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Penile / parapenile hematoma / trauma / abscess
Synonym(s): Penis fracture, Broken penis
Introduction
- Cause: rupture of the tunica albuginea at pressures >14000 mmHg.
- Signs: symmetrical swelling dorsal to the penis near the scrotal neck.
- Diagnosis: based on clinical signs +/- ultrasonography.
- Treatment:
- Salvage for slaughter.
- Medical:
- Broad spectrum antibiotics.
- NSAIDs.
- Cold hosing.
- Sexual rest 60-90 days.
- Surgical: evacuate clot and repair rupture in tunica.
- Prognosis: 50% recovery.
Presenting signs
- Symmetrical swelling dorsal to the penis near the scrotal neck
.
- Mild discomfort +/- unwillingness to mount Bull: lack of libido.
Age predisposition
- Younger (inexperienced) bulls.
- Older bulls with joint problems.
Breed/species predisposition
- Hereford bulls Hereford were over-represented in one study.
Cost considerations
- Surgical intervention will increase the likelihood of preserving future breeding.
- However, in a non-valuable breeding bull, it may be prudent to consider a salvage procedure for slaughter Phallectomy.
Special risks
- Surgical management requires either general anesthesia Anesthetizing cattle or heavy sedation Sedating cattle, thus a risk analysis should be done, ie underlying conditions could complicate the anesthetic.
Pathogenesis
Etiology
- Initial trauma, eg cow going down during mating or penis hits perineum at full erection. This causes a rupture in the tunica albuginea
:
- At insertion of the retractor penis muscle on dorsal aspect of the distal sigmoid flexure. The swelling may extend caudally along the retractor penis muscles.
- 150-250 ml blood is present in an erect penis, however, this amount will increase with repeated sexual stimulation.
Predisposing factors
General
- Age.
- Stage of breeding season:
- Early = lots of cows in heat.
- Late = bulls fatigued or in low body condition score.
- Size disparity between bull and females, ie small bull mating females of greater stature.
Pathophysiology
- Subsequent preputial edema can lead to preputial/penile prolapse.
- Preputial prolapse can persist for one week in Bos taurus bulls and >2 weeks in Bos indicus bulls.
- If a penile hematoma becomes infected, it can lead to abscessation in 60% of cases.
- The inflammation can result in adhesions forming within the preputial cavity.
- Vascular shunts can be a sequelae; meaning that even with repair of the primary injury, full erection may not be able to be achieved subsequently.
- If there is damage to the dorsal nerves, this will result in a loss of sensation to the distal penis meaning a bull will no longer be able to breed naturally.
Timecourse
- Depending on when the swelling is noticed, can influence the method of treatment, ie:
- Medical treatment should be used for long-standing cases.
- Surgical management should be within 5-7 days of the initial trauma to prevent fibrosis and clot development.
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.
- Koziol J (2023) Practical review of diagnosis, treatment and prognostic indicators of acquired conditions of the penis and prepuce in the bull. Clin Theriogenol 15 (9642), 11-17 VetMedResource.
- Ismail Z A B & Ababneh M (2007) Penile haematoma in a Shami buck. Can Vet J 48 (4), 433-434 PubMed.
- Musser J M B, St-Jean G, Vestweber J G & Pejsa T G (1992) Penile haematoma in bulls: 60 cases (1979-1990). J Am Vet Med Assoc 201 (9), 1416-1418 PubMed.
Other sources of information
- Hopper R M (2021) Bovine Reproduction. 2nd edn. Wiley Blackwell, USA.
- Noakes D E, Parkinson T J & England G C W (2019) Veterinary Reproduction and Obstetrics. 10th edn. Saunders Ltd, UK.
- Youngquist R S & Threlfall W R (2006) Current Therapy in Large Animal Theriogenology. 2nd edn. Saunders, USA.