Auer Ch 60 Penis And Prepuce

Front 1

Back 1

Front 2

Back 2

Front 3

Back 3

Front 4

Back 4

penile hematoma

Front 5

Back 5

Front 6

Back 6

persistent frenulum

Front 7

Back 7

preputial avulsion

Front 8

Back 8

preputial prolapse

Front 9

Back 9

Front 10

Back 10

Front 11

Back 11

segmental posthectomy

Front 12

Back 12

Front 13

Back 13

urethra rent

Front 14

Back 14

Front 15

Back 15

Front 16

Back 16

Front 17

Location of the urethra:

Back 17

passes over the ischial arch at the root of the penis, and becomes incorporated into the shaft of the penis. The urethra is located more ventral in the shaft of the penis

Front 18

What forms the root of the penis?

Back 18

a left and right crura originating on the lateral aspect of the ischial arch and converging below the arch, forming the shaft

Front 19

How is the proximal portion of the shaft attached?

Back 19

to the ventral aspect of the ischium by the suspensory ligaments of the penis

Front 20

Location of corpus cavernosum penis (CCP):

Back 20

dorsal to the urethra, begins at the union of the crura and ends distally in 3 projections, 1 centrally located, and 2 ventrolateral

Front 21

What is the urethral groove?

Back 21

ventral surface of the CCP

Front 22

Location of corpus spongiosum penis:

Back 22

surrounds the urethra and is located within the urethral groove of the CCP.

Front 23

What is the glans penis?

Back 23

CSP expands distally, covering the distal projections of the CCP

Front 24

Location of bulbospongiosus muscle:

Back 24

covers the ventral aspect of the CSP, the entire length of the penis

Front 25

What is the bulbospongiusus continuous with?

Back 25

Proximally with the urethralis muscle

Front 26

What surrounds the CCP and CSP?

Back 26

tunica albuginea, which is a thick, fibroelastic capsule, