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756.e6 Paraphimosis

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G H
PARAPHIMOSIS, cont’d G, Two weeks after phallopexy surgery, the skin incision has healed completely. H, Only
the penile tip can be expressed out of the prepuce with the phallopexy in place. (Used with permission from Kutzler
MA: Paraphimosis. In Monnet E, editor: Small animal soft tissue surgery, Ames, IA, 2013, Wiley-Blackwell, pp 686-690.)

musculature that cannot fully retract the mucosa, prevent additional swelling (edema, castration alone is not successful in correcting
penis into the prepuce; hair ring or scar inflammation) and trauma, and return the penis paraphimosis.
tissue also possible within the prepuce as quickly as possible. The
○ After sexual excitement or copulation, the underlying cause is then addressed to reduce Behavior/Exercise
engorged penis may become entrapped the risk of recurrence. Affected intact males should be separated from
outside the prepuce, causing penile stran- estrous females for at least 4 weeks afterward.
gulation, congestion, and paraphimosis. Acute General Treatment Efforts should be made to prevent excessive
○ Cranial preputial muscles (paired muscles • Conservative: reduction of penis size by licking of the penis and prepuce that may result
originating from the cutaneous trunci) topical cold compresses, topical hyperosmotic in self-mutilation.
draw the prepuce cranially, normally solutions (e.g., sugar, honey), and systemic
≈1 cm beyond the tip of the penis. antiinflammatory therapy Possible Complications
• Passage of urinary catheter to ensure patency • Erection and ejaculation may be impaired
DIAGNOSIS of urethra after long-standing paraphimosis.
• If paraphimosis occurred secondary to • Balanoposthitis secondary to phimosis may
Diagnostic Overview promazine-induced priapism, benztropine occur after surgical retention of the penis
Paraphimosis is diagnosed conclusively on mesylate 0.015 mg/kg IV should be admin- within the preputial cavity.
physical exam alone. Additional testing may istered as soon as possible (i.e., within 6 • Urethral stricture formation and recurrent
help elucidate the cause; in dogs, ≈30% of hours of onset of clinical signs). urinary tract infections may result after penile
cases are idiopathic. • Removal of hair from around the preputial amputation.
orifice
Differential Diagnosis • Manual replacement of the penis in the PROGNOSIS & OUTCOME
• Balanoposthitis preputial sheath using lubrication and gentle
• Phimosis digital pressure. If unsuccessful, emergency The prognosis is good to guarded for
• Priapism surgical intervention is required. the resolution of paraphimosis, depending
on the severity and duration of clinical
Initial Database Chronic Treatment signs.
Neurologic exam with specific attention Surgical intervention:
to posterior peripheral motor and sensory • Attempt manual reduction under general PEARLS & CONSIDERATIONS
function anesthesia.
○ If unsuccessful, incisional enlargement of Comments
Advanced or Confirmatory Testing preputial orifice and retraction of penis Dogs with developmental preputial conditions
• Electromyographic testing and/or histo- within prepuce associated with paraphimosis should not be
pathologic evaluation of cranial preputial • Options for preserving reduction: purse- used for breeding.
muscles to identify abnormal function or string suture at the preputial orifice, preputial
cellular architecture; rarely necessary orifice narrowing, preputial lengthening Prevention
• Radiographs to identify concomitant os penis (preputioplasty), preputial advancement, • Hairs around the preputial orifice should be
fracture preputial muscle myorrhaphy, and phallopexy kept short in long-haired dogs.
• Cytology of mass lesions on penis (my preference); none entirely eliminates the • After mating or semen collection, applica-
possibility of recurrence. tion of a topical lubricant to penile mucosa
TREATMENT • Chronic paraphimosis can be eliminated around the preputial opening can prevent
with amputation of the penis and concurrent inversion of the prepuce during detumescence
Treatment Overview scrotal urethrostomy. (natural resolution of erection and penile
Paraphimosis is an emergency condition. • Castration is often performed in conjunction retraction).
Immediate treatment should protect the penile with surgical correction of paraphimosis, but

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