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Paraphimosis
Synonym(s): Erection
Introduction
- Cause: trauma, debilitation, inflammation, neoplasia, paralysis or priapism.
- Signs: swollen penis and prepuce, inability to retract penis into sheath, priapism, penile paralysis.
- Diagnosis: based on clinical signs.
- Treatment: reduce edema and inflammation; replace penis; preputiotomy (surgical enlargement of the preputial orifice), phallopexy or phallectomy/ penectomy (removal of the entire or part of the penis).
- Prognosis: this is dependent of the underlying cause.
- This article will focus on the medical management of paraphimosis in bulls.
Presenting signs
- Swelling of the penis and prepuce with an inabilty of the penis to be retracted within the prepuce
. - Varying degrees of compromized penile tissue (inflammation or necrosis).
- Presence of neoplasia on the penis.
Geographic incidence
- Worldwide.
Age predisposition
- Observed in sexually mature/active animals.
Breed/Species predisposition
- Bos indicus breeds are more often affected than Bos taurus breeds (prepuce is longer, the preputial orifice is larger and the sheath is pendulous).
- Polled Bos taurus bulls, Hereford and Angus bulls, are more often affected than other Bos taurus breeds because these breeds have a rudimentary caudal (retractor) preputial muscle, predisposing them to preputial prolapse.
Cost considerations
- Some producers may elect for salvage slaughter for affected animals (particularly in cases where the condition is longstanding and significant trauma and necrosis of the penis is observed or extensive neoplasia is observed).
- Losses may be high in valuable stock or AI bulls.
Pathogenesis
Etiology
- There are three main mechanisms for the pathogenesis of paraphimosis in bulls:
- Preputial edema: penile injury, preputial trauma/lacerations and/or diseases that result in ventral or generalized edema.
- Damage to the penile innervation: spinal cord injury and/or a consequence of a penile laceration or hematoma.
- Penile paralysis: paralysis of the penis, consequence of priapism and/or use of acepromazine/phenothiazine tranquilizer.
Predisposing factors
General
- Trauma to the penis and prepuce .
- Inflammation of the penis.
- Neoplasia of the penis.
- Inflammation of the prepuce.
- Infection of the prepuce.
Specific
- Breed.
- Excessive amounts of parietal preputial epithelium.
- Absence or lack of development of the caudal prepuce muscle.
Pathophysiology
- The general pathophysiology of the condition is either the constriction of the prepuce behind the glans penis or to swelling (inflammatory/edema) of the glans penis which results in the prevention of the organ being withdrawn back through the naturally small preputial orifice:
- Traumatic injury: false copulation - penis strikes the pevis of the cow or the cow kicks the bull's penis which results in enlargement or swelling (inflammation/edema) of the distal penis, preventing the penis form being retracted back into the prepuce.
- Neoplasia (malignant or benign): of the penis which results in enlargement or swelling of the distal penis that prevents the penis form being retracted back into the prepuce.
- Swelling of the prepuce (inflammatory, edema, or, infectious): resulting in the narrowing of the preputial orifice and, therefore, an inability to retract the penis into the prepuce.
- Neurogenic origin, causing paralysis of the penis, and, therefore an inability to retract the penis into the prepuce. This may be due to a spinal injury leading to paralysis of the rectractor muscles.
Timecourse
- The time course of the condition will be dependent on the underlying cause:
- Swelling of penis and prepuce occurs within a few hours of paraphimosis.
- With traumatic lesions, resolution of the lesion with medical treatment is generally rapid if the condition is observed and treated promptly.
- If the condition is due to penile paralysis, the resolution may be protracted or even unlikely.
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed Papers
- Recent references from PubMed and VetMedResource.
- Desrochers A, St-Jean G & Anderson D E (1995) Surgical management of preputial injuries in bulls: 51 cases (1986-1994). Can Vet J 36 (9), 553 PubMed.
- Neal F C (1960) Surgical Problems of the Penis and Prepuce of Bulls, Part II. Iowa State University Veterinarian 22 (3), 5.
Other sources of information
- Cockcroft P (2015) Bovine Medicine. John Wiley & Sons.