TUGAS MATA KULIAH

ILMU BEDAH KHUSUS VETERINER

“Teknik Operasi Amputasi Penis’

Oleh :

Kelas A

1. I Gede Arick Eristiawan 1609511094

2. Ida Bagus Nararya Primastanaa. A 1609511096
3. I Gusti Ngurah Gede Arbi Kencana 1609511098
4. I Komang Ari Windu Sancaya 1609511102

LABORATORIUM ILMU BEDAH KHUSUS VETERINER

FAKULTAS KEDOKTERAN HEWAN

UNIVERSITAS UDAYANA

DENPASAR

2019
 KATA PENGANTAR

Puji syukur kami haturkan kehadirat Tuhan Yang Maha Esa atas segala
limpahan rahmat dan hidayah-Nya sehingga Paper “Teknik Operasi Amputasi
Penis” ini dapat diselesaikan tepat waktu.

Makalah ini dibuat dalam rangka menyelesaikan tugas yang akan dijadikan
landasan dalam penilaian softskill pada proses pembelajaran Mata Kuliah Ilmu
Bedah Khusus Veteriner Fakultas Kedokteran Hewan Universitas Udayana.

Ucapan terima kasih dan penghargaan yang setinggi-tingginya kami

sampaikan kepada dosen pengajar yang telah memberikan banyak bimbingan dan
arahan kepada kami dalam penyusunan makalah ini. Tidak lupa penulis juga
mengucapkan terima kasih kepada semua pihak yang telah membantu dan
memberikan dukungan pada kami. Kami menyadari bahwa tulisan ini masih banyak
kekurangan baik dari segi materi, ilustrasi, contoh, maupun sistematika penulisan.
Oleh karena itu, saran dan kritik dari para pembaca yang bersifat membangun
sangat kami harapkan. Besar harapan kami karya tulis ini dapat bermanfaat baik
bagi pembaca pada umumnya terutama bagi dunia kedokteran hewan di Indonesia.

Denpasar, 01 Oktober 2019

Penulis

ii
 DAFTAR ISI

KATA PENGANTAR ................................................................................. ii

DAFTAR ISI ................................................................................................ iii

BAB I PENDAHULUAN ............................................................................ 1

1.1 Latar Belakang .................................................................................. 1

1.2 Rumusan Masalah ............................................................................. 2
1.3 Tujuan Penulisan ............................................................................... 2
1.4 Manfaat Penulisan ............................................................................. 2

BAB II PEMBAHASAN ............................................................................. 3

2.1 Definisi Amputasi Penis.................................................................... 3

2.2 Persiapan Operasi Amputasi Penis ................................................... 3
2.3 Premedikasi Dan Anestesi ................................................................ 5
2.4 Teknik Operasi Amputasi Penis ........................................................ 5
2.5 Hasil Operasi ..................................................................................... 5
2.6 Pasca Operasi Amputasi Penis .......................................................... 6

BAB III PENUTUP ..................................................................................... 8

3.1 Simpulan ........................................................................................... 8

3.2 Saran .................................................................................................. 8

DAFTAR PUSTAKA .................................................................................. 9

iii
 BAB I

PENDAHULUAN

1.1 Latar Belakang

Fungsi utama dari seekor pejantan adalah untuk menghasilkan sel-sel
kelamin jantan (spermatozoa) yang hidup, aktif dan potensial fertil serta secara
sempurna meletakkannya ke dalam saluran reproduksi betina.
Sistem reproduksi hewan jantan terdiri atas tiga komponen yaitu:
1. Organ kelamin primer yaitu dua buah testis yang terdapat di dalam
skrotum. Testis berfungsi untuk memproduksi spermatozoa dan
menghasilkan testosteron (hormon seksual jantan) dan scrotum berfungsi
untuk menyediakan lingkungan yang menguntungkan untuk produksi dan
pematangan spermatozoa.
2. Organ asesoris (pelengkap) yaitu kelenjar yang terdiri atas vesikuler,
prostat, dan Cowper serta saluran yang terdiri atas epididimis dan vas
deferens.
3. Alat kelamin luar atau organ kopulatoris yaitu penis. Kehadiran kelenjar
asesoris, orientasi testis, tipe penis, dan tempat sperma (semen) di letakkan
pada organ reproduksi betina berbeda-beda pada setiap spesies hewan.
Sehingga penis merupakan organ yang penting dalam hal sistem reproduksi
dan genitalia.
Amputasi penis adalah suatu kasus yang jarang ditemukan.
Amputasi penis dapat ditemukan pada pasien dengan indikasi perlukaan
yang hebat disertai nekrosa pada penis, tumor pada ujung penis, paralysis
penis yang telah berlangsung lama, prolapsus penis, trauma pada preputium
dan penis yang menyebabkan hematoma dan patah tulang penis, karena
adanya neoplasia seperti tumor veneral menular (transmissible venereal
tumor/TMT), squamus sel karsinoma, hemangiosarkoma, dan papilloma.
TMT adalah tumor yang menular melalui kontak seksual atau jilatan.

1
1.2 Rumusan Masalah
1. Apa yang dimaksud dengan Amputasi Penis?
2. Bagaimana persiapan operasi dan anestesi Amputasi Penis?
3. Bagaimana teknik operasi Amputasi Penis?
4. Bagaimana hasil operasi dan pasca operasi Amputasi Penis?
1.3 Tujuan Penulisan
1. Untuk mengetahui apa yang dimaksud dengan Amputasi Penis
2. Untuk mengetahui persiapan dari operasi Amputasi Penis
3. Untuk mengetahui teknik operasi Amputasi Penis
4. Untuk mengetahui hasil operasi dan pasca operasi Amputasi Penis
1.4 Manfaat Penulisan
Manfaat dari pembuatan makalah ini yaitu untuk pembelajaran tentang
pembedahan system reproduksi dan genitalia khususnya tentang teknik operasi
amputasi penis yang suatu saat akan diterapkan.

2
 BAB II

PEMBAHASAN

2.1 Definisi Amputasi Penis

Amputasi penis adalah tindakan pembedahan yang dilakukan untuk
memotong penis. Amputasi penis biasanya dilakukan pada pasien dengan
indikasi perlukaan yang hebat disertai nekrosa pada penis, tumor pada ujung
penis, paralysis penis yang telah berlangsung lama, prolapsus penis, trauma
pada preputium dan penis yang menyebabkan hematoma dan patah tulang
penis, karena adanya neoplasia seperti tumor veneral menular (transmissible
venereal tumor/TMT), squamus sel karsinoma, hemangiosarkoma, dan
papilloma. TMT adalah tumor yang menular melalui kontak seksual atau
jilatan.
2.2 Persiapan Operasi Amputasi Penis
1.2.1 Persiapan Hewan / Pasien
1. Anamnesa
2. Pemeriksaan fisik
3. Pemeriksaan Lab
4. Stabilisasi pasien
5. Persiapan site operasi
6. Pelaksanaan operasi
Stabilisasi Pasien :
1. Dehidrasi : terapi cairan LR atau Dextrose 5% IV
2. Infeksi : pemberian antibiotika
3. Asidosis ( pH < 7,2 ) : terapi sodium bikarbonat
4. Penyakit kronis : pengobatan penyakit dan peningkatan status
gizi
5. Perdarahan atau Shock : terapi cairan LR dosis 60-
90ml/kgbb/jam IV

3
 6. Anemia ( PCV < 20mg%, Hb < 9mg% ) : terapi antianemia ( fe,
vit B12 ) (elective surgery)
7. Transfusi darah ( emergency surgery )
Persiapan Site Operasi :
1. Restrain
2. Pencukuran bulu atau rambut di sekitar site operasi
3. Setelah pencukuran bulu atau rambut, cuci site operasi dan beri
antiseptic ( povidoneiodin/yodium tincture )
Pasien Masuk Ruang Operasi :
1. Lakukan anestesi dengan anestesi regional atau anestesi umum
2. Baringkan dengan posisi dorsal recumbency
3. Pasang cateter pada uretra untuk orientasi dan melindungi
terjadinya trauma pada uretra.
1.2.2 Persiapan Alat, Bahan, dan Obat
Alat yang digunakan dalam melakukan pembedahan yaitu
Pinset anatomis, pinset sirorgis, towel
clamp, gunting bengkok, scalpel,needle holder, syiringe 1 cc,
tampon, kapas, kassa, plester, tang arteri, jarum bulatdan
penampang segitiga, cut gut chromic 3/0, silk 3/0, kain duk, tali
restrain,timbangan, lampu operasi, pencukur rambut, sarung tangan,
masker, penutupkepala, dan baju bedah. Bahan-bahan yang
digunakan antara lain premedikasi, yaitu atropin sulfat dengan dosis
0,25 mg/kg BB secara subkutan. Bahan anasthetikum, yaitu
xylazine2% dengan dosis 2 mg/kg BB dan ketamine HCL 10%
dengan dosis 10 mg/kg BB secara intramuskular. Bahan antibiotik,
yaitu oxytetracyclin (terramycin) 50% dengan dosis 14 mg/kg BB,
Amocillin 25% dengan dosis 20 mg/kg BB, dan penicillin 50000 IU.
Alkohol 70%, iodine tincture.

4
2.3 Premedikasi Dan Anestesi
Premedikasi merupakan suatu tindakan pembeian obat sebelum
pemberian anestesi yang dapat menginduksi jalannya anestesi. Premedikasi
dilakukan beberapa saat sebelum anestesi dilakukan. Tujuan premedikasi
adalah untuk mengurangi kecemasan, memperlancar induksi, mengurang
keadaan gawat anestesi, mengurangi timbulnya hipersalivasi, bradikardia
dan muntah selama anestesi. Premedikasi yang digunakan adalah atropine
sulfat yang diberikan secara subcutan. Kemudian untuk anestesi digunakan
ketamine yang dikombinasikan dengan xylazine yang disuntikkan 10 menit
setelah pemberian atropine sulfat yang diberikan secara intra muscular.
2.4 Teknik Operasi Amputasi Penis
Penis dikeluarkan semaksimal mungkin dari preputium, posisi penis
dipertahankan dan dipasang tourniquet disebelah kaudal penis yang akan
diamputasi. Dibuat incisi berbentuk “V” sepanjang tunika albuginea dan
jaringan kavernosus pada tulang penis dan uretra. Tulang penis dipotong
dengan pemotong tulang pada bagian paling kaudal dan hati- hati agar tidak
membuat trauma uretra. Uretra dipotong 1-2 cm di kranial potongan penis.
Diidentifikasi dan diligasi arteri dibagian dorsal penis untuk dapat
melepaskan tourniquet. Uretra yang telah dipotong dibuka dan dilipat
bagian ujungnya diatas potongan penis. Dipertautkan mukosa uretra dengan
tunika albuginea dan jaringan kavernosus dengan jahitan simple interrupted
atau continuous. Preputium dipotong agar lebih pendek sesuai dengan sisa
penis yang terpotong. Incisi pada preputium dibuat berbentuk elip dan
dilakukan penutupan kulit dengan jahitan simple interrupted atau
continuous dengan benang nonabsorable
2.5 Hasil Operasi
Setelah melakukan pengangkatan massa tumor, kemudian dilakukan
penjahitan lapisan muskulus pada bagian caudal penis yang terinsisi dengan
menggunakan benang cromic cat gut 2/0 dengan pola simple interupted dan
penjahitan pada kulit bagian cranial preputium dengan menggunakan
benang cromic cat gut 2/0 dengan pola simple continuous (Sudisma, 2012)

5
 Penanganan pasca operasi merupakan tindakan yang paling penting
untuk mencegah terjadinya infeksi sekunder. Hewan diberikan antibiotika
oral yaitu ciprofloxacin. Ciprofloxacin merupakan antibiotika golongan
quinolone yang mekansime kerjanya menghambat enzim DNA gyrase
bakteri dan bersifat bakterisid terhadap kebanyakan kuman patogen
penyebab infeksi saluran kemih (Mariana, 2011).
Setelah tindakan operasi pengangkatan massa tumor selesai
dilakukan, pasien diberikan antibiotik penisilin streptomisin secara
intramuskuler sebanyak 0,8 ml untuk mencegah adanya infeksi sekunder .
Kemudian dilakukan kemoterapi dengan menyuntikkan vincristine 0,2 ml
secara intravena dengan interval satu minggu. Hal ini dilakukan mengingat
venereal sarcoma pada anjing kasus sudah pernah kambuh, dan setelah
kemoterapi yang kedua massa tumor sudah tidak muncul kembali.
Pemberian antibiotik amoxan syrup 125 mg dengan pemberian 3 kali sehari
11 /2 sendok teh selama lima hari. Antibiotik diberikan untuk mencegah
infeksi bakteri. Analgesik asam mefenamat 500 mg dengan pemberian 2 kali
sehari 1 /2 tablet secara per-oral selama lima hari. Asam mefenamat
diberikan sebagai analgesik yang juga memiliki efek anti-inflamasi
(Parkinson, 2016). Selain dilakukan treatmen dengan pemberian obat,
dilakukan juga treatment lainnya. Adapun treatmen yang dilakukan adalah
dengan mengurangi gerak, menjaga kebersihan daerah tempat tidurnya,
pemasangan Elizabeth collar, dan perlindungan terhadap luka jahitan
dengan pemberian enbatic salep (Wilmana 2010).
2.6 Post atau Pasca Operasi
Perawatan Post operasi meliputi penyuntikan antibiotik
oxytetracycline 14mg/kg BB intra muskular dan dilakukan monitoring
terhadap kondisi fisiologis secara hewan yang meliputi temperatur,
frekuensi nafas, frekuensi jantung, nafsu makan dan minum feces, dan
urine. Pengobatan dilakukan setiap hari meliputi pemberian antibiotik,
vitamin dan pembersihan pada luka jahitan. Pemberian antibiotik
amoxicillin (27.2 mg/ml) untuk mencegah infeksi selama 5 hari dilanjutkan

