equis - Articles
Penis: paraphimosis
Introduction
- Paraphimosis is the inability to retract the penis back into the prepuce.
- Cause: trauma, myelitis, purpura hemorrhagica Purpura hemorrhagica, debilitation, or priapism Penis: paralysis / priapism.
- Signs: swollen penis and prepuce, inability to retract penis into sheath, priapism, penile paralysis.
- Diagnosis: clinical signs.
- Treatment: reduce edema and inflammation; replace penis; preputiotomy, phallopexy Penis: phallopexy or phallectomy Penis: phallectomy - Scott's technique.
- Prognosis: depends on cause.
Presenting signs
- Inability to retract penis into sheath.
- With penile paralysis.
- With priapism (persistent erection) Penis: paralysis / priapism.
Geographic incidence
- Worldwide.
Age predisposition
- Adult.
Cost considerations
- May cause loss of breeding potential of stallion.
Pathogenesis
Etiology
Preputial edema
- Penile injury including hematomas.
- Preputial trauma/lacerations Penis: trauma.
- Castration Testis: castration - technique.
- Various disease processes leading to edema.
- Purpura hemorrhagica Purpura hemorrhagica.
- Balanoposthitis (dourine) Penis: balanoposthitis.
- Trypanosomiasis: infection with T. equiperdum.
Damage to penile innervation
- Myelitis.
- Spinal cord injury Spinal cord: trauma.
- Rabies Rabies.
Penile paralysis
- Exhaustion.
- Debilitation.
- Penile paralysis or priapism Penis: paralysis / priapism.
- Use of phenothiazine tranquillizers Etorphine hydrochloride, especially foromazine.
Pathophysiology
- Inability to retract penis into sheath → impaired drainage → preputial and penile swelling.
- Penile/preputial injury → edema (penis/prepuce) → increased weight → muscular fatigue of retractor muscles → prolapse of penis/internal preputial laminae.
- Debility → loss of muscle tone → penile prolapse → damage to pudendal nerves.
- Penile paralysis following phenothiazine derivatives.
- Inability to retract penis into sheath → compromise of venous and lymphatic drainage → preputial and penile swelling → edema at preputial ring → constricts proximal penis → further swelling.
- Accumulation of edema leads to seepage through epithelium → fragile → wounds → infected fissures → excoriation and secondary bacterial infection.
- Fibrous tissue develops → impossible to manually replace penis into sheath.
Timecourse
- Swelling of penis and prepuce occurs within a few hours of paraphimosis.
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.
- Feary D J et al (2005) Chemical ejaculation and cryopreservation of semen from a breeding stallion with paraphimosis secondary to priapism and haemorrhagic colitis. Equine Vet Educ 17 (6), 299-304 VetMedResource.
- McDonnell S M (2005) Managing the paralysed penis, priapism or paraphimosis in the horse. Equine Vet Educ 17 (6), 310-311 VetMedResource.
- Nie G J & Pope K C (1997) Persistent penile prolapse associated with acute bloodloss and acepromazine maleate administration in a horse. JAVMA 211 (5) 587-589 PubMed.
- Perkins N R & Frazer G S (1994) Reproductive emergencies in the stallion. Vet Clin North Am Equine Pract 10 (3) 571-638 PubMed.
- Love C C, McDonnell S M & Kenney R M (1992) Manually assisted ejaculation in a stallion with erectile dysfunction subsequent to paraphimosis. JAVMA 200 (9) 1357-1359 PubMed.
- Little T V & Holyoak G R (1992) Reproductive anatomy and physiology of the stallion. Vet Clin North Am Equine Pract 8 (1) 1-29 PubMed.
- Schumacher J & Vaughan J T (1988) Surgery of the penis and prepuce. Vet Clin North Am Equine Pract 4 (3) 473-491 PubMed.