How to – Preputial resection

Indications

Preputial wounds and preputial tumors can be resected. Extra prepuce in bulls and pigs can be removed, even if not injured. The penis must be able to be exteriorized for preputial resection to be possible. If the penis cannot be exteriorized, preputial amputation is the only surgical option.

Relevant anatomy

The prepuce permits extension of the penis for breeding. For bulls, the remaining prepuce must be at least 1.5 times the length of the free portion of the penis to permit intromission.

The equine prepuce is in a double fold.

Preoperative management

Food restrictions: No food restriction is required for standing surgeries. Food should be withheld if the animal will be placed into lateral or dorsal recumbency. Horses are held off feed for at least 6 hours and bulls for at least 24 hours.

NSAIDs/analgesics: NSAIDs are indicated both pre- and postoperatively. Swelling is common and can restrict urination.

Antibiotics: Antibiotics are recommended. Antibiotics should target skin organisms and are typically continued for at least 5 days postoperatively

Tetanus prophylaxis is recommended in horses, pigs and small ruminants. 

Local blocks: Options include a ring block, epidural or pudendal block.

Position/preparation: Surgery can be performed in the standing animal if the animal can be restrained appropriately. Standing surgery permits better anatomical alignment. Otherwise, dorsal recumbency is preferred for the same anatomical perspective.

Surgery Supplies: 

• Penrose drain (tourniquet)
• Urinary catheter
• Minor or laceration pack
• 3-0 and 2-0 absorbable suture, taper needle

Surgical procedure

• With the penis extended, determine the amount of prepuce (generally the damaged portion) that needs to be removed. If you don’t have an assistant, it can help to use a towel clamp or piece of gauze to keep the penis extended. A penrose drain makes a good tourniquet.
  Keeping dorsal aspects aligned, create a circumferential incision at each end of the area to be removed. The incision should extend into the loose connective tissue. Connect the two circumferential incisions with a linear incision to the same depth. Remove the damaged area using scissors.
  Reconnect the two ends using simple continuous runs of suture (at least two to avoid a purse string effect). Absorbable suture is probably wise.

Postoperative care

• Continue antibiotics and NSAIDs for at least 3 days.
• Ensure the animal is urinating for the first 3 days [house in an area that permits observation]

Complications

• Preputial prolapse due to swelling
• Dehiscence is possible with excess swelling
• Urinary obstruction is rare but can occur

Videos

• Major reefing on a bull

Resources