6
dengan vitamin A ipi untuk regenerasi sel-sel epitel. Luka jahitan tersebut
dibersihkan dengan rivanol kemudian diberi betadine dan ditutup dengan
kassa Kebersihan kandang untuk proses recovery juga perlu diperhatikan
dan dijaga kebersihannya (Burrow, 2011)

7
 BAB III

SIMPULAN DAN SARAN

3.1 Simpulan
Amputasi penis adalah tindakan pembedahan yang dilakukan untuk
memotong penis. Amputasi penis biasanya dilakukan pada pasien dengan
indikasi perlukaan yang hebat disertai nekrosa pada penis, tumor pada ujung
penis, paralysis penis yang telah berlangsung lama, prolapsus penis, trauma
pada preputium dan penis yang menyebabkan hematoma dan patah tulang
penis, karena adanya neoplasia seperti tumor veneral menular (transmissible
venereal tumor/TMT), squamus sel karsinoma, hemangiosarkoma, dan
papilloma.
Dalam melakukan operasi amputasi penis hal-hal yang harus
dipersiapkan adalah mulai dari persiapan preoperasi sampai dengan post
operasi. Persiapan preoperasi meliputi persiapan hewan/pasien, Persiapan
Site Operasi, dan terakhir hewan/pasien masuk ruang operasi. Sedangkan
persiapan post operasi, penyembuhan luka setelah operasi/pembedahan bisa
diberikan penyuntikan antibiotik oxytetracycline. Hewan yang habis
melakukan operasi/pembedahan lebih baik dikandangkan di kandang yang
bersih dan kering agar kita bisa mengawasi gerak-gerik pasien. Pemberian
makanan dan vitamin yang tekontrol dengan baik akan mempercepat
penyembuhan pasien dari segi fisik. Bila kondisi pasien buruk pada pasca
operasi bisa diberikan infus larutan Dextrose 5% dalam Saline atau larutan
Laktat Ringer’s, atau pemberian tranfusi darah.

3.2 Saran
Untuk mencegah timbulnya penyakit ini dapat dilakukan dengan
beberapa cara selain dengan mengkandangkan hewan peliharaan dapat juga
dengan memperhatikan kandungan nutrisi pada pakan yang diberikan
(perbaikan nutrisi) , status kesehatan hewan. Perlu diperhatikan penanganan
post operasi sehingga tidak menyebabkan kematian.

8
 DAFTAR PUSTAKA

Burrow, R. D., Gregory, S. P., Giejda, A. A., & White, R. N. (2011). Penile
amputation and scrotal urethrostomy in 18 dogs. Veterinary Record,
169(25), 657–657. doi:10.1136/vr.100039

Mariana, Yanti dan Setiabudy, R. 2011. Farmakologi dan Terapi. Hal : 595. Edisi
ke-4. Bagian Farmakologi Fakultas Kedokteran Universitas Indonesia.
Gaya Baru. Jakarta.

Marzok, M.A. dkk. 2013. A comparison of surgical Outcomes of Perineal

Urethrostomy Plus Penile Resection and Perineal Urethostomy in Twelve
Calves with Perineal or Prescrotal Urethral Dilatation. Open Veterinary
Journal Volume 3, halaman 106-113.

Rizk, Awad. dkk. 2013. Surgical Management of Penile and Preputial Neoplasms
in Equine with Special Reference to Partial Phallectomy. Hindawi
Publishing Comporation Journal of Veterinary Medicine Volume 2013.

Sudisma, I.G.N.,G.A.G.Pemayun.,A.A.G.J.Wardhita.,I.W.Gorda. 2012. Ilmu

Bedah Veteriner dan Teknik Operasi Edisi I. Pelawa Sari. Denpasar.

Wilmana, P. Feddy. 2010. Farmakologi dan Terapi. Hal : 217. Edisi ke-4. Bagian
Farmakologi Fakultas Kedokteran Universitas Indonesia. Gaya Baru.
Jakarta.

Parkinson, K. (2016). A case of penis amputation and scrotal urethrostomy. The

journal for the veterinary profession, 9.

9
See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/287706105

Surgical conditions of the canine penis and prepuce

Article  in  Compendium on Continuing Education for the Practising Veterinarian -North American Edition- · March 2002

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 204
CE Article #2 (1.5 contact hours)
Refereed Peer Review
KEY FACTS
■ Many penile and preputial
abnormalities are hereditary;
trauma is the main cause of
acquired defects.
■ Dogs that have one defect should
be examined (especially in the
midline) for the presence of other
abnormalities.
■ Emergency surgery is often
required in cases of traumatic
abnormalities to treat or prevent
urinary dysfunction or
reproductive failure.
Vol. 24, No. 3 March 2002
Comments? Questions?
Email: compendium@medimedia.com
Web: VetLearn.com • Fax: 800-556-3288
Surgical Conditions
of the Canine Penis
and Prepuce
Aristotle University of Thessaloniki
Thessaloniki, Greece
Lysimachos G. Papazoglou, DVM, PhD, MRCVS
George M. Kazakos, DVM
ABSTRACT: Abnormalities of the canine penis and prepuce may have congenital or acquired
causes. Diagnosis is based mainly on physical examination of the external genitalia. Treatment
of these abnormalities may require surgical intervention or medical management. Because
many of the conditions may be hereditary, normal breeding is discouraged; therefore, surgical
treatment (whether emergency or elective) should be aimed at repairing urinary rather than
reproductive function.
C
ongenital and acquired penile and preputial abnormalities have been
described in dogs.1–3 Trauma is the main cause of acquired abnormali-
ties. Dogs with congenital or acquired abnormalities may be either
asymptomatic or have urinary dysfunction or breeding failure. Dogs that have
one defect should be examined thoroughly (especially in the midline) for the
presence of others.1–3
Because many penile and preputial defects are hereditary, normal breeding
should be discouraged; therefore, surgical intervention of congenital defects
should be aimed at correcting or preventing urinary dysfunction rather than
restoring reproductive performance. Traumatic abnormalities often require emer-
gency surgery to manage or prevent urinary dysfunction and reproductive failure.
Thorough knowledge of the pertinent anatomy and experience with surgical
reconstructive and urologic techniques are essential for a successful outcome.
SURGICAL CONDITIONS OF THE PENIS
Paraphimosis
The inability to retract the penis into the preputial cavity results in paraphi-
mosis. In a study of 185 dogs with penile and preputial diseases,4 paraphimosis
was reported in 7%. Paraphimosis may be attributed mainly to an abnormally
small preputial orifice, ineffective preputial muscles, or a hypoplastic prepuce.
Other reported causes include trauma, infection, neoplasia, persistent erection,
or idiopathic causes.5–9 Paraphimosis is also encountered during sexual excite-
Compendium March 2002 Penile and Preputial Surgery 205

A B
Figure 1—Postcoital paraphimosis in a dog. Note the blood
and bumps.
Figure 2—A crescent-shaped piece of skin has been removed
ment (Figure 1) or coitus. The small preputial orifice cranial to the prepuce, and the preputial muscles have been
initially allows protrusion of the penis; but as the transected and excised (A). Reapposition is performed using a
horizontal mattress suture pattern (B). (From Papazoglou
penis becomes engorged and swollen the small orifice
LG: Idiopathic chronic penile protrusion in the dog: A report
makes retraction impossible. This may lead to severe of six cases. J Small Anim Pract 42:510–513, 2001; with per-
edema and congestion as well as dryness and irrita- mission.)
tion. Consequently, ischemic necrosis and urethral
obstruction may occur. Preputial hairs may encircle
the protruded penis and form a band that contributes
to or causes paraphimosis.3–10
Diagnosis of paraphimosis is made by physical exam-
ination. Determining the cause is essential for effective
treatment. If the prepuce can be drawn forward to
cover the penile protrusion, preputial muscle ineffec-
tiveness may be suspected as the cause.6
Medical treatment should be aimed initially at
retracting the penis into the preputial cavity. While the
dog is under general anesthesia or heavy sedation, cold
compresses consisting of hyperosmolar solutions and
lubricants should be applied to the penis to reduce the
swelling and facilitate retraction into the preputial cav-
ity. If retraction is impossible, surgical enlargement of Figure 3—Abnormal preputial fusion in association with
the prepuce is required. Paraphimosis accompanied by glandular hypospadias in a dog.
penile necrosis is managed with amputation. Paraphi-
mosis that is attributed to preputial muscle ineffective-
ness, preputial hypoplasia, or idiopathic causes is man- Hypospadias
aged with cranial advancement of the prepuce Hypospadias is a rare developmental anomaly in
combined with shortening or imbrication of preputial both male and female dogs in which the urethral ori-
muscles (Figure 2).3,5,9,11,12 In a study of six dogs with fice is located ventral and proximal to the normal
idiopathic paraphimosis in which preputial muscle opening.15,16 In male dogs, hypospadias is caused by
ineffectiveness had been implicated as a cause, results of failure of the urethral folds to fuse when the urethra is
preputial advancement were considered excellent in formed.1,17 This condition is most commonly seen in
four dogs when the length of the exposed penis was 1.5 male dogs with cryptorchidism and, to a lesser extent,
cm or less.9 Longer protrusions, however, may also be with other sexual defects.16 The etiology of hypospa-
managed successfully using the same technique. In case dias seems to be multifactorial in association with
of recurrence or if the penis protrudes too far, partial inadequate fetal androgen production.18 Boston terriers
penile amputation or a staged reconstructive technique reportedly have a familial predisposition to the devel-
may be performed to manage the paraphimosis.9,13,14 opment of hypospadias.16 Anatomic classification of
206 Small Animal/Exotics
A B C D
E
Figure 4—Complete amputation of the external genitalia.
The skin around the prepuce and scrotum is incised in an
elliptical fashion (A). The penis is amputated proximal to the
os penis; and the distal penis, scrotum, and prepuce are
excised (B). A ligature is placed around the remaining penis,
and the penile stump is closed using a simple interrupted
suture pattern. The urethra is incised, and scrotal urethros-
tomy is performed by apposing urethral mucosa and skin in a
simple interrupted pattern with 3-0 or 4-0 nonabsorbable
monofilament suture material (C). The urethral mucosa may
be sutured to the skin in a simple continuous suture pattern
starting at the caudal aspect of the wound (D and E). This
pattern may result in decreased postoperative hemorrhage.
hypospadias may be glandular (Figure 3), penile, scro-
tal, or perineal, depending on the location of the ure-
thral opening.16 In addition to visual abnormalities,
clinical signs include hematuria, dysuria, and urinary
incontinence and scalding.
Diagnosis is made by physical examination of the
penis and perineum. Surgical correction depends on
the severity and location of the lesion.19 Usually a rea-
sonably sized urethral opening can be seen. Dogs with
mild defects may not require surgical correction 19
because the urethra proximal to the abnormal orifice
is underdeveloped.7 Dogs with severe irritation associ-
ated with an abnormally fused prepuce or a hypoplas-
tic penis may need resection of penile and preputial
remnants combined with a scrotal or perineal ure-
throstomy (Figures 4 and 5).7,19 In addition, castration
is always recommended because of the possible
genetic involvement.10,18
Trauma-Related Conditions
In a study of 185 dogs with penis and prepuce condi-
tions,4 trauma accounted for 19% of the causes. Penile
trauma may result from motor vehicle accidents, ani-
mal fights, gunshot injuries, mating attempts, separa-
Compendium March 2002
B
C
Figure 5—Perineal urethrostomy. The urethra is catheterized
and an incision made in the midline approximately 2 to 3
cm dorsal to the scrotum (A). The urethra is incised over
the catheter (B), and a urethrostomy is created by apposing
urethral mucosa and skin in a simple interrupted suture
pattern using 3-0 or 4-0 nonabsorbable monofilament
suture material (C).
tion from the copulatory tie, or failing to clear fences
when jumping.6,17 Penile trauma may lead to hematoma
formation and strangulation and extensive necrosis of
the penis. Profuse hemorrhage and pain are the pre-
dominant clinical signs. Urethral obstruction and frac-
tured os penis can also be seen.6,20 Three recent cases21
of dogs with corpus cavernosum trauma possibly
caused by mating have been reported. All three dogs
were presented with signs of hindquarter pain, whereas
dysuria was noted in two of the animals.
Minor lacerations should be managed as open
wounds. In dogs with major lacerations or persistent
hemorrhage during excitement, suturing the tunica
albuginea with 4-0 or 5-0 synthetic monofilament
absorbable suture material (armed in a taper-cut nee-
dle) in a simple continuous or interrupted pattern is
recommended.7 After surgery, analgesia or antibiotics
may be used (if needed) along with an Elizabethan col-
lar. Sedation and avoidance of contact with females are
recommended to prevent erection.6,7 If penile necrosis
occurs, however, partial or complete amputation of the
penis should be performed (Figures 4 and 6). If partial
penile amputation is performed, preputial shortening
may be required to prevent urine pooling in the
preputial cavity (Figure 7).12
Compendium March 2002 Penile and Preputial Surgery 207

