indicated)
what are two indications for penile amputation?(1)Carcinoma involving structures deeper than the skin (2) Penile paralysis (Boltz technique is better tho)
If you are considering penile amputation, what is recc you do before this?castration
is it more difficult to do a more cr or more ca penile amputation?more ca more difficult.
if you are doing a penile ampuation for penile paralysis (remember, boltz technique is better tho) what things do you need to carefully consider when selecting where you will perform the procedure?carefully select site to avoid urine scald or excoriation
describe the traditional technique of penile amputationUrethra catheterized for identification (Gum rubber tubing tourniquet is suggested but not necessary) --> Apply an umbilical tape snare caudal to the gland to pull the penis anteriorly--> Triangular incision approximately 4 cm/ side with the base anterior continued down to the urethra --> Urethra split on the midline --> Simple interrupted sutures #00 started at the apex to approximate the urethra and skin --> Amputate the penis starting at the base of the triangular incision so that the cut edge at the dorsal aspect of the penis is slightly anterior to the ventral cut edge --> Ligate branches of the dorsal artery of the penis and the large veins between the deep fascia and the tunica albuginea--> Close the stump with vertical 4 bite sutures taken through the urethral wall, the tunica albuginea of the urethral groove, tunica albuginea of the opposite side and the skin --> Sutures preplaced - first should be in the middle, the 2nd and 3rd bisect the two halves to divide into quarters, continue until adequate sutures have been taken to close
what is the main cause for post-op minor dehissance after penile amputation? Dissecting hematomas cause dehiscence (Minor dehiscence is not unusual)
if you do a penile amputation and you get post-op Granulomas and stenosis , what did you do wrong?result of inadequate ligation and an inadequate number of skin sutures
If you need to amputate a considerable amount of penis, what post-op complication might you run into?When it has been necessary to amputate a considerable amount of the penis, it is sometimes not possible for the horse to extend the penis when urinating--> This results in urine scald of the skin at the preputial orifice
what are some recent modifications which have been made to the penile amputation procedure? (2)(1) standing instead of dorsal recumbency. The horse was sedated with an epidural and the dorsal nerves of the penis blocked at the level of the ischial arch. A midline incision was made 10 cm ventral to the anus. The shaft of the penis was bluntly dissected and with traction the internal reflection of the prepuce was identified and divided so that the entire penis could be retroverted through the the incision. The penis was divided and sutured to the skin as in the traditional approach (2) A bander, as used in the castration of cattle, was used to place maximally stretched laboratory tubing distal to the urethrotomy site. A urethrotomy was performed as described in the traditional approach (above). The shaft of the penis was incised and removed slightly distal to the laboratory tubing. The distal aspect of the penis sloughed and the resulting wound healed by second intention
what are the indications for the boltz technique?(retraction of the penis technique) Paralysis of the penis after all efforts to stimulate spontaneous retraction have been exhausted
what two things must you do pre surgically before the boltz technique?(retraction of the penis technique) Castration - at least one month prior. Removal of granulomatous growths - if necessary
describe the technique for the boltz techniqueDorsal recumb- Pass catheter for urethral identification. 10 cm incision on the midline just caudal to the castration scar. Dissection to the penis. Retract the penis so that the glans is just inside the preputial orifice. Identify the preputial reflection. Insert #2 non absorbable, non capillary suture through the preputial reflection 2 cm on either side of the midline - be sure to avoid the urethra. Place the sutures deep but not through to the preputial cavity (Have an assistant palpate in the prepuce to be sure the suture does not penetrate). Pass the ends of the suture through the skin 5 cm on either side of the incisionTie suture with a bow knot over large tubing (pieces of 1/2" stomach tube are suggested). A drain may be indicated. Repair the initial incision. After the horse is standing, adjust the stay sutures so that the glans is just inside the preputial orifice - very important. Remove non absorbable sutures in 2 to 3 weeks. The aim is to produce a firm adhesion between the prepuce and the skin and in this way maintain the penis in a retracted position!!!! (Making adhesions btwn prepuce and skin so penis stays retracted inside prepuce)