ISSN 2398-2977      

Penis: phimosis

pequis

Introduction

  • Phimosis is the inability to protrude the penis from the sheath.
  • Cause:
    • Stenosis of the preputial orifice, eg congenital stricture, trauma, edema, inflammation, or impairment of normal preputial telescoping action.
    • Lesion on the penis or prepuce, eg a squamous cell carcinoma Penis: squamous cell carcinoma, which prevents protrusion through a normally sized preputial orifice.
    • Swelling of a retracted penis due to trauma and inflammation which then prevents protrusion through a normally sized preputial orifice.
  • Signs: inability to protrude penis from the sheath, inflammation of the prepuce, excessive smegma accumulation.
  • Diagnosis: signs, biopsy, microbiology, serology and parasitology.
  • Treatment: depends on cause.
  • Prognosis: guarded to fair; depends on cause.

Pathogenesis

Etiology

  • Stenosis of preputial orifice may be caused by:
    • Congenital defects.
    • Acquired defects:
      • Edema.
      • Inflammation.
      • Infection with equine herpesvirus 3 Equine herpesvirus Reproduction: coital exanthema - EHV 3 or Corynebacterium pseudotuberculosis or lesions at the preputial crevice/ring prevent telescoping action.
      • Genital phycomycosis.
      • Genital cutaneous habronemiasis Penis: habronemiasis.
      • Neoplasia Penis: neoplasia.
      • Urine retention in the preputial cavity subsequent to phimosis producing further mucosal inflammation and cicatrisation.
      • Lesion on the penis or prepuce which prevent protrusion through a normally sized preputial orifice are often neoplastic in origin, eg a squamous cell carcinoma Penis: squamous cell carcinoma, but can be parasitic, eg habronema infection habronemiasis Penis: habronemiasis.
      • Swelling of a retracted penis which then prevents protrusion through a normally sized preputial orifice is most commonly due to trauma. The trauma may have occurred whilst the penis was extruded, eg during breeding, and the stallion then withdrew it into the prepuce before the swelling started.

Pathophysiology

  • Stenosis of preputial orifice leads to inability to protrude penis from sheath:
    • Impairment of normal preputial telescoping action.
    • Congenital phimosis is normal for the first month of life: the epithelium of the free part of the penis is fused with the inner lamina of the preputial fold. Separation occurs within 1 month of birth.
    • Excessive secretion of smegma Prepuce: smegma → chronic irritation and thickening of prepuce → phimosis → urination within prepuce → exacerbates inflammation.
    • Horses castrated when young may fail to protrude penis when urinating → inflammation → scarring → constriction of preputial orifice → phimosis.
  • Enlargement of the penis may make it impossible to extrude through a normally sized preputial orifice:
    • The penis or prepuce may become deformed or fixed by neoplasia Penis: neoplasia or granulomas.
    • Trauma or chronic infection may cause inflammation or edema of prepuce (posthitis Penis: balanoposthitis) → stenosis of preputial orifice.

Timecourse

  • Usually gradual onset (may be acute if consequent upon traumatic injury to the penis).

Epidemiology

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Colgate V A & Payne R J (2021) Surgical treatment of phimosis due to preputial stenosis in a Thoroughbred colt. Equine Vet Educ WileyOnline.
  • Canisso I F, Ellerbrock R E & Wilkins P A (2020) Congenital phimosis causing preputial swelling in a newborn foal. Can Vet J 61 (3), 247-250 PubMed.
  • Perkins N R & Frazer G S (1994) Reproductive emergencies in the stallion. Vet Clin North Am Equine Pract 103 (3), 571-638 PubMed.
  • Little T V & Holyoak G R (1992) Reproductive anatomy and physiology of the stallion. Vet Clin North Am Equine Pract (1), 1-29 PubMed.
  • Simmons H A et al (1985) Paraphimosis in seven debilitated horses. Vet Rec 116 (5), 126-127 PubMed.

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