A B C

D
B

A E
C Figure 7—Preputial shortening. A portion of the prepuce is
excised full-thickness (A and B). The skin and mucosa are
Figure 6—Partial penile amputation. A catheter is placed in reapposed in a simple interrupted suture pattern (C).
the urethra and a Penrose tube is used as a tourniquet and for
preputial reflection (A). The penis is incised at a 45˚ angle.
The incision is made down to the os penis dorsally, and the
urethra is elevated from the groove of the os penis (B). The os
penis along with the amputated part of the penis is removed
with a rongeur. The penile stump is closed in a simple inter-
rupted suture pattern (C). The urethra is spatulated (D) and
sutured to the penile stump in a simple interrupted suture
pattern with 4-0 to 5-0 monofilament absorbable suture
material (E).

Tumors
Penile tumors account for 0.24% of all tumors in
male dogs22; transmissible venereal tumors (TVTs) and
squamous cell carcinomas (Figure 8) are the most com-
mon neoplasms of the canine penis.10,17 Other penile
tumors include fibromas, papillomas, and various mes-
enchymal tumors.6,10,23 Penile tumors usually affect
older dogs. In contrast, TVTs occur in young (mean
age, 4 to 5 years), free-roaming dogs and are transmit-
ted by contact with genital mucous membranes during
coitus.24 Clinical signs include preputial enlargement,
serosanguineous or hemorrhagic preputial discharge,
licking of the penis and prepuce, hematuria, dysuria,
and urethral obstruction.7,10
Diagnosis is based on physical examination and is
confirmed by cytology of fine-needle aspirate or
impression smear, incisional or excisional biopsy, and
histopathology.7,17,24 Clinical staging is essential for
squamous cell carcinomas because of the metastatic
potential. 25 Vincristine chemotherapy (0.5 to 0.7
mg/m2 IV in four to eight weekly cycles) is very effec-
tive in treating TVTs, even in dogs with metastatic dis-
ease.24,26 Doxorubicin is also effective.24 Radiotherapy is
Figure 8—Squamous cell carcinoma of the penis and prepuce,
resulting in secondary phimosis.
recommended for animals that are resistant to
chemotherapy.24 Prognosis is usually very good. Surgical
excision is not recommended for TVTs because the
recurrence rate is high.26 Partial or complete penile
amputation combined with scrotal urethrostomy is rec-
ommended for penile tumors, depending on the loca-
tion and type of tumor. Perineal urethrostomy may also
be used in cases in which the tumor extends too far
proximal in the urethra (Figure 5). Ventral midline
preputiotomy may be employed, especially for penile
tumors that are large enough to allow penile extrusion
through the preputial orifice.27 Preputial closure is
accomplished in two layers. The mucosa is closed in a
simple continuous pattern with 4-0 or 5-0 synthetic
monofilament absorbable suture, and the skin is closed
in a routine fashion.27 The effect of adjuvant therapies
in prolonging survival has not been documented.25
Compendium March 2002
Figure 9—Urethral prolapse in a castrated 4-year-old Yorkshire
terrier.
Urethral Prolapse
Prolapse of the distal urethra through the external
urethral orifice is rarely reported in intact male dogs.7
Although this condition has been reported in two
Boston terriers, a Yorkshire terrier, and other breeds,
English bulldogs are mainly affected.28–31 Most of the
affected animals are young. 32 The cause may be
unknown, or the condition may occur after excessive
sexual excitement or urogenital tract infection. 7,23
Abnormal urethral anatomy in relation to increased
intraabdominal pressure caused by upper airway
obstructive syndrome, dysuria, and sexual excitement
have also been proposed to explain the increased
predilection in brachycephalic breeds.32 The prolapsed
urethra, which appears as a pea-shaped mass at the dis-
tal end of the penis, becomes edematous and con-
gested (Figure 9). Licking and intermittent hemor-
rhage, which becomes worse during erection, are the
usual clinical signs.6,7,31
Diagnosis is made by visual examination of the
penis. The condition should be differentiated from
fracture of the os penis, neoplasm, persistent penile
frenulum, urethral stricture, and urethral calculi.30 The
use of castration and hormonal therapy to prevent
erection has been unsuccessful.30,31 Surgical excision of
the prolapse is the treatment of choice, especially for
dogs with severe trauma and necrosis.10,30,33 The ventral
aspect of the penis is incised down to the penile and
urethral mucosa halfway around the circumference.30
The urethral mucosa is sutured to the penile mucosa
in a simple interrupted or continuous pattern17 using
4-0 synthetic monofilament absorbable suture. The
Penile and Preputial Surgery 209
Figure 10—The prolapsed urethra has been resected, and the
urethral mucosa is sutured to the penile mucosa in a simple
interrupted suture pattern.
Figure 11—Persistent penile frenulum in a German short-
haired pointer.
dorsal aspect of the urethral mucosa is then incised
and sutured with the same pattern (Figure 10).30 An
Elizabethan collar should be placed after surgery to
prevent licking of the anastomosis site. For 5 to 10
days, sedation and avoidance of contact with females
in estrus are also recommended to control postopera-
tive hemorrhage. If further trauma of the anastomosis
site is prevented, prognosis following surgical removal
is usually good.17 In rare cases in which urethral pro-
lapse recurs, re-excision is recommended.33
Persistent Penile Frenulum
Persistent penile frenulum is a thin band of connec-
tive tissue that unites the ventral midline aspect of the
glans penis to the prepuce. Rupture of the frenulum in
dogs occurs during puberty, and the process is con-
trolled by testosterone levels.6,7 The condition has been
reported in cocker spaniels, miniature poodles,
Pekingese, and mixed-breed dogs.17,34–36 Dogs with a
penile frenulum may be asymptomatic or may be pre-
sented with penile and preputial licking, urine scalding
212 Small Animal/Exotics
of the hindlimbs caused by diversion of the urine
stream, pain during penile engorgement, unsuccessful
mating, and deviation of the penis during erection (i.e.,
phallocampsis).6,17,23
Diagnosis of penile frenulum is made by visual
examination (Figure 11). Treatment includes severing
the abnormal band with electrosurgery or a surgical
blade while the animal is under light anesthesia. Prog-
nosis following surgery is good. 7 Persistent penile
frenulum is sometimes accompanied by other congeni-
tal defects of the prepuce and penis that may require
reconstructive surgery.3,17
Hypoplastic Penis
Hypoplastic penis, which is an uncommon disorder,
usually occurs in association with other anomalies.17,23,37
This condition is often seen in intersex dogs.6,10,17 Dogs
with penile hypoplasia are usually asymptomatic; the
condition is often found incidentally during routine
clinical examination.6,10 In most cases, no treatment is
required.6,10 However, if the abnormality is accompa-
nied by a hypoplastic preputial orifice, urine pooling,
scalding inside the prepuce, or urine dribbling, then
Compendium March 2002
Figure 12—Transverse fracture of the os penis (arrow) in a
dog. (Courtesy of M. N. Patsikas, DVM, Aristotle University
of Thessaloniki, Greece.)
surgical intervention is necessary.37 Surgical enlarge-
ment of the preputial orifice can be accomplished by
making a triangular incision on the dorsal side of the
orifice; preputial shortening should be performed for
correction of the abnormality (Figure 7).12,37 However,
severe penile hypoplasia may be more easily managed
by amputation and scrotal urethrostomy.
Fracture of the Os Penis
Fracture of the canine os penis is a rarely reported
surgical condition.38,39 This condition can occur in any
size or breed of dog and often follows external penile
trauma.2,6 Simple fractures with minimal displacement
may go undetected, especially if accompanied by mini-
mal soft tissue injury.17 In the reported studies,4,38,39 the
most common presenting signs were associated with
urinary outflow obstruction (e.g., strangury, dysuria,
distended urinary bladder, uremia). Other signs
include local pain, inflammation, and urethral bleed-
ing.20,38 Palpation may reveal crepitus, but radiographic
examination will determine os penis damage and the
amount of callus formation, especially if the lesion is
old (Figure 12).38–40 Urethral catheterization and retro-
grade urography will determine urethral involvement
(e.g., tear, obstruction).4,6,38,39
Treatment may not be necessary in dogs with mini-
mally displaced simple fractures.6,7,17,20 Mobile fractures
require immobilization (for 1 to 3 weeks) with the use
of a urinary catheter that should extend beyond the os
penis.4,17 More severe fractures may require plating,
wiring, or partial or total amputation of the penis.2,7,38,39
Urethral tears rarely need to be sutured and usually heal
around the catheter, except in cases in which complete
severance has occurred.17,20 Retrograde urography is rec-
ommended for 6 to 8 months after the fracture to mon-
Compendium March 2002
Figure 13—Priapism and self-induced traumatization of the
penis in a dog following intervertebral disk disease.
itor whether callus formation impedes urine passage.6 In
one study,39 however, obstructive uropathy appeared 21
months after the fracture occurred. Urethral obstruction
caused by callus formation can be managed with ure-
throstomy distal to the obstruction site.17
Deformity of the Os Penis
Phallocampsis may be caused by deformity of the os
penis. Mild phallocampsis may result in the inability to
achieve vaginal penetration because of misdirected cop-
ulatory efforts, leading to infertility.10,41 This abnormal-
ity may predispose some dogs to urethral obstruction.10
Penile exposure results in drying of the exposed portion
of the penis, self-induced trauma, and eventually infec-
tion and necrosis.7,20
Treatment depends on the condition of the exposed
penis and is generally the same as for paraphimosis.7,20
Treatment may include fracturing the os penis with
wedge osteotomy and straightening it with the aid of
an indwelling urinary catheter and without fixa-
tion.7,20,41 Partial penile amputation may be performed
in severe cases (e.g., infection, necrosis).7 However, if
no other problems (e.g., paraphimosis, outflow urine
obstruction) accompany the deformity, therapy may
not be indicated.10
Priapism
Priapism, which is rarely reported in dogs, is a per-
sistent penile erection not associated with sexual excite-
ment.7,10 The condition is either idiopathic or associ-
ated with spinal cord lesions (Figure 13), trauma
during mating, genitourinary infection, constipation,
thromboembolism of the cavernous venous tissue at the
base of the penis, or therapy for narcolepsy.2,7,42 Exces-
sive parasympathetic stimulation or decreased venous
outflow caused by an occlusive thrombosis or mass
results in stagnation of blood with increased carbon
dioxide and low oxygen concentrations in the corpus
cavernosum penis. This leads to edema with enhanced
Penile and Preputial Surgery 213
A B
Figure 14—Surgical correction of phimosis. A full-thickness,
V-shaped incision is made in the dorsal aspect of the prepuce
(A). The skin and preputial mucosa are apposed using a sim-
ple interrupted or continuous pattern (B).
venous obstruction and eventually irreversible fibrosis
in the main venous outflow tracts of the penis.42
This condition must be differentiated from frequent
erections seen in young small-breed dogs6 and, at least
in early stages, from paraphimosis.7 Chronic exposure
and excessive licking of the penis result in congestion,
swelling, and finally drying and necrosis, rendering dif-
ferentiation from paraphimosis difficult. Although
spontaneous remission can occur,7,17 delay in providing
supportive care may necessitate amputation. The penis
must be kept clean, lubricated with antibiotic creams to
prevent desiccation, and protected from self-induced
trauma. 7,10,17 The erection should subside once the
spinal condition is resolved.7 Amputation of the penis
and scrotal urethrostomy (Figure 4) may be necessary if
the underlying cause cannot be identified and cor-
rected.10,17 According to other reports, successful surgi-
cal treatment has consisted of incision of the bulbus
and pars longa glandis and exsanguination of accumu-
lated blood from the corpus cavernosum penis. The
ability to maintain an erection after surgery, however,
was not reported in the study.43
SURGICAL CONDITIONS OF THE PREPUCE
Phimosis
Phimosis is a condition in which the preputial orifice
is absent or too small to allow extrusion of the penis.44
In a study of 185 dogs with penile and preputial
lesions,4 phimosis accounted for 0.5%. The condition
may be congenital or acquired. Congenital preputial
stenosis has been reported in Bouvier de Flandres, Ger-
216 Small Animal/Exotics
man shepherds, Labrador and golden retrievers, and
mixed-breed dogs. 6 The most common causes of
acquired phimosis are scarring from lacerations follow-
ing trauma, sucking of the puppy’s prepuce by litter-
mates, and licking from the dam.7,17 Neoplasia in this
area may also narrow the preputial orifice.7,17 When the
preputial opening is large enough to allow urination,
puppies may be asymptomatic. In severely affected
dogs, either urine retention in the prepuce is noted or,
depending on the size of the orifice, urine dribbling or
an abnormal stream of urine is evident. Secondary
infections may lead to balanoposthitis and septicemia if
left untreated.2,6 Phimosis may interfere with erection
in sexually mature dogs.10,44
Diagnosis is made by inspecting an anatomically
small preputial opening in relation to the penis. In less
severe cases, it may be necessary to observe the erect
penis and its inability to be extruded from the preputial
orifice.10,44 Differentiation from persistent penile frenu-
lum should be made since phimosis can also result in
the inability of the penis to fully protrude from the pre-
puce.44 In congenital phimosis, in which the preputial
orifice is stenotic, it is possible to further evaluate the
penis and prepuce by performing a radiographic exami-
nation with the use of a contrast media injected into
the preputial cavity via the external opening.45
Surgical correction of the primary condition or
enlargement of the preputial orifice usually leads to a
successful outcome. Removal of neoplasms is usually
accompanied by aggressive removal of the prepuce and
sometimes partial penile amputation.7,46 Postsurgical
stenosis of the orifice should be avoided.7,46 Surgical
enlargement of the orifice should be performed on the
craniodorsal surface instead of the ventrocaudal aspect
to avoid excessive protrusion of the penis.12,46 A midline
full-thickness incision is made to the desired length to
ensure an unrestricted opening.12 It is sometimes neces-
sary to excise a V-shaped amount of tissue in order for
the penis to protrude normally (Figure 14). 37 The
preputial mucosa and ipsilateral skin edges can be
apposed in a simple interrupted7 or continuous pattern
using 4-0 or 5-0 synthetic monofilament nonab-
sorbable suture material to avoid irritation from
knots.46 If necessary, the incision may extend cranially
into the skin on the ventral abdominal wall.46
Neoplasms
All neoplastic diseases that affect the skin can be
found in the prepuce. 7,8 Those most commonly
encountered include mastocytomas, TVTs, squamous
cell carcinomas, and perianal gland adenomas.7,8,25 As
they grow, tumors may obstruct the preputial orifice,
eventually causing phimosis. Ulcerations may favor
Compendium March 2002
bacterial overgrowth; therefore, orifice involvement
may lead to balanoposthitis.44 Preputial neoplasms may
sometimes extend to the penis.17
Diagnosis is made using cytology of fine-needle aspi-
rate or impression smear, incisional or excisional biopsy,
and histopathology.7,24 Clinical staging is required for
mast cell tumors and squamous cell carcinomas because
of their metastatic potential.25 Appropriate therapy
depends on tumor type, behavior, and metastases.
Treatment of small neoplasms includes surgical removal
of the mass with closure of the prepuce in two layers.7
Postoperative paraphimosis should be avoided.7 Wide
surgical excision (partial or total preputial/penile ampu-
tation) should be included in the therapy plan for
malignant tumors.7,44 Radiotherapy or chemotherapy
may be required for mast cell tumors not amenable to
surgical excision or as an adjuvant therapy.47 Manage-
ment of preputial TVTs is the same as for penile
TVTs.24 Orchidectomy is advised in cases of perianal
gland tumors.
Trauma- and Foreign Body–Related Conditions
Preputial trauma may result from motor vehicle acci-
dents, dog fights, attempts to mate, environmental
injuries, gunshot injuries, or failing to clear fences when
jumping.6,17 In some cases only the external lamina is
involved; with full-thickness lacerations, both the exter-
nal and internal laminae may be involved. 8 Preputial
wounds, which may also result from foreign bodies
(e.g., grass awns, plant seeds, urinary calculi), usually
cause irritation or ulceration of the mucosa, leading to
mucopurulent or blood-tinged discharge, discomfort,
and mild hindlimb stiffness. A draining tract is usually
present ventral or lateral to the penis. Draining tract
exploration, foreign-body removal, and tract drainage
should be performed.7 Prognosis is usually good after
foreign-body removal.7,10 For dogs with full-thickness
lacerations or those in which loss of tissue has occurred,
the prepuce should be closed in two layers. 17 The
mucosa is closed in a continuous pattern with 4-0 or 5-
0 synthetic monofilament absorbable suture material,
and the skin is closed routinely. Measures aimed at pre-
venting self-induced trauma should be taken. Extensive
traumatic loss of the prepuce may be managed with
reconstructive staged surgery. 14 Partial or complete
preputial and penile amputation should also be consid-
ered with injuries resulting from extensive trauma.17
Preputial Hypoplasia and Abnormal Fusion
The prepuce may be underdeveloped or absent or
may not fuse normally because of failure of the genital
folds to close normally during fetal life.7 Abnormal
preputial fusion can be seen in association with
Compendium March 2002
hypospadias (Figure 3).6,15,48 Clinical signs are related to
chronic paraphimosis, which may lead to inflamma-
tion, drying, self-mutilation, and penile trauma.7,46
Paraphimosis may be managed successfully with cra-
nial advancement of the prepuce.9 Severe preputial
hypoplasia usually requires staged reconstruction of
both preputial laminae using skin flaps and oral
grafts13,14; however, partial penile amputation remains
an alternative to reconstructive surgery. 9 Abnormal
preputial fusion may be treated by complete excision of
the exposed preputial mucosa, partial amputation of
the penis, and scrotal or perineal urethrostomy.7,12,48
REFERENCES
1. Rawlings CA: Correction of congenital defects of the urogenital
system. Vet Clin North Am Small Anim Pract 14:49–60, 1984.
2. Johnston SD: Disorders of the canine penis and prepuce, in
Morrow DA (ed): Current Therapy in Theriogenology, ed 2.
Philadelphia, WB Saunders Co, 1986, pp 549–550.
3. Olsen D, Salwei R: Surgical correction of a congenital preputial
and penile deformity in a dog. JAAHA 37:187–192, 2001.
4. Ndiritu CG: Lesions of the canine penis and prepuce. Mod Vet
Pract 60:712–715, 1979.
5. Chaffee VW, Knecht CD: Canine paraphimosis: Sequel to inef-
ficient preputial muscles. Vet Med Small Anim Clin 70:1418–
1420, 1975.
6. Johnston DS: Disorders of the external genitalia of the male, in
Ettinger SJ (ed): Textbook of Veterinary Internal Medicine, ed 3.
Philadelphia, WB Saunders Co, 1989, pp 1881–1889.
7. Boothe HW: Penis, prepuce, and scrotum, in Slatter D (ed):
Textbook of Small Animal Surgery, ed 2. Philadelphia, WB Saun-
ders Co, 1993, pp 1336–1348.
8. Fowler DJ: Preputial reconstruction, in Bojrab MJ (ed): Current
Techniques in Small Animal Surgery, ed 4. Baltimore, Williams &
Wilkins, 1998, pp 534–537.
9. Papazoglou LG: Idiopathic chronic penile protrusion in the dog:
6 cases. J Small Anim Pract 42:510–513, 2001.
10. Feldman EC, Nelson RW: Canine and Feline Endocrinology and
Reproduction, ed 2. Philadelphia, WB Saunders Co, 1996, pp
691–696.
11. Leighton RL: A simple surgical correction for chronic penile
protrusion. JAAHA 12:667, 1976.
12. Hobson HP: Surgical procedures of the penis, in Bojrab MJ
(ed): Current Techniques in Small Animal Surgery, ed 4. Balti-
more, Williams & Wilkins, 1998, pp 527–534.
13. Pope ER, Swaim SF: Surgical reconstruction of a hypoplastic
prepuce. JAAHA 22:73–77, 1986.
14. Smith MM, Gourley IM: Preputial reconstruction in a dog.
JAVMA 196:1493–1496, 1990.
15. Ader PL, Hobson HP: Hypospadias: A review of the veterinary
literature and report of three cases in the dog. JAAHA 14:
721–727, 1978.
16. Hayes Jr HM, Wilson GP: Hospital incidence of hypospadias in
dogs in North America. Vet Rec 118:605–606, 1986.
17. Hobson HP: Surgical pathophysiology of the penis, in Bojrab
MJ (ed): Disease Mechanisms in Small Animal Surgery, ed 2.
Philadelphia, Lea & Febiger, 1993, pp 552–559.
18. Meyers-Wallen VN, Patterson DF: Disorders of sexual develop-
ment in dogs and cats, in Kirk RW (ed): Kirk’s Current Veteri-
nary Therapy X: Small Animal Practice. Philadelphia, WB Saun-
ders Co, 1989, pp 1261–1269.
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19. Howard PE, Bjorling DE: The intersexual animal: Associated
problems. Probl Vet Med 1:74–84, 1989.
20. Johnston DE: Repairing lesions of the canine penis and prepuce.
Mod Vet Pract 46:39–47, 1965.
21. Lobetti RG, Griffin HE, Nothling JO: Suspected corpus caver-
nosum trauma in three dogs. Vet Rec 137:492, 1995.
22. Schneider R: Epidemiological aspects of mammary and genital
neoplasia, in Morrow DA (ed): Current Therapy in Theriogenol-
ogy. Philadelphia, WB Saunders Co, 1980, pp 636–639.
23. Root Kustritz MV: Disorders of the canine penis. Vet Clin North
Am Small Anim Pract 31:247–257, 2001.
24. Rogers KS, Walker MA, Dillon HB: Transmissible venereal tumor:
A retrospective study of 29 cases. JAAHA 34:463–470, 1998.
25. Cooley DM, Waters DJ: Tumors of the male reproductive system,
in Withrow SJ, MacEwen EG (eds): Small Animal Clinical Oncol-
ogy, ed 3. Philadelphia, WB Saunders Co, 2001, pp 478–489.
26. Boscos C: Canine transmissible venereal tumor: Clinical obser-
vations and treatment. Anim Fam 3:10–15, 1988.
27. Hayes AG, Pavletic MM, Schwartz A, Boudrieau RJ: A preputial
splitting technique for surgery of the canine penis. JAAHA
30:291–295, 1994.
28. Copland MD: Prolapse of the penile urethra in a dog. N Z Vet J
23:180–181, 1975.
29. Hobson HP, Heller RA: Surgical correction of prolapse of the
male urethra. Vet Med Small Anim Clin 66:1177–1179, 1971.
30. Sinibaldi KR, Green RW: Surgical correction of prolapse of the
male urethra in three English Bulldogs. JAAHA 9:450–453,
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31. McDonald RK: Urethral prolapse in a Yorkshire terrier. Com-
pend Contin Educ Pract Vet 11(6):682–683, 1989.
32. Osborne CA, Sanderson SL: Medical management of urethral
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erinary Therapy XII: Small Animal Practice. Philadelphia, WB
Saunders Co, 1995, pp 1027–1029.
33. Birchard SJ: Surgical treatment of urethral prolapse in male dogs,
in Bojrab MJ (ed): Current Techniques in Small Animal Surgery,
ed 4. Baltimore, Williams & Wilkins, 1998, pp 475–477.
34. Hutchison JA: Persistence of the penile frenulum in dogs. Can
Vet J 14:71, 1973.
35. Ryer KA: Persistent penile frenulum in a cocker spaniel. Vet
Med Small Anim Clin 74:688, 1979.
36. Balke J: Persistent penile frenulum in a cocker spaniel. Vet Med
Small Anim Clin 76:988–990, 1981.
37. Proescholdt TA, De Young DW, Evans LE: Preputial reconstruc-
tion for phimosis and infantile penis. JAAHA 13:725–727, 1977.
38. Stead AC: Fracture of the os penis in the dog—Two case reports.
J Small Anim Pract 13:19–22, 1972.
39. Kelly SE, Clark WT: Surgical repair of fracture of the os penis in
a dog. J Small Anim Pract 36:507–509, 1995.
40. Denholm TC: Fracture of the os penis. Vet Rec 69:15, 1957.
41. Bennet D, Baughan J, Murphy F: Wedge osteotomy of the os
penis to correct penile deviation. J Small Anim Pract 27:379–
382, 1986.
42. Root Kustritz MV, Olson PN: Theriogenology question of the
month. JAVMA 214:1483–1484, 1999.
43. Orima H, Tsutsui T, Waki T, et al: Surgical treatment of priapism
observed in a dog and a cat. Jpn J Vet Sci 51:1227–1229, 1989.
44. Christie TR: Phimosis and paraphimosis, in Bojrab MJ (ed):
Pathophysiology in Small Animal Surgery. Philadelphia, Lea &
Febiger, 1981, pp 442–443.
45. Sarierler M, Kara ME: Congenital stenosis of the preputial ori-
fice in a dog. Vet Rec 143:201, 1998.
218 Small Animal/Exotics Compendium March 2002

46. Pope ER: Surgery of the penis, prepuce and scrotum. Proc ACVS c. partial penile amputation
Vet Symp:492–494, 1997. d. cranial preputial advancement
47. Thamm DH, Vail DM: Mast cell tumors, in Withrow SJ,
MacEwen EG (eds): Small Animal Clinical Oncology, ed 3.
Philadelphia, WB Saunders Co, 2001, pp 261–282.
8. Which of the following conditions does not predispose
a dog to urethral obstruction?
48. Croshaw JE, Brodey RS: Failure of preputial closure in a dog.
JAVMA 136:450–452, 1960. a. persistent penile frenulum c. os penis fracture
b. os penis deformity d. paraphimosis

ARTICLE #2 CE TEST 9. Which of the following statements regarding the man-

CE
The article you have read qualifies for 1.5 con- agement of hypospadias is false?
tact hours of Continuing Education Credit from a. Dogs with hypospadias always require surgical cor-
rection.
the Auburn University College of Veterinary Med-
b. Dogs with mild hypospadias may require no surgi-
icine. Choose the best answer to each of the follow- cal treatment.
ing questions; then mark your answers on the c. Dogs with severe hypospadias may need penile
postage-paid envelope inserted in Compendium. amputation and urethrostomy.
d. Surgical correction depends on the severity and
1. Cranial advancement of the prepuce should not be location of hypospadias.
performed in cases of
a. paraphimosis caused by preputial muscle ineffec- 10. The prepuce in dogs with full-thickness lacerations
tiveness. should be closed
b. idiopathic paraphimosis. a. using one suture layer.
c. preputial hypoplasia. b. using two suture layers.
d. paraphimosis following trauma. c. using healing by second intention.
d. by suturing the mucosa with nonabsorbable suture
2. Vincristine chemotherapy may be used to treat penile material.
TVTs at a dose of _______ mg/m2.
a. 0.2 c. 0.5 to 0.7
b. 0.1 d. 1

3. Which of the following statements regarding the treat-

ment of urethral prolapse is true?
a. Surgical excision of the prolapsed mass is necessary.
b. Spontaneous resolution of the prolapse is common.
c. Castration is effective in treating urethral prolapse.
d. Hormonal therapy should be included in the treat-
ment protocol for urethral prolapse.

4. Priapism may result from

a. a spinal cord lesion. c. genitourinary infection.
b. constipation. d. all of the above

5. Which of the following conditions is not included in

the diagnostic differentials of urethral prolapse?
a. stricture c. calculus
b. tumor d. phimosis

6. Which of the following tumors is commonly located

in the prepuce?
a. melanoma c. lymphoma
b. mastocytoma d. osteosarcoma

7. Which of the following is not recommended for the

treatment of preputial hypoplasia?
a. staged reconstructive surgery using skin flaps and
oral grafts
b. mesh skin graft

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Vet Times
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A case of penis amputation and scrotal urethrostomy

Author : Kate Parkinson

Categories : Companion animal, Vets

Date : October 3, 2016

ABSTRACT

Penis amputation and scrotal urethrostomy in a dog is indicated for several conditions, including
severe wounds of the distal penile shaft. Hair ligatures are a common cause of penile injury and
should be ruled out in all cases of penile prolapse and paraphimosis.

The author found the surgery challenging, but suitable for colleagues comfortable with their soft
tissue handling skills. A scrotal urethrostomy is the preferred site. Scrotal ablation is advised and
aggressive pain relief during and after surgery is indicated. A round-bodied needle is
recommended for suture of the urethral stoma to the skin. Fashioning the stoma was the most
technically demanding part of the procedure.

Veterinary surgeons should discuss complications and postoperative expectations with owners,
including the possibility of postoperative haemorrhage and the potential requirement of a lengthy
postoperative period. The patient’s temperament is an important consideration.

A five-year-old castrated male retriever-type dog with suspected penile prolapse presented
to the clinic as an emergency, following a three-hour mounting session with a long-coated
bitch.

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Figure 1. Necrotic penis with prepuce retracted.

The owners reported the dog seemed unable to retract his penis into its sheath, he was in pain and
was attempting to urinate, but seemed incapable of passing urine.

The patient was ambulatory on admission, with a prolapsed, discoloured and tumescent penis. No
initial sign of penile trauma was apparent. Following application of a commercial lubricant and
lavage with a hypertonic sugar solution, the penis rapidly became flaccid. However, the patient was
still unable to pass urine and the penis remained extruded from the prepuce.

Following a more detailed examination, a constricting hair ligature was found encircling the penis
just distal to the bulbus glandis. A dose of medetomidine (10µg/kg IV) and butorphanol (0.2mg/kg
IV) resulted in good sedation. The ligature was removed gently with scissors. Following ligature
removal, 1L of concentrated urine was removed from the bladder via catheterisation.

The penis was lubricated and replaced within the prepuce. A purse-string suture was placed
around the preputial opening to prevent further prolapse before sedation was reversed using
atipamezole.

IV lactated Ringer’s solution was provided at 5ml/kg/hr via the cephalic vein. Pain relief
(meloxicam 0.1mg/kg by mouth once daily) and broad-spectrum antibiotic treatment
(amoxicillin/clavulanate 12.5mg/kg by mouth twice daily) were instituted. An Elizabethan collar was
applied to prevent injury to the penis.

Hair rings
Hair rings have been documented as a cause of reproductive injury in cats1, bulls2, chinchillas3 and
humans4, as well as other food-producing animals. Although our patient had been castrated by

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another vet several years prior to presentation, this had not prevented a prolonged period of
mounting. This is not unusual, even in castrated male dogs, as behavioural responses to castration
may vary5.

Indication for penile amputation

Figure 2. Necrotic penis protruding from prepuce.

The purse-string suture was removed 24 hours after presentation and the penis was examined
(Figure 1). The patient was passing urine normally by this time. However, the penis was mildly
prolapsed (Figure 2) and the shaft of the penis distal to the ligature was discoloured. Twice-daily
lubrication was instituted, and pain relief and broad-spectrum antibiotic cover was continued. The
prognosis appeared guarded and the potential for penile amputation was discussed with the
owners at this stage.

At 48 hours after presentation, the shaft distal to the ligature had become necrotic. The dog was
bright, urinating, eating and comfortable. Due to the advanced stage of the necrosis, it was clear a
salvage procedure, such as amputation followed by urethrostomy, was the only remaining surgical
option. The author researched surgical techniques with the help of Small Animal Surgery6 and the
Veterinary Information Network website7.

Surgery preparation
Unfortunately, referral of the case was not an option due to financial concerns. At first, the
patient’s owners were reluctant to consider amputation due to fear of an unacceptable cosmetic
outcome, and euthanasia was discussed at this time. Following a conversation, which included
photographs of similar cases and discussion of potential complications, surgery was scheduled for
the following day.

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At 72 hours after presentation, the distal portion of the penile shaft sloughed and the dog
consumed the portion of necrotic tissue en route to the main clinic, despite the use of an
Elizabethan collar.

A premedication of acepromazine (0.01mg/kg) and morphine (0.1mg/kg; used under the cascade)
was administered IM and general anaesthesia was induced by IV propofol given to effect.
Following intubation, anaesthesia was maintained with isoflurane. A urinary catheter was inserted
and the patient’s bladder was drained prior to surgery. The urethral opening was difficult to locate
due to the advanced state of necrosis, and placement of the urinary catheter aided intraoperative
location of the urethra prior to scrotal urethrostomy. A constant rate IV infusion of morphine and
ketamine was used during surgery and continued until 24 hours after surgery.

Surgical technique
An elliptical incision was made around the genitalia and the penis was dissected carefully from the
abdominal wall. The preputial and caudal superficial epigastric vessels were carefully ligated with
3-0 polydioxanone suture material. The penis was dissected from the body in a caudal direction.

The dorsal penile vessels were identified and ligated and the penis was separated from the
abdominal wall just caudal to the os penis. A tourniquet was used just proximally to the
urethrostomy site during the early stages of surgery. This proved invaluable in reducing
intraoperative haemorrhage. As the patient retained a small scrotum, despite castration, a scrotal
ablation was performed.

To create the urethrostomy opening, the urethral mucosa was incised over the indwelling catheter.
The incision was about 3cm in length. An incision length of 2cm to 4cm is recommended to ensure
sufficient lumen size after healing is complete8. The urethral mucosa was flared and sutured to the
skin with a simple interrupted pattern of 5-0 polydioxanone suture. This was the most technically
demanding stage of the surgery.

The skin was closed using a simple interrupted pattern of 3-0 polyglactin 910 suture. Simple
continuous closure patterns have also been described9. A swaged reverse cutting needle was used
to place the sutures, beginning at each corner of the flared urethra before suturing around the
edges of the stoma. The incised edges of the corpus cavernosum were incorporated into the suture
using a “sandwich” technique, in the hope this method would reduce postoperative bleeding. No
additional haemostasis was required.

Urethrostomy site

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Figure 3. Urethrostomy site following surgery.

Several urethrostomy locations are possible in small animals. Preputial urethrostomy was deemed
inappropriate in this case, due to the proximal location of the injury. This procedure, when feasible,
is desirable as the dog can still urinate through the prepuce – reducing the risk of skin irritation or
urine scalding in the postoperative period10.

Transpelvic urethrostomy using an ischial ostectomy has been performed by specialist surgeons
with good results11. However, this radical approach was not a treatment the author was familiar
with or comfortable performing.

Scrotal or perineal urethrostomy in the dog is a widely recognised and well-documented procedure,
associated with good surgical outcomes. A caudally positioned stoma ensures urine is voided
straight down the perineal urethra. Careful assessment of the site and excision of any remaining
scrotal folds is necessary to prevent postoperative urine scalding. This option was chosen by the
author due to the ease of the procedure and high chance of a successful postoperative outcome
(Figure 3).

Postoperative care
An Elizabethan collar was used post-surgery to prevent licking. The patient’s inguinal region and
inner thighs were clipped short to prevent urine staining (Figure 4) and zinc barrier cream was
used generously in this region to prevent urine scald. Petroleum jelly is a good alternative due to
the risk of zinc toxicity12 if large quantities of zinc cream are consumed.

Bandages were applied to both hindfeet for several days post-surgery to prevent traumatic
damage. Broad-spectrum antibiotic cover was continued until five days postoperatively. The patient
was exercised on flat ground only for two weeks following his operation to encourage a squatting

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position while urinating. Exercise was strictly limited to short lead walks only. The sutures were
dissolvable.

Pain relief
A constant rate IV infusion of morphine (0.25mg/kg/hr) and ketamine (0.8mg/kg/hr) was used
intraoperatively and continued until 24 hours post-surgery. Maropitant (1mg/kg SQ once daily) was
administered in the initial postoperative procedure to provide additional visceral pain relief. NSAIDs
(meloxicam 0.1mg/kg by mouth once daily) were administered for several days following the
procedure.

Complications

Figure 4. Patient two days after surgery.

The patient experienced some moderate post-surgical haemorrhage when urinating. This
haemorrhage continued for 14 days post-surgery. This is a recognised complication and may have
been marginally exacerbated with the use of a reverse cutting needle to suture the urethrostomy
site.

For this reason, round-bodied needles are preferred if available. The haemorrhage was not
clinically significant, although it was sufficiently dramatic that the dog was hospitalised for the full
14 days. This should be taken into account when calculating presurgical estimates and managing
owner expectations.

Due to the potential for postoperative and intraoperative haemorrhage, penis amputation and
scrotal urethrostomy would not be recommended in patients with coagulation defects. Excitement
in some dogs can also lead to excessive haemorrhage from the urethrostomy site and sedation

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may be necessary to control the bleeding in these cases.

Complications associated with penile amputation and scrotal urethrostomy were evaluated in a
small study13. A total of 18 dogs were evaluated following surgery. All 18 dogs experienced some
postoperative bleeding for up to 21 days following surgery.

Four dogs (22.2%) experienced minor post-surgical complications at suture removal, including
haemorrhage at the site of suture removal, postoperative bruising and swelling, and granulation of
the edge of the surgical site.

One dog experienced a major postoperative complication when post-surgical dehiscence caused a
stricture of the stoma. All dogs with non-neoplastic diseases had excellent long-term outcomes.

A retrospective study of 38 dogs with scrotal urethrostomies14 found 26 of 36 dogs (72.2%)

enrolled in the study experienced similar post-surgical bleeding. Mean duration of postoperative
bleeding in the study population was of much shorter duration (3.1 days), indicating the length of
postoperative bleeding is reduced if urethrostomy is performed without penile amputation.

Urine scalding is another potential complication of this surgery. Excision of all redundant skin is
crucial. A caudally positioned perineal or scrotal urethrostomy is less likely to cause scald as the
urine is voided straight down the pelvic urethra.

Squatting to urinate should be encouraged as this urination posture is less likely to cause
contamination of the inguinal region with urine. Urination should be closely monitored, good
hygiene observed and barrier cream used when necessary.

Stricture of the urethrostomy site is associated with incisional dehiscence. Dehiscence should be
repaired without tension if required. One advantage of a scrotal urethrostomy is a subsequent
perineal urethrostomy can be performed if needed.

Temperament
The patient experienced no other postoperative complications and coped well with the long
postoperative hospitalisation period. He was a very relaxed dog with an exceptionally good
temperament.

Aggressive animals would be much more difficult to manage postoperatively and this must be
taken into account when planning surgery and postoperative care.

Outcome
Long-term outcome was excellent. Three months following surgery, the urethrostomy site had

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healed well and the patient was able to pass urine easily, although his coat had to be kept clipped
short to prevent scald. His owners were pleased with the outcome.

Conclusion
In conclusion, this was an interesting surgery well within the abilities of the average general
practitioner. The author found the surgery of comparable difficulty to a mammary strip or mature
spay in a large breed dog.

A scrotal urethrostomy is generally preferred to prevent urine scald and a urethral incision of at
least 2cm is recommended to prevent stricture formation at the stoma. A round-bodied needle is
recommended when placing sutures between the skin and urethral mucosa.

Aggressive pain relief is necessary in the initial postoperative period and some haemorrhage is to
be expected. As with all surgeries, the importance of managing the client’s expectations, as well
as excellent communication, cannot be overestimated. A prolonged postoperative period of
hospitalisation may be required. For this reason, patients of good temperament are better suited to
this procedure than aggressive or nervous dogs, whose natural tendencies may be exacerbated by
fear, pain and anxiety resulting from a change in their daily routine.

Acknowledgment
The author would like to thank the staff of VetSouth Winton, Jeni Watts for photography and Marie
Kubiak for reviewing the article.

References

1. Little S (2001). Uncovering the cause of infertility in queens, Veterinary Medicine 96(7):
557-568.
2. Hopper RM (2016). Management of male reproductive tract injuries and disease, The
Veterinary Clinics of North America: Food Animal Practice 32(2): 497-510.
3. Donnelly T (2015). Chinchillas: nutrition, husbandry and medicine, BSAVA Congress,
Birmingham.
4. Ba?tu? O, Korkmaz L, Korkut S, Halis H and Kurto?lu S (2015). Hair-thread tourniquet
syndrome in a preterm baby, Turkish Paediatric Archives 50(4): 245-247.
5. Kuhne F (2012). Castration of dogs from the standpoint of behaviour therapy, Tierarztl
Praxis Ausg K Klientiere Heimtiere 40(2): 140-145.
6. Fossum TW (2007). Small Animal Surgery (3rd edn), Elsevier Mosby, St Louis: 672-673
and 763-766.
7. www.vin.com
8. Aronson LR (2015). Small Animal Surgical Emergencies, Wiley Blackwell, Ames: 245.
9. Newton JD and Smeak DD (1996). Simple continuous closure of canine scrotal

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 urethrostomy: results in 20 cases, Journal of the American Animal Hospital Association
32(6): 531-534.
10. Pavletic MM and O’Bell SA (2007). Subtotal penile amputation and preputial urethrostomy
in a dog, Journal of the American Veterinary Medical Association 230(3): 375-377.
11. Liehmann LM, Doyle RS and Powell RM (2010). Transpelvic urethrostomy in a
Staffordshire bull terrier: a new technique in the dog, Journal of Small Animal Practice
51(6): 325-329.
12. Wright S and Sobczak BR (2014). Toxicology case: how to help dog owners manage zinc
oxide toxicosis, Veterinary Medicine 109(5).
13. Burrow RD, Gregory SP, Giejda AA and White RN (2011). Penile amputation and scrotal
urethrostomy in 18 dogs, Veterinary Record 169(25): 657.
14. Bilbrey SA, Birchard SJ and Smeak DD (1991). Scrotal urethrostomy: a retrospective
review of 38 dogs (1973 through 1988), Journal of the American Animal Hospital
Association 27(5): 560-564.

Further Reading

Bojrab MJ, Ellison GW and Slocum B (1990). Current Techniques in Small Animal Surgery
(3rd edn), Lea and Febiger, Philadelphia: 382.
Brockman DJ (2013). Lower urinary tract salvage options, Proceedings of the WSAVA
World Congress, Auckland.
Giejda AA, Gregory SP, White RN and Burrow RD (2009). Penile amputation in 14 dogs – a
retrospective study, Proceedings of BSAVA Congress 1: 300.

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Papers

Papers
Penile amputation and scrotal urethrostomy
in 18 dogs
R. D. Burrow, S. P. Gregory, A. A. Giejda, R. N. White

The objective of this study was to report the signalment, indications for surgery,
postoperative complications and outcome in dogs undergoing penile amputation and scrotal
urethrostomy. Medical records of three surgical referral facilities were reviewed for dogs
undergoing penile amputation and scrotal urethrostomy between January 2003 and July
2010. Data collected included signalment, presenting signs, indication for penile amputation,
surgical technique, postoperative complications and long-term outcome. Eighteen dogs
were included in the study. Indications for surgery were treatment of neoplasia (n=6),
external or unknown penile trauma (n=4), penile trauma or necrosis associated with urethral
obstruction with calculi (n=3), priapism (n=4) and balanoposthitis (n=1). All dogs suffered
mild postoperative haemorrhage (posturination and/or spontaneous) from the urethrostomy
stoma for up to 21 days (mean 5.5 days). Four dogs had minor complications recorded at
suture removal (minor dehiscence (n=1), mild bruising and swelling around the urethrostomy
site and mild haemorrhage at suture removal (n=2), and granulation at the edge of stoma
(n=1)). One dog had a major complication (wound dehiscence and subsequent stricture of
the stoma). Long-term outcome was excellent in all dogs with non-neoplastic disease. Local
tumour recurrence and/or metastatic disease occurred within five to 12 months of surgery
in two dogs undergoing penile amputation for the treatment of neoplasia. Both dogs were
euthanased.

THE surgical technique for penile amputation, ablation of the external The level at which penile amputation is actually performed (ie,
genitalia and urethrostomy in the dog have been described by Leighton partial or complete) and the site of the subsequent urethrostomy
(1976), Hobson (1990) and Boothe (2003). Penile amputation has been depends on the nature and location of the penile lesion and/or prepu-
reported and/or suggested for the treatment of penile trauma includ- tial lesion that is being treated. Distal penile lesions may be treated
ing strangulation of the penis resulting in gangrene of the distal por- by partial penile amputation alone, and if a large portion of the glans
tion and severe damage to the urethra (Hobson 1990, Boothe 2003) penis is removed, shortening of the prepuce has been recommended
and for the treatment of priapism (Martins-Bessa and others 2010), (Hayes and others 1994) to avoid the complications associated with
penile neoplasia (Michels and others 2001, Bleier and others 2003, urine being voided into the prepuce on urination. More extensive
Marolf and others 2006, Root Kustritz and Fick 2007, Peppler and penile lesions or extensive preputial disease (eg, trauma, neoplasia)
others 2009, Webb and others 2009), urethral neoplasia (Davis and may necessitate more aggressive penile amputation with excision of
Holt 2003), arteriovenous fistula of the prepuce (Trower and others the prepuce. The urethrostomy site may be prescrotal, scrotal or peri-
1997), hypospadias (Galanty and others 2008) and other conditions neal depending on the actual site at which penile amputation has been
where there is traumatic loss, acquired or congenital abnormalities of performed.
the prepuce leaving the distal portion of the penis exposed (Croshawe Urethral stricture is a possible complication of partial penile ampu-
and Brodey 1960, Hobson 1990, Soderbergh 1994, Papazoglou 2001, tation if healing is complicated (Boothe 2003). Other complications
Hedlund 2002, Papazoglou and Kazakos 2002, Boothe 2003). reported for penile amputation include early postoperative urine scald
and the inability to urinate due to suspected urethral sphincter hyper-
tonus (Michels and others 2001). Postoperative haemorrhage from the
Veterinary Record doi: 10.1136/vr.100039 urethrostomy site (Bilbrey and others 1991) and urine dribbling with
scalding of the medial surface of the hindlimbs are possible complica-
R. D. Burrow, BVetMed, CertSAS, R. N. White, BSc, BVetMed, CertVA, tions of urethrostomy performed alone without penile amputation
CertVR, DipECVS, MRCVS, DSAS (soft tissue), DipECVS, MRCVS, (Kyles and others 1996, Smeak 2000, Bjorling 2003). Despite the sur-
A. A. Giejda, DVM, MRCVS, Willows Veterinary Centre and Referral gical technique being well described, penile amputation is a procedure
The Royal Veterinary College, Service, Shirley, Solihull,West Midlands that is uncommonly performed and there are only individual cases of
University of London, B90 4NH, UK penile amputation reported in the English language veterinary litera-
London, UK ture. This retrospective study describes a further 18 cases and reviews
S. P. Gregory, BVetMed, PhD, DVR, E-mail for correspondence: the indications for surgery, postoperative complications and long-term
DSAS (soft tissue), MRCVS, rburrow@liv.ac.uk outcome.
Department of Veterinary
Clinical Sciences, Royal Veterinary Provenance: not commissioned; Materials and methods
College, North Mymms, externally peer reviewed The medical records of three referral facilities (The Small Animal
Hertfordshire Teaching Hospital, University of Liverpool; Queen Mother Hospital
AL9 7TA, UK Accepted August 31, 2011 for Small Animals, The Royal Veterinary College, and Robert N.

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Papers

TABLE 1: Clinical details of 18 dogs undergoing penile amputation and scrotal urethrostomy
Hosp. Late
Case Age Sex Breed Presenting signs Diagnosis (days) Urethrostomy closure Early complications complications Outcome

1 7y MN Labrador Preputial mass Intermediate grade 3 Continuous MIHSU for 5 days None Euthanased 1 year
mast cell tumour later, metastatic
disease
2 1y 6m M Bull dog Persistent erection Chronic priapism, 3 Continuous MIHSU for 3 days None Excellent
following coitus thrombus within corpus
cavernosum
3 6y M Golden Unseen trauma with Fracture of the os penis, 4 Continuous MIHSU for 3 days, None Excellent
retriever resulting chronic chronic balanoposthitis localised bruising and
penile engorgement spontaneous bleeding at
and irritation urethrostomy site on 5th
day postoperatively
4 12y 3m MN Cross bred Preputial mass Liposarcoma 4 Continuous MIHSU for 3 days None Excellent
5 5y 8m MN Dalmatian Dysuria, Obstruction of penile 4 Continuous MIHSU for 21 days None Excellent, dietary
traumatisation of urethra with urate control of urate
penis and prepuce calculi urolithiasis
6 5y 2m M Rottweiler Preputial mass Haemangiosarcoma 6 Continuous MIHSU for 1 day, localised None Euthanased 5
bruising and spontaneous months later,
haemorrhage from metastatic disease
urethrostomy at 5 days
postoperatively
7 7y 5m MN Cross bred Severe penile/ Fractured os penis, 7 Simple interrupted MIHSU for 1 day, localised None Excellent
preputial trauma penile urethral rupture bruising and spontaneous
associated with dog bleeding at urethrostomy at
fight 7 days postoperatively
8 4y 7m MN Yorkshire Protrusion and Chronic idiopathic 3 Simple interrupted MIHSU for 7 days None Excellent
terrier vascular engorgement priapism
of penis
9 7y M Golden Dysuria, stranguria, Severe 5 Simple interrupted MIHSU for 1 day, mild None Excellent
retriever penile swelling and thrombophlebitis, bruising and spontaneous
haemorrhage after cellulitis and penile bleeding at urethrostomy
dog fight 3 weeks haematoma at 11 days postoperatively,
previously urinary tract infection
10 11y MN Bassett Hound Profuse penile Balanoposthitis, 8 Simple interrupted MIHSU for 7 days None Excellent
haemorrhage lacerations of bulbus
glandis penis
11 4y M Swedish Dysuria swollen Balanitis, fracture of the 13 Simple interrupted MIHSU for 3 days None Excellent
Vallhund haemorrhagic penis os penis, urethral and
cystic calculi
12 10y M Sheltie Collapsed, dysuric Penile necrosis, orchitis, 62 Simple interrupted MIHSU for 1 day, complete Stricture of Excellent
swollen testicles, urethral and cystic dehiscence of skin and urethrostomy
swollen and calculi urethrostomy wounds site, urinary
discoloured penis tract infection
following prescrotal
urethrotomy
13 5y M Staffordshire Preputial mass Intermediate grade 10 Simple interrupted MIHSU for 7 days, None Excellent
bull terrier mast cell tumour dehiscence of cranial skin
wound allowed to heal by
second intention
14 3y MN Labrador Preputial mass Grade 1 mast cell 5 Simple interrupted MIHSU on days 4-6 None Excellent
tumour postoperatively, swelling/
reddening of skin wound
at 10 days postoperatively,
resolved after suture
removal
15 11y MN Affenpinscher Persistent Penile squamous cell 4 Simple interrupted Mild spontaneous None, Excellent, no gross
haemorrhagic carcinoma haemorrhage from stoma histology tumour recurrence
preputial/penile for 5 days postoperatively, report showed at 1 year
discharge, penile MIHSU for 10 days, swelling tumour postoperatively
swelling and irritation around stoma at suture invasion into
removal, mild granulation blood vessels
tissue at cranial aspect of and neoplastic
stoma,suspected urinary cells at margin
tract infection at 10 days of excision
postoperatively
16 7y 10m MN Miniature Dysuria, self-trauma/ Idiopathic priapism, 4 Simple interrupted MIHSU for 4 days None Excellent
longhaired laceration and necrosis with self-trauma
dachshund of proximal 3-4 cm of
persistently protruding
penis following
bilateral perineal
hernia repair
17 4y 3m MN Pug Persistent penile Idiopathic priapism 4 Simple interrupted MIHSU and spontaneous None Excellent
protrusion and with trauma secondary spontaneous haemorrhage
engorgement to exposure from stoma for 2 days
18 2y 10m MN Chihuahua Self-trauma, Self-trauma 5 Simple interrupted MIHSU and spontaneous None Excellent
amputation of distal 2 haemorrhage from stoma
cm of penis following for 3 days
coitus

Hosp Hospitalisation, M Male, N Neutered, MN Male neutered, y Year, m Month, MIHSU Mild intermittent haemorrhage from stoma on urination

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FIG 1: Preputial haemangiosarcoma (case 6)
FIG 2: Idiopathic priapism and devitalised penis (case 16)
White Surgical Consultancy Services) were reviewed for dogs under-
going penile amputation and scrotal urethrostomy between January
2003 and August 2010. Data collected from the dogs’ medical records
included signalment, presenting signs, indication for penile amputa-
tion, surgical technique and method of urethrostomy closure, postop-
erative complications and long-term outcome.
Dogs were excluded from the study if their medical records were
incomplete, a partial penile amputation had been performed or no
long-term follow-up was available.
Results
Nineteen dogs were identified that had undergone penile amputa-
tion and scrotal urethrostomy, and one dog was excluded because of
incomplete records. The case details are listed in Table 1.
Signalment and diagnosis
The dogs ranged in age between one year six months and 12 years
three months (mean six years six months). The mean age of dogs
with neoplastic and non-neoplastic disease was six years six months
in both groups. Fifteen pure breeds were recorded, both labrador and
golden retriever were recorded twice and crossbreed was recorded three
times. Eleven dogs were neutered and seven dogs were entire.
The indication for surgery was neoplasia in six dogs (preputial
neoplasia, n=5 [mast cell tumour, n=3; liposarcoma, n=1; haeman-
giosarcoma, n=1, see Fig 1] and penile/urethral neoplasia, n=1 [squa-
mous cell carcinoma]). Preoperative haematology and biochemistry
were performed and preoperative staging was done (two- or three-view
thoracic radiography performed under sedation or general anaesthesia,
abdominal ultrasonography and aspiration of prominent or enlarged
local lymph nodes); no dogs had evidence of gross metastatic disease.
Other indications for surgery were penile trauma in four dogs (dog
fight injury [n=1], road traffic accident [n=1], self-trauma following
coitus [n=1] and unknown trauma [n=1]), penile trauma or necrosis
associated with urethral obstruction with calculi in three dogs (urate
Papers
FIG 3: Devitalised distal penis and lacerated penile body (case 16)
FIG 4: Chronic idiopathic priapism. In this dog, priapism was
secondary to thrombosis of the deep penile veins
[n=1], calcium oxalate [n=1], struvite [n=1]), priapism in four dogs
(with self-trauma in two of these dogs, see Figs 2, 3 and 4) and balano-
posthitis with penile haemorrhage in one dog. One of the dogs (case
12) with urethral obstruction presented in a collapsed state and was
uraemic with a calculus obstructing the penile urethra. The referring
veterinary surgeon had attempted a prescrotal urethrostomy but the
incision had been made into the penile body and had not entered the
urethra. At presentation, the penis was swollen, dark red in colour and
the prepuce and ventral abdominal tissues were oedematous. The scro-
tum was swollen, erythematous and exuding serosanguineous fluid.
A cystotomy tube was placed to allow urinary diversion while this
dog was stabilised. The decision to perform penile amputation was
delayed for 12 hours; despite improvement in the animal’s renal and
cardiovascular parameters with intravenous fluid therapy, the penis
became cold and blackened (Fig 5), suggesting continued vascular
interruption and necrosis. Priapism was considered to be idiopathic
in three dogs and occurred following bilateral perineal hernia repair in
one of these dogs and following coitus in one dog.
Surgical technique
Eight male neutered dogs underwent penile amputation and scrotal
urethrostomy, and 10 male entire dogs underwent castration and
scrotal ablation in addition to the above. The surgical technique used
was as described by Hobson (1990). In brief, an elliptical incision was
made around the base of the prepuce taking lateral and caudal margins
appropriate for the disease being treated. Entire male dogs then under-
went concurrent castration and scrotal ablation (see Fig 6). The penis
cranial to the scrotum was dissected free and a tourniquet was applied
to the body of the penis proximal to the proposed amputation site.
The penis was excised distal to the tourniquet and the tunica albug-
inea was oversewn with monofilament absorbable suture material.
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FIG 5: Devitalised penis, swollen prepuce and testicles and area of skin necrosis around peputial/penile
incision immediately before penile amputation (case 12)
FIG 6: Intraoperative photograph showing penile amputation,
castration and scrotal ablation
The urethra was incised along the ventral midline, at least 1 cm from
the amputation site and a scrotal urethrostomy was performed. In
six cases, a simple continuous pattern with polypropylene was used
to appose urothelium to skin and in 12 cases the urethrostomy was
closed with a simple interrupted suture pattern using polypropylene
or polyamide. The remaining skin incision was closed routinely and a
closed suction drain was placed in one case (see Fig 7).
Histological diagnoses
Five dogs were diagnosed with preputial neoplasia based on the results
of preoperative incisional and postoperative excisional biopsies (n=3
mast cell tumours [MCTs]: grade 1, completely excised [n=2] and
grade 2, completely excised [n=1]; n=1 liposarcoma [completely
excised], n=1 haemangiosarcoma [completely excised]). One dog had
a penile/urethral squamous cell carcinoma (SCC); this was incom-
pletely excised with evidence of tumour emboli in local vasculature.
Postoperative treatment
All dogs received NSAIDs and/or opioid drugs for two to 10 days
postoperatively. None of the dogs with neoplastic disease received
radiotherapy. The dog with the SCC received ongoing treatment with
meloxicam and the other dogs with neoplastic disease did not receive
chemotherapy.
All dogs received lead-restricted exercise for 10 to 14 days post-
operatively. All dogs wore Elizabethan collars and the stoma was
4 of 8 | Veterinary Record | 10.1136/vr.100039
not cleaned until after suture
removal, which was performed
10 to 14 days postoperatively
in 17 of 18 dogs. The three
dogs undergoing penile ampu-
ta t i o n fo l l ow i n g u re t h ra l
obstruction for calculi received
dietary management appropri-
ate to their calculus type once
results of calculi analysis were
available.
Postoperative
complications
All dogs had intermittent haem-
orrhage from the urethrostomy
site, either spontaneously or dur-
ing and/or immediately after uri-
nation for three to 21 days post-
operatively (mean 5.5 days). The duration of stomal bleeding was not
reported in one dog but had resolved by the time of discharge at five
days postoperatively. In five cases, intermittent postoperative haemor-
rhage at urination or excitement was managed during hospitalisation
by the application of cold compresses to the urethrostomy site. Mild
bruising around the urethrostomy site was recorded in four dogs.
Duration of postoperative hospitalisation ranged from three to 62
days (mean 8.6 days). Case 12 was hospitalised for 62 days; initially
this was to allow management of postoperative complications but was
extended at the owners’ request for their convenience rather than for rea-
sons related to the dog’s condition. Exclusion of this dog from the data
analysis for duration of hospitalisation reduced this mean to 5.4 days.
Minor complications were noted at the time of suture removal in
four dogs (n=1 mild dehiscence of the cranial aspect of the skin inci-
sion that subsequently healed by second intention, n=2 mild swell-
ing and bruising of the urethrostomy site with mild haemorrhage
at suture removal, n=1 granulation tissue at the cranial edge of the
stoma). No treatment was administered and all the above had resolved
on re-examination seven days later. Case 12 had major postoperative
complications. This dog developed wound dehiscence at the cranial
extent of the incision starting three days postoperatively, it extended
caudally to involve the entire wound and it was not secondary to sub-
cutaneous urine leakage as a cystotsomy tube was placed before penile
amputation to allow urinary diversion. The sutures were removed
and the wound was allowed to heal by second intention. The scro-
tal urethrostomy site strictured and subsequently this dog underwent
perineal urethrostomy. The cystostomy tube was removed once the
perineal urethrostomy had healed.
Two dogs had urinary tract infections (UTIs) based on positive
bacterial cultures of urine samples obtained by cystocentesis. In one
dog, a UTI was diagnosed at the time of penile amputation and in the
second dog, case 12, which had a cystostomy tube, a UTI was diag-
nosed six weeks postoperatively. The cystostomy tube had been main-
tained until this animal’s other postoperative complications (wound
dehiscence and stricture of the scrotal urethrostomy) had been resolved
and UTI was confirmed at the time of cystostomy tube removal six
weeks later. Both dogs had a resolution of infection with appropriate
antibacterial therapy. A UTI was suspected in one dog on the basis
of foul-smelling urine at the time of suture removal although urine
culture was not performed. The signs resolved with empirical anti-
bacterial therapy.
Long-term follow-up
Long-term follow-up was by telephone report from the owner and/or
referring veterinary surgeon in all cases. Metastatic disease occurred
within five and 12 months of surgery in the two dogs that under-
went penile amputation for the treatment of a preputial haeman-
giosarcoma and intermediate grade MCT, respectively. These dogs
were euthanased as a result of the neoplastic disease. In all other cases,
long-term follow-up of six months to five years confirmed there were
no complications associated with penile amputation and scrotal
urethrostomy.
 Downloaded from veterinaryrecord.bmj.com on October 9, 2014 - Published by group.bmj.com
FIG 7: Immediate postoperative appearance of the surgical wound
following penile amputation, castration and scrotal urethrostomy
Discussion
Penile amputation and scrotal urethrostomy is an uncommonly
performed surgical procedure in dogs with few cases reported in
the veterinary literature. Here, the authors report the signalment,
indications for surgery, postoperative complications and outcome
in 18 dogs undergoing penile amputation and scrotal urethrostomy.
All dogs suffered minor postoperative haemorrhage from the ure-
throstomy stoma, however, complications of wound dehiscence and
stomal stricture were rare. Other postoperative complications were
minor and of minimal clinical significance. The long-term outcome
was excellent in all dogs that had non-neoplastic disease, whereas
for two of five dogs with a diagnosis of preputial neoplasia (hae-
mangiosarcoma and grade 2 MCT), metastatic disease resulted in
euthanasia within one year after surgery. The postoperative com-
plications seen in the present cases are those that have previously
been reported to accompany scrotal urethrostomy and the long-term
outcome following this surgery was dependent on the underlying
disease.
Penile necrosis secondary to penile urethral obstruction with
calculi has not been reported previously, it was the reason for penile
amputation in three dogs in this study. In these three dogs, the ure-
thral calculus had been causing obstruction for several days and the
dogs were reported to have been straining unsuccessfully to urinate
for 24 to 48 hours before referral. The cause of the necrosis in these
cases is uncertain but is likely to be associated with disruption of the
penile blood supply. In one of these cases, penile necrosis may have
been secondary to attempted urethrotomy performed by the referring
veterinary surgeon. The indications for penile amputation and scrotal
urethrostomy in the other cases in this series included those that have
been previously reported.
Scrotal urethrostomy is the preferred urethrostomy site in dogs
because the membranous urethra is wider, more distensible and
more superficial at this location, and is surrounded by less cavernous
tissue so incision at this location is associated with less haemor-
rhage (Fossum 2007). All dogs in the present case series suffered mild
Papers
postoperative haemorrhage from the urethrostomy site for up to 21
days postoperatively, regardless of the suture pattern used to appose
urothelium and skin. Haemorrhage was managed conservatively in
all cases. While postoperative haemorrhage has not been reported to
be a serious or life-threatening postoperative complication following
urethrostomy in the dog, requiring supportive or further surgical
intervention, it may however, increase the duration of postoperative
hospitalisation, or cause owner concern and/or inconvenience if it
happens after the animal is discharged from the hospital. Bruising of
the urethrostomy site was also a common complication, occurring
in 29 per cent of these cases. Similarly, Bilbrey and others (1991)
reported postoperative haemorrhage in 72.2 per cent of cases and
bruising or swelling of the surgical site in 41.2 per cent of cases
undergoing scrotal urethrostomy sutured using a simple interrupted
pattern.
