Page 214 - Manual of Equine Field Surgery
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210 MALE UROGENITAL SURGERIES
cally.4 Minor dehiscence of the suture line usually COMMENTS
results in adequate healing by second intention.
More extensive dehiscence may result in urethral Amputation in the distal portion of the penis is
stricture. Recurrence or metastasis of neoplastic considerably less complicated than in the more
lesions carries a poor prognosis and requires proximal portions. In the proximal portions> the
further surgery. diameter of the penis is larger and the redundant
tissue of the prepi1ce must be dealt with, which
increases surgical and anesthetic time. In cases of.
ALTERNATIVE PROCEDURES squamous cell carcinoma> every attempt must be
made to assess the horse for evidence of metasta-
Alternative techniques for amputation have been sis and to identify small satellite lesions elsewhere
described and include Scott's and Vinsot's tech- on the penis or prepuce. For horses with lesions
niques.l" In Scott's technique> a full circumferen- too proximal to amputate or requiring preputial
tial incision is made at the intended site of ablation and inguinal lymph node removal> more
resection. Dissection is carried down to but not involved procedures have been described. 6•8
into the urethra. Approximately 4 to 6 cm of
urethra is freed distal to the site of penile ampu-
tation. This is the most difficult aspect of the REFERENCES
entire procedure> because the wall of the urethra
is intimately associated with the corpus spongio- 1. Schumacher J: The penis and prepuce. In Auer JA>
sum. The vascular spaces of the corpus caver- Stick JA, editors: Equine surgery, Philadelphia, 1999,
nosum are closed by apposing the tunica WB Saunders.
albuginea with simple interrupted sutures using 2. Howarth S, Lucke VM, Pearson H: Squamous cell
No. 0 or 1 absorbable suture material. The ure- carcinoma of the equine external genitalia: a review
thral stump is separated into three triangular por- and assessment of penile amputation and urethros-
tomy as a surgical treatment, Equine Vet J 23:53,
tions> folded back, and sutured to the epithelium.5 1991.
Advantages and disadvantages of this technique 3. Mair TS, Walmsley JP, Phillips TJ: Surgical treat-
are similar to those for William's technique. ment of 45 horses affected by squamous cell carci-
With Vinsot's technique> a triangular portion noma of the penis and prepuce, Equine Vet J 32:406,
of epithelium and underlying tissue with the base 2000.
proximal to the apex is removed. A modification 4. Adams SB, Fessler JF: Penile amputation. In Adams
of this procedure performed in standing horses SB, Fessler JF, editors: Atlas of equine surgery,
involves making a longitudinal incision directly to Philadelphia, 2000, WB Saunders.
the urethra.1 A nonabsorbable circumferential lig- 5. Scott EA: A technique for amputation of the equine
ature is placed around the penis> and the penis is penis, J Am Vet Med Assoc 168:1048, 1976.
transected distal to the ligature. After longitudinal 6. Archer DC, Edwards GB: En bloc resection of
the penis in :five geldings, Equine Vet Educ 16:12,
incision> the urethral mucosa is sutured to the 2004.
skin as previously described. The penile stump is 7. Doles J, Williams JW, Yarbrough TB: Penile amputa-
allowed to heal by second intention. The advan- tion and sheath ablation in the horse, Vet Surg
tages of this technique are the decreased surgery 30:327, 2001.
time and the potential to perform the procedure 8. Markel MD, Wheat JD, Jones K: Genital neoplasms
standing. The disadvantage of this technique is treated by en bloc resection and penile retroversion
the tendency for stricture formation and the in horses: 10 cases ( 1977-1986), J Am Vet Med Assoc
potential for inadequate hemostasis. 1 192:396, 1988.
