Surgical management of preputial injuries in bulls: 51 cases (1986-1994)

Introduction

Preputial injury is common in beef bulls and can cause problems with copulation, resulting in economic loss for the producer. Preputial injuries occur during or immediately after coitus, or are secondary to chronic prolapse^1,2. Bas indicus breeds are more often affected than Bas taurus breeds because of their anatomical differences^3-6. The prepuce of Bas indicus is longer (mean of 55 cm compared with 49.5 cm for Bas taurus), the preputial orifice is larger, and the sheath is pendulous^4,7,8. However, certain breeds of Bas taurus are predisposed to preputial injuries. Polled breeds, including Angus and polled Hereford, have a rudimentary caudal (retractor) preputial muscle, resulting in preputial prolapse and thereby exposing the prepuce to injury^8,9.

The therapeutic approach is influenced by the nature and chronicity of the injury, the breed, the presence of infection, the ability to extend the penis, and the value of the animal. Medical treatment consists of controlling infection, decreasing inflammation, and preventing preputial prolapse. Surgical intervention is indicated if medical treatment has failed or if fibrous tissue resulting from the healing process prevents normal movement of the prepuce. Circumcision (preputial amputation) and posthioplasty (resection and anastomosis, or reefing) are 2 surgical techniques used to reestablish the normal function of the prepuce^2,3,10,11. The success rate of surgical treatment for preputial injuries has been reported to be between 76% and 87%, and no difference was reported between circumcision and posthioplasty^3-6. The breeds affected in those reports were principally Bas;nd;cus. Limited information is available on surgical treatment of preputial injuries in Bas taurus breeds. The purpose of this study was to compare breeds, success rates for preputial surgery depending on the initial diagnosis, ability to extend the penis, use of sedation and local anesthesia versus general anesthesia for surgery, and surgical technique.

Material and methods

Medical records of 51 bulls treated surgically for preputial injury were reviewed (February 1986 to April 1994). Follow-up data were obtained after evaluation by the surgeon or telephone conversation with the owner after at least I breeding season. Successful outcome was based on return to previous activity (semen collection or pasture breeding).

The surgical techniques used in this study were posthioplasty, circumcision, scar revision, primary closure, abscess drainage, and penile hematoma evacuation when present with preputial prolapse. The surgery was performed under sedation or general anesthesia, based on the severity of the injury, the animal's value, and the surgeon's preference. Food was withheld for 48 to 72 h (except for preputial avulsion) and water for 12 to 24 h. Bulls operated on in a rotary chute received a combination of anesthetic drugs composed of acepromazine (0.04 mg/kg/body weight (BW), IV), xylazine (0.05 to 0.1 mg/kg/BW, IV), and ketamine (2.2 mg/kg/BW. IV). The bulls operated on under inhalation anesthesia in a surgery suite were induced with IV injection of a mixture of glycerol guaiacolate 10% (70 to 80 mg/kg/BW) and thiopental sodium (5 mg/kg/BW). Anesthesia was maintained with halothane in oxygen in a semiclosed circle system.

Posthioplasty was performed as previously described^2,10. The bull was placed in lateral recumbency. The penis was extended and held with a penetrating towel clamp placed under the apical ligament of the free portion of the penis. The surgical site was aseptically prepared. Circumferential incisions were made proximal and distal to the lesions, and I simple suture was placed on the dorsal aspect of each pan of the remaining prepuce to ensure correct alignment. A longitudinal incision united the 2 circumferential incisions. The flap of prepuce was removed by blunt and sharp dissection. The elastic tissue layers were carefully dissected - and hemorrhage was controlled by ligature or electrocautery. Anastomosis of the prepuce was performed with 2-0 polyglactin 910 or polydioxanone in a simple interrupted or cruciate pattern. A Penrose drain was sutured to the free portion of the penis. A polyvinyl tube (2.5 cm outside diameter, 15 cm long) was inserted in the preputial orifice, taped with elastic adhesive, and secured to the skin with 4 simple interrupted-sutures. The bandage was removed 4 to 5 d after surgery.

Circumcision was also performed as previously described^2,11. The prepuce was extended to expose the affected part to be resected. A line for amputation was defined between the prepuce to be resected and the preputial orifice. Mattress sutures with #lor #2 polyglactin 910 or polydioxanone were placed through the .external and the internal preputial layers along the intended resection line. The prepuce was amputated distal to the sutures, and the external and internal layers were sutured together with #1 or #2 polyglactin 910 or polydioxanone in a simple continuous pattern.