The pattern used to suture the urethra to the skin may affect
the likelihood of postoperative haemorrhage. Newton and Smeak
(1996) reported reduced postoperative haemorrhage using a simple
continuous pattern and three-needle bite sequence for urethrostomy
closure, passing the suture needle via the urethral mucosa first. Using
this technique, Newton and Smeak (1996) reported a dramatic reduc-
tion in active bleeding, bleeding after micturition and bruising after
surgery, with no suture line breakdown or stricture. These modifica-
tions are suggested to produce a better tissue seal by more completely
apposing the tissues. Continuous patterns have fewer knots and
thus reduce tissue irritation, needle bites are placed closer together to
improve urethra to skin apposition and incorporation of the tunica
albugenia helps to seal the incised cavernous edges. All of these fac-
tors may reduce postoperative haemorrhage and this technique is
also faster to perform (Newton and Smeak 1996). In 12 of the 18
dogs, a simple interrupted pattern was used to close the urethros-
tomy stoma. The use of continuous or interrupted suture pattern
was dependent on the surgeon’s preference. Unfortunately, due to
differences in detail of data recording between clinicians, the authors
were sometimes unable to reliably differentiate between active/spon-
taneous haemorrhage and haemorrhage associated with urination so
cannot report on differences between these specific types of haemor-
rhage in relation to technique of stomal closure. However, postopera-
tive haemorrhage was recorded in all cases, regardless of technique
of urethrostomy closure and no advantage of reduced haemorrhage
associated with the use of a continuous pattern was recognised in
this study.
Non-absorbable suture material was used to appose the skin
and urethra in all animals in this series. Sutures were removed 10
to 14 days postoperatively under sedation or a short general anaes-
thesia; this also allowed for close inspection of the stoma. The use
of monofilament absorbable suture material eliminates the need for
suture removal. Polydioxanone has been used for closure of perineal
urethrostomies in cats. In one study, leaving absorbable sutures in
place did not result in any more complications when compared with
the use of non-absorbable sutures (Agrodnia and others 2004). The
mild haemorrhage that occurred in two dogs at suture removal in the
present study was due to physical trauma to the stoma; this was not
considered to be a significant problem but the use of monofilament
absorbable suture would avoid the risk of traumatising the stoma in
this way.
Only one dog suffered major complications of surgery, experienc-
ing wound dehiscence, stricture of the urethrostomy site and UTI.
This association of urethrostomy stricture after stomal dehiscence
has been suggested by Boothe (2003) although this appears to be an
uncommon complication; no cases were reported by Bilbrey and oth-
ers (1991) in their study of the complications of scrotal urethrostomy
in dogs. In the dog suffering dehiscence and subsequent stricture in this
series, a surgical intervention had been performed before referral that
appeared to have permanently interrupted the vascular supply of the
penis, prepuce, scrotum and ventral abdominal tissues. In retrospect,
the level of penile amputation and urethrostomy in this dog should
have been performed more proximally at a perineal location where
the tissues were normal. UTIs are a well-recognised potential compli-
cation of perineal urethrostomy in the cat (Smith and Schiller 1978,
Scavelli 1989, Griffin and Gregory 1992, Osborne and others 1996,
10.1136/vr.100039 | Veterinary Record | 5 of 8
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Papers
Agrodnia and others 2004, Bass and others 2005) and may be associ-
ated with stoma formation and shortening of the urethra. Bilbrey and
others (1991) reported persistent clinically significant postoperative
UTIs in 15 per cent of dogs after scrotal urethrostomy. Two dogs in
the present study had positive urine cultures but these were considered
to be unrelated to the urethrostomy procedure and to be a consequence
of the preexisting disease (balanoposthitis) or management of the
underlying problem (urinary diversion via cystostomy catheter). One
dog was suspected of having a UTI, which may have been associated
with the urethrostomy; this resolved after a 10-day course of antibac-
terial therapy. No other dogs in this case series showed clinical signs
of UTI although urine cultures were not performed in any other dogs.
It is possible that subclinical UTIs occurred in some or all of the dogs
in this study but these were not identified because postoperative urine
cultures were not performed.
Other possible complications that can accompany urethrostomy
in the dog are subcutaneous leakage of urine with resulting cellulitis
and urine staining of the hindlimbs or scald of the local tissues (Kyles
and others 1996, Bjorling 2003); these complications were not record-
ed in any of the present cases.
All of the dogs undergoing penile amputation and excision of the
prepuce for the treatment of preputial tumours had complete excision
of the primary tumour. Depending on the size of the tumour, wide
excision of preputial tumours with primary wound closure is often
possible. Preputial excision with amputation of the penis achieves a
deep tissue plain in tumours of the prepuce and of the skin overlying
the body of the penis. Of the three dogs that had preputial MCTs,
the dog with the grade 2 tumour was euthanased for metastatic dis-
ease 12 months after surgery. The dogs with grade 1 tumours have
had no recurrence of disease currently either locally or at distant sites
(36 months follow-up).
The biological behaviour of MCTs ranges from benign, solitary
lesions that can be cured by surgical excision to aggressive, highly
metastatic neoplasms that lead to disseminated disease and death
(London and others 2009). Grade 2 MCTs in particular, have an unpre-
dictable behaviour (Bostock 1973, Patnaik and others 1984, Simoes
and others 1994, London and Seguin 2003) and assigning the affected
animal an accurate prognosis is challenging (Welle and others 2008)
although a number of potential prognostic indicators have been iden-
tified. MCTs at inguinal, perineal and preputial locations have been
correlated with a worse prognosis than those in other parts of the
body (Tams and Macy 1981, Macy 1986, O’Keefe 1995, Thamm and
Vail 2007), although this is not supported by all studies (Cahalane and
others 2004, Sfiligoi and others 2005) and definitive evidence for this
is lacking.
Histological grading using the widely accepted Patnaik grading
system has historically been and remains the most reliable predictor
of the outcome of the tumour (Patnaik and others 1984, Murphy and
others 2004, London and others 2009) although for grade 2 MCTs in
particular, a wider range of biological behaviour is recognised (Bostock
1973, Patnaik and others 1984, Simoes and others 1994, London
and Seguin 2003) making prognostication for an individual animal
more challenging (Welle and others 2008). To aid the ability to predict
outcome, advanced stains and certain molecular biology techniques
can be performed on tissue biopsy specimens; this can help to predict
outcome with potentially greater accuracy. These include markers of
cell proliferation, AgNor count (silver staining chromosomal nucleo-
lar organising region) (Bostock and others 1989, Simoes and others
1994), PCNA (proliferating cell nuclear antigen) labelling fraction
(Simoes and others 1994, Abadie and others 1999, Seguin and others
2006), Ki-67 staining score (Abadie and others 1999, Scase and others
2006) and mitotic index (Bostock and others 1989, Simoes and others
1994, Romansik and others 2007), and investigation for gene muta-
tions in the proto-oncogene c-kit. This gene codes for the Kit receptor
protein and mutations in the gene result in dysregulated cellular pro-
liferation and survival in canine mast cells (London and others 2009,
Downing and others 2002). Higher-grade MCTs are more likely to
possess a mutation, the outcome being increased risk of local tumour
recurrence and development of metastatic disease (Downing and oth-
ers 2002, London and others 2009). In future, therefore, together with
histological grade, it is likely that prognostic panels for MCT biopsies
6 of 8 | Veterinary Record | 10.1136/vr.100039
will routinely include evaluation of mitotic index, Ki-67, PCNA,
AgNOR, Kit mutational status and Kit localisation. Studies into the
use of such panels have already been completed (Webster and others
2007, Thompson and others 2011a, b).
The dog with a grade 2 preputial MCT in the present study may
have benefited from adjunctive chemotherapy (Thamm and others
1999, London and Seguin 2003).
Cutaneous haemangiosarcomas have a variable prognosis depend-
ing on their site of origin and their depth of invasion. Tumours with
hypodermal and underlying muscular involvement, as in the dog in
this study, tend to be larger in size, have a bruised appearance and
shorter survival times (Ward and others 1994). Adjunctive chemo-
therapy should be offered for these cases (Thamm 2007, Bulakowski
and others 2008).
Penile neoplasia is uncommon; the most common tumour of the
penis in the dog is the transmissible venereal tumour (TVT), which is
rarely diagnosed in the UK. TVT is responsive to chemotherapy and
radiotherapy so amputation of the penis should be considered rarely,
if ever, for treatment of this condition (Brown and others 1980, Thrall
1982, Singh and others 1996). Other reported neoplasms of the penile
soft tissues include fibrosarcoma, lymphosarcoma, adenocarcinoma,
mast cell tumour, haemangiosarcoma, squamous cell carcinoma
and idiopathic mucosal penile squamous papilloma (Hall and others
1976, Ndiritu 1979, Herron 1983, Krishna and Gupta 1990, Wakui
and others 1992, Michels and others 2001, Marolf and others 2006,
Cornegliani and others 2007). Individual cases of neoplasia of the
os penis have been reported, including osteosarcoma, mesenchymal
chondrosarcoma, multilobular osteochondrosarcoma and ossifying
fibroma (Patnaik and others 1988, Bleier and others 2003, Mirkovic
and others 2004, Root Kustritz and Fick 2007, Peppler and others
2009, Webb and others 2009). Squamous cell carcinoma (Patnaik and
others 1988), transitional cell carcinoma (Varshney and others 1986)
and lymphosarcoma of the penile urethra (Struble and others 1997)
have also been reported.
The one dog in the present study that had a penile SCC had an
incomplete excision of the tumour; a second surgical procedure to
excise a wider margin of tissues together with a perineal urethrostomy
was offered which the owners declined. Meloxicam was prescribed
postoperatively for its possible antineoplastic effects (Knapp and oth-
ers 1992, 1994, Schmidt and others 2001). Despite the incomplete
excision, this dog had no clinical signs of recurrence of disease in the
nine months of follow-up.
Longer-term problems associated with recurrent urethral obstruc-
tion by calculi following scrotal urethrostomy is unlikely. Bilbrey and
others (1991) reported recurrence of calculi in two of 38 dogs that
underwent scrotal urethrostomy for the treatment of urethral obstruc-
tion secondary to calculi and only one of these dogs had recurrent ure-
thral obstruction secondary to calculi. In the present study, all cases in
which urolithiasis was the underlying disease which resulted in penile
amputation, owners were given dietary and management recommen-
dations to reduce the risk of urolith recurrence.
The only dog that suffered a serious complication of urethrostomy
wound dehiscence subsequently developed a stricture. Boothe (2003)
suggested stricture as a complication following dehiscence; no cases
in the study of complications associated with scrotal urethrostomy
reported by Bilbrey and others (1991) suffered either of these compli-
cations. This complication appears to be uncommon.
This study has several limitations. The case numbers presented
are relatively small, which reflects that penile amputation is per-
formed uncommonly. The study is retrospective so the dogs’ records
may be incomplete and some details may have been omitted. In
addition, the surgeries were performed by four different surgeons.
Histopathological analysis of excised tissue was not performed in all
cases undergoing amputation following urethral obstruction with
calculi and subsequent penile necrosis. This study does, however,
suggest that penile amputation has few long-term complications
following wound healing. The complications accompanying penile
amputation are those that are associated with scrotal urethrostomy.
The long-term outcome depends on the underlying disease and is
excellent in animals that have undergone penile amputation for trau-
matic causes.
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Papers

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Penile amputation and scrotal urethrostomy

in 18 dogs
R. D. Burrow, S. P. Gregory, A. A. Giejda, et al.

Veterinary Record published online October 2, 2011

doi: 10.1136/vr.100039

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References This article cites 63 articles, 14 of which can be accessed free at:
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