Surgery of the Penis and Prepuce

Chapter 89 Surgery of the Penis and Prepuce



Harry W. Boothe


Surgical procedures of the penis and prepuce include the following:


• Penile amputation to treat traumatic or neoplastic lesions

• Enlargement of the preputial orifice to treat phimosis or paraphimosis

• Cranial advancement of the prepuce to treat minor deficiency in preputial length

• Severance of persistent penile frenulum

Diagnosis and medical treatment of penile problems are discussed in Chapter 88.



ANATOMY



Penis



• The feline penis is shorter, directed caudally, and covered with small papillae compared with its canine counterpart, but both species have three principal penile divisions: root, body, and distal portion (glans).

• The penile corpora contain enlarged venous spaces and have two principal divisions: the corpora cavernosa and the corpus spongiosum.

• Each corpus cavernosum (right and left) arises from the ischial tuberosity, continues distally in the dorsolateral part of the penile body as far as the os penis, and is covered by the tunica albuginea.

• The corpus spongiosum originates within the pelvic cavity, surrounds the penile urethra throughout its course, and supplies both the bulbus glandis and the pars longa glandis in the distal penis.

• The os penis is located in the penile body and is attached to the bulbus glandis, pars longa glandis, and tunica albuginea.

• The four paired extrinsic penile muscles in the dog are the retractor penis, ischiocavernosus, bulbospongiosus, and ischiourethralis.

• The principal blood supply to the penis is from three branches of the artery of the penis, which are continuations of the internal pudendal artery: artery of the bulb, deep artery of the penis, and dorsal artery of the penis.

• Venous drainage occurs via the internal and external pudendal veins. Lymphatic drainage is to the inguinal lymph nodes.

• See Chapter 82 for penile anatomy associated with perineal urethrostomy in cats.


Prepuce



• The canine and feline prepuce covers the non-erect penis.

• Paired preputial muscles extend from the xiphoid cartilage to the dorsal preputial wall.

• Blood supply is via the caudal superficial epigastric artery and the dorsal artery of the penis; lymphatic drainage is to the inguinal lymph nodes.


PENILE AMPUTATION



Preoperative Considerations



• The location and extensiveness of traumatic or neoplastic penile lesions determine the site of penile amputation. Animals with urethral prolapse that recurs after attempts to resect urethral mucosa may require partial penile amputation. Non-surgical management of certain neoplasms of the penis (e.g., transmissible venereal tumor) may be preferable (see Chapter 88).

• Preputial shortening may be indicated after partial penile amputation.

• Bilateral orchidectomy, scrotal ablation, and scrotal (preferred) or perineal urethrostomy are indicated following extensive penile amputation.


Surgical Procedure



Objectives



• Provide hemostasis by ligation of blood vessels and closure of the tunica albuginea.

• Create a permanent urethrostomy by suturing urethral mucosa to either penile mucosa or skin.

• Avoid an osteotomy by positioning the amputation site either cranial or caudal to the os penis.


Equipment



• Standard general surgical pack and suture

• Penrose drain tubing for temporary tourniquet application


Technique for Partial Amputation



1. Place the dog in dorsal recumbency, prepare the preputial cavity by multiple flushes with chlorhexidine solution (Nolvasan, Fort Dodge), and catheterize the urethra.

2. Maintain penile exteriorization from the prepuce by placing Penrose drain tubing in tourniquet fashion around the penis as far caudally as possible.

3. Create bilateral flaps of the tunic and cavernous tissue, using sharp dissection, proximal to the os penis while leaving the urethra intact (Fig. 89-1A).

4. Dissect the urethra and transect it just distal to the proposed amputation site.

5. Transect the os penis, if necessary, with bone-cutting forceps at the base of the flap.

6. Identify and ligate blood vessels after loosening the tourniquet, and appose the tunica albuginea and flaps of erectile tissue (simple interrupted pattern, absorbable suture).

7. Suture urethral mucosa to penile mucosa over the ventral portion of the end of the penile stump (simple interrupted, absorbable suture) after incising the urethra along its ventral midline (Fig. 89-1B,C).

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Aug 27, 2016 | Posted by in SMALL ANIMAL | Comments Off on Surgery of the Penis and Prepuce

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