The chi-square test was used to compare success rates for the following variables: diagnosis, ability to extend the penis before or during surgery, sedation or general anesthesia, and comparison between posthioplasty avd circumcision. Fisher's exact test was used, instead offhe chi-square test, when the expected count in lor more cells was <5. p < 0.05 was considered significant.

Results

The affected breeds were Angus (n = 23), Simmental (n = 6), brangus (n = 5), Hereford (n = 3), Limousin (n = 2), Santa Gertrudis (n = 2), amerifax (n = 1), beefmaster (n = 1), Charolais (n = 1), gelbvieh (n = 1), Holstein (n = 1), Maine Anjou (n = 1), Red Angus (n = 1), Romagnol (n = 1), salers (n = 1), and shorthorn (n = 1). The affected population was 82.3% Bas taurus and 17.7% Bas indicus breeds. Angus (27%), Hereford (22%), and Simmental (16.8%) were the predominant beef breeds seen in our hospital based on information obtained from the Veterinary Medical Database for the same period of time. The mean age was 2.5 y (range, 1 to 5 y). Twenty-seven bulls (52.9%) were admitted to the hospital during May to July, and 17 bulls (33.3%) during November to February (Figure I).

 

 

The mean duration of clinical signs was 15 d (range, 1 to 90 d). Fifteen bulls had been treated medically with antibiotics and local treatment before admission. Phimosis was the most common preputial abnormality (n = 14), followed by laceration (n = 11), prolapse and laceration (n = 7), prolapse and posthitis (n = 6), parapenile abscess (n = 4), avulsion of the prepuce from the attachment to the penis (n = 4), paraphimosis (n = 3), and preputial prolapse secondary to penile hematoma (n = 2). The hospitalized bulls were treated medically for a mean period of 5 d (range. 1 to 14 d) before surgery. Treatments consisted of systemic antibiotics and non-steroidal anti-inflammatory drugs, hydrotherapy, gentle debridement, topical antiseptic ointment, and bandaging with a polyvinyl tube (2.5 cm outside diameter, 15 cm long) placed within the preputial lumen to prevent prolapse recurrence or to reduce edema. Eighty-two percent (n = 42) of the surgeries were performed in a rotary chute, and 18% (n = 9) were performed in a surgery suite. Posthioplasty was performed on 25 bulls, and circumcision on II bulls. The preputial sheath was incised in 5 bulls to gain access to infected or adhered peripreputial tissue for debridement and lavage. The 4 bulls with preputial avulsion were admitted shortly after the injury had been noticed by a technician at a semen collection center. Blood was either observed in the artificial vagina after semen collection or seen dripping from the prepuce. Avulsions were repaired by primary closure. Scar revision was performed on 3 animals. Two bulls with penile hematoma were circumcised because of recurrent preputial prolapse, and a V -plasty was made on the preputial orifice of I bull to allow correction of a paraphimosis. The penis was extended before or during the surgery in 32 bulls. Penile extension was not obtained or performed in 19 bulls. A mean of 7.5 cm of prepuce was removed during circumcision or posthioplasty (n = 15, range, 2.5 to 12 cm). The bulls were treated postoperatively for a duration of 7 d (range, I to 29 d). Postoperative treatment consisted of systemic antibiotic and non-steroidal anti-inflammatory drugs, topical application of antiseptic ointment, and hydrotherapy. Decisions to maintain a preputial retaining tube and bandage were based on the type of lesion, surgery performed, and the surgeon's preference. The bulls were hospitalized for a mean period of 11 d (range, I to 38 d).

Follow-up information was obtained on 40 animals.

The average period of sexual rest after release from hospital was 5 mo (range, 2 to 12 mo). Successful outcome was obtained in 28 bulls. At the time. Qf follow-up, 12 animals were still being used in the herd. Bulls were used for a mean of 2 breeding years (range, 1 to 4 y). The reasons for unsuccessful outcome were: unable to resume natural breeding (n = 7); hematoma and dehiscence after surgery (n = 3); prolapse recurrence shortly after the surgery (n = I); and prepuce too short, leaving the penis outside the sheath (n = 1). Two bulls from the successfut group were culled later for recurrence of prolapse during the year following the surgery. The success rate was 88% if the penis was extended before the surgery, compared with 36% if extension was not achieved (P < 0.05). The success rate for surgeries performed under inhalation anesthesia in the surgery suite was 100% compared with a success rate of 63% for surgeries performed with injectable anesthesia in a chute (P < 0.05). The success rate for posthioplasty was 90% compared with 43% for circumcision (P < 0.05) (Table 1). Sixty-three percent of bulls affected with phimosis returned to breeding soundness. Surgery on bulls with preputial laceration had an 86% success rate. Preputial prolapse with and without laceration was treated successfully in 83% and 75% of the animals, respectively. Incision of the sheath was necessary in bulls with no penile extension and abscess of the elastic layers. The 2 bulls that returned to breeding soundness ha4. a localized abscess with minimal adhesion of the elastic layers. All the animals with preputial avulsion were used successfully in a semen collection center. Recurrence was observed in 1 bull, 4 mo after the surgery, but it was used successfully for 1 y after recurrence. Scar revision was successful in 2 of 3 bulls. One bull with concurrent penile hematoma returned to pasture breeding. A V -shaped incision had been performed on the preputial orifice to correct a paraphimosis, but the bull had severe adhesions due to the injury itself and was unable to extend his penis.

Discussion

The breed populations in this study differ from those of previous studies^3-6,12. The proportion of Bos taurus breeds (82.3%) to Bos indicus breeds (17.7%) was in proportion to the breed population in Kansas (Spire, personal communication). Posthioplasty was preferred over circumcision in Bos taurus animals, because the prepuce is shorter, compared with that of Bos indicus, and the procedure is more appropriate to prevent excessive preputial resection. This is supported by our greater success rate for posthioplasty (90%) compared with circumcision (43%). Posthioplasty allows thorough evaluation of the prepuce and the penis after extension and prior to resection. The type of injuries encountered in those 2 breeds is probably different, thus influencing the choice of the appropriate surgical technique. Bos indicus breeds are anatomically more susceptible to chronic prolapse, where circumcision is appropriate. Our overall success rate (70%) was slightly lower than that previously reported^3-6. This may be explained by the predominance of Bos taurus breeds and the different type of preputial lesions.

When penile extension was performed, the success rate was significantly higher. This differs from results of a previous study that included mostly Bos indicus breeds³. The same preputial lesions on Bos taurus breeds may have a detrimental effect on penile extension because of a smaller preputial diameter. Extension of the penis provides thorough assessment of the extent of preputial injury and the integrity of the elastic layer. We recognize that extension of the penis is not always necessary when performing an elective circumcision for chronic preputial prolapse, but, according to our results, it may be a useful prognostic indicator.

Operations done under inhalation anesthesia in a surgery suite had a better outcome than those done under sedation and local anesthetic in a rotary chute. Inhalation anesthesia allows the surgeon to perform optimal hemostasis and more precise tissue handling, and prevents any movement from the animal during surgery, thus reducing the chance of contamination. Surgery performed under sedation requires infiltration of local anesthetic, which may interfere with tissue healing¹³. We recognize that case selection may have influenced our results. The options of inhalation anesthesia versus sedation and local anesthesia were usually given to owners. In the situation where the bull had a poor prognosis, the decision could have been driven toward the less expensive option.

The mean age of 2.5 y for injured bulls was similar to that in previous studies^3,5. The incidence of preputial injuries increased after the spring and fall breeding seasons; spring is the predominant breeding season in the Midwest.

Our success rate of 50% with surgery for preputial abscesses was similar to that reported previously⁵. Severe abscesses can be drained by a lateral incision of the sheath or an incision through the preputial orifice to access the infected layers. Although infection can be dealt with successfully, severe adhesions develop during the healing process and prevent nor-mal penile extension. All bulls with preputial avulsion in this study returned to semen collection. These bulls were brought for treatment shortly after the injury , which may explain the good outcome of the surgery. The wound should be evaluated before the animal is returned to semen collection, and the artificial vagina should be lubricated carefully¹⁴. Based on the results of this study, posthioplasty is recommended over circumcision in Bos taurus breeds of cattle. Penile extension should be performed, if possible, at the time of surgery for complete evaluation of the preputial and penile injury. Surgery should be performed under general anesthesia in an operating room, if the animal is of sufficient economic value. CVJ

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