1.23 Diseases of the Penis and Prepuce

What are examples of diseases of the penis and prepuce?

1. Balanitis, postitis, balantopostitis

2. Pseudomonas aeruginosa

3. Phimosis

4. Paraphimosis

5. Priapism

6. Neoplasia

7. Trauma

8. Lacterations

9. Penile and preputial lesions

What is balanitis, postitis, and balantopostitis?

Inflammation of the penis, prepuce, and penis with prepuce

What are the causes of balanitis, postitis, and balantopostitis?

• Infectious: virus (EHV-3), parasitic (dourine), bacteria (Pseudomonas, Klebsiella, Streptococcus, Chlamydia, Brucella, Salmonella abortus equi).

• Non-infectious: trauma, immunosuppression, unhygienic environment, smegma accumulation

What are the clinical signs of balanitis, postitis, and balantopostitis?

Green-yellow purulent fetid discharge, erythematous and hyperaemic MM, erosions, pain, dysuria

How is balanitis, postitis, and balantopostitis diagnosed?

Swab

How is balanitis, postitis, and balantopostitis treated?

Flushing, sexual rest, ATB

What is Pseudomonas aeruginosa?

Part of the normal flora of the skin, mm, and intestinal contents. It is an opportunistic pathogen.

How does Pseudomonas aeruginosa cause infection?

Infection of the penis follows injuries or wounds, commonly after ATB or disinfecting treatments. As Pseudomonas can be very resistant to common disinfectant, their use reduces the normal flora and allows for an overgrowth of Pseudomonas

What are the clinical signs of Pseudomonas aeruginosa infection?

Classic greenish discharge or pus and a “grape-like” odour

How is Pseudomonas aeruginosa infection treated?

1% cream of silver sulfadiazine

What is phimosis?

Inability to normally protrude to constriction of preputial orifice or preputial ring

How is phimosis treated?

Remove triangular segment of external lamina, suture to cut edge of internal preputial lamina

What is paraphimosis?

Inability to withdraw the penis into the prepuce due to preputial oedema, systemic disease or phenothiazines

How is paraphimosis treated?

Conservative (manual fixation with bandages) or surgical (incision, amputation)

What is priapism?

Persistent erection without sexual arousal due to blood flow disturbance, phenothiazine, tumour, GA, nematodes

How is priapism treated?

Benztropine, heparinised saline, evacuation of blood and irrigation of penis.

What is the most common neoplasia of the penis?

Squamous cell carcinoma.

What are the causes of penile and preputial lacerations?

Injuries include lacerations and haematomas and are usually caused by:

• Kicks (especially to erect penis),

• Mounting of stationary objects,

• Attempting to breed a mare across a barrier,

• Severe bending of the penis shaft after coitus or semen collection.

What are the potential complications of penile and preputial lacerations?

• Deep lacerations extending into the corporeal body → haemospermia or incompetence.

• Deep laceration extending into urethra → severe necrosis of tissue from escape of urine.

• Damaged pudendal nerves → penis paralysis → protrusion of the penis and prepuce → cause further damage to exposed penile and preputial epithelium

How are penile and preputial lacerations treated?

Depends on age of lesion and location:

• Fresh: sutured with soft, absorbable or nonabsorbable.

• Infected: left open to heal, dressed with non-irritating antimicrobial ointment. Later closed when not inflamed.

• Oedema: penis and prepuce retained within the preputial cavity with a retainer bottle, nylon netting or hosiery.

• Tunica albuginea: suture.

• Urethra: sutured. If transverse laceration → large-bore catheter maintained in the lumen of urethra to prevent formation of a stenosing cicatrix (scar)

What is the recommended management of a stallion with penile and preputial trauma?

A stallion affected with preputial and penile trauma should be isolated from mares until the wound has healed.