Page 569 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

544 CHAPTER 2

VetBooks.ir 2.149 relubricated. Alternatively, the penis can be kept
within the prepuce using a purse-string suture or
clamps placed at the preputial ring. This may require
sedation or general anaesthesia in the uncooperative
animal. If the penis cannot be immediately replaced,
it is placed within a sling or similar supportive
device to limit the gravitational effects, which will
worsen the oedema. A combination of manual mas-
sage, hydrotherapy, exercise and anti-inflammatory
therapy is indicated. Hydrotherapy should be limited
to no more than 20 minutes of cold application per
session, repeated every 3–4 hours. Longer applica-
tion of cold (ice packs, cold hosing) can potentially
Fig. 2.149 Penile haematoma and paraphimosis in a cause more oedema as well as significant damage to
stallion following a kick from a mare during breeding. the skin and tissues. If gentle massage is not effec-
tive in alleviating the penile oedema enough to allow
replacement, pressure wrapping with rubber ban-
Diagnosis dages, beginning at the distal end of the penis, can
Diagnosis is made by identification of the penis out- be used temporarily to reduce oedema. In chronic
side of the prepuce. This may be more challenging cases the penile skin becomes cracked, oozing and
than it appears, particularly when both penis and eventually necrotic and gangrenous. In chronic
prepuce are severely swollen and in cases where the cases refractory to treatment, partial penile amputa-
penis is only partially prolapsed. Identification of the tion may be required.
urethral process is diagnostic.
Prognosis
Management The prognosis is dependent on the rapidity with
Immediate therapy is required. If the condition is which veterinary treatment is sought and initiated.
acute, the penis is placed back into the prepuce and Preputial and penile dysfunction can occur follow-
retained with an easily fashioned retention device ing successful treatment of prolonged cases due to
consisting of a cut-off plastic bottle and rubber tub- fibrosis of the skin and damage to the vascular tis-
ing. The penis is lubricated with vaseline or other sues of the penis. Prolonged paraphimosis may also
emollient dressing and placed within the bottle with result in nerve damage, leading to secondary penile
the urethral process aligned to the tapered bottle paralysis.
opening, allowing urine to escape via the open bot-
tle cap end. The opposite end of the bottle is lightly PENILE PARALYSIS
padded with tape or foam. The open-ended bottle
with the penis inside is then gently placed within Definition/overview
the preputial cavity and held with the rubber tub- True penile paralysis is an inability to retract the
ing. One set of tubing is passed over the stallion’s flaccid penis into the prepuce.
back and tied, while the other is passed caudally
through the hindlimbs and tied dorsally over the Aetiology/pathophysiology
back to the first set of tubing. A stallion sling is then Motor innervation of the retractor penis muscle
placed over the prepuce to ensure proper position- is through the alpha-adrenergic fibres. The most
ing. When properly applied, the stallion can readily common cause of true penile paralysis in geldings
urinate through the bottle-sling system. The bottle and stallions is the administration of alpha-adren-
and sling system should be removed twice daily for ergic blockers such as the phenothiazine tranquil-
cleaning and to allow the penis to be inspected and lisers. Penile paralysis may be a sequela to chronic