Preputial wounds

Preputial wounds are relatively common in breeding bulls. Due to their location, these wounds do have more associated complications, particularly swelling, infection and adhesions.

Fresh lacerations are not usually detected. Bos taurus breeds retract the injury and present with cellulitis, abscessation or stenosis later. Bos indicus breeds develop preputial prolapse secondary to the injury-related swelling. The prolapse creates more edema and more prolapse.

Evaluation

Acepromazine (0.003-0.05 mg/kg), pudendal nerve blocks, or ring blocks combined with manual exteriorization of the penis assist with evaluation of the prepuce. Electroejaculation can make lesion(s) worse and should be avoided.

Conservative Therapy

Remove from cows and prevent breeding for 60 days. Preventing abscess and adhesion formation is crucial.

Most preputial wounds should be treated by second intention healing or delayed primary closure due to contamination.

Contamination

It is very difficult to clean the sheath to minimize contamination. Wound identification may also be delayed, letting bacteria adhere and form a protective glycocalyx. Assume the wound needs sharp debridement. Soaking in an antiseptic solution may also help remove surface bacteria.

Many do get abscesses; this is okay if going to slaughter. If treatment is needed, antibiotics are administered for two weeks. Abscesses need to be drained into the sheath versus through tissues/skin. If these drain through the tissues (either surgically or naturally), they tend to create adhesions that prevent penile extension and lead to a very poor prognosis.

Swelling

Trauma leads to swelling and this is particularly significant in ventral tissues. If the prepuce can be returned to the sheath, the swelling is minimized. A purse string may be necessary to retain the tissues in the sheath.

However, if the prepuce is not reducible,  the area needs to be elevated as much as possible. The prepuce can be slung or held next to the ventral abdomen with old sheets or with sticky tape applied over a soft wrap.

Swelling and bandaging can lead to urethral obstruction; a penrose drain or silicon tube can be used to wick urine out of the sheath.

Adhesions

A lanolin based ointment can be coated on the damaged tissue to minimize adhesions within the sheath that would prevent intromission or semen collection. Pink penis prep has been used historically (lanolin+ oxytetracycline+ scarlet oil) but is not great use of the oxytetracycline and the scarlet oil may be unnecessarily irritating. As healing progresses, sight stimulation of a cow in heat will also encourage movement of the prepuce.

Surgical therapy

These cases may need surgery if prolapses recur or if they develop a preputial stricture. Phimosis is often due to a longitudinal incision healing transversely.

Surgery needs to be delayed until edema is reduced, infection eliminated and the tissue has a good granulation bed. This typically means waiting 2-8 weeks. The exception is preputial avulsions. These wounds are 360º avulsions of the prepuce from the free portion of the penis at the preputial ring. Generally these are seen in bulls being collected for AI. These wounds heal poorly if left unsutured; however, since the bull was generally cleaned prior to collection, the area is only minimally contaminated and the wounds can be closed primarily after light debridement of the wound edges. Use 0 absorbable suture to appose the edges.

Preputial resection

Preputial resection is preferred over preputial amputation when possible. It is only possible when the penis can be extended and exteriorized. With the penis extended, the damaged area of prepuce is removed by making a circumferential incision around each side of the damage. These are connected by a longitudinal incision and then peeled off the underlying layers. The two circumferential incisions are then reanastomosed, taking care to not twist the penis and prepuce while doing so.

Preputial amputation

Preputial amputation is performed when the penis cannot be exteriorized. After placement of overlapping sutures 360º around the healthy prepuce to control bleeding, the distal prepuce is transected and the cut edges anastomosed. It may be helpful to cut a “v” incision in to the circle to avoid cicatrix formation. These do tend to stricture, regardless. For breeding purposes, a prepuce length of at least 1.5-2x as long as the free portion of the penis.

Other species

Boars occasionally get prolapses secondary to drugs or mycotoxins; the therapy is the same as for cattle.

Resources (google at your own risk)

Medical and Surgical Management of Conditions of the Penis and Prepuce, 2024 VCNA

How to- preputial resection chapter

Penile and preputial problems in the bull, MS Gill

Surgical procedures in the bovine, start at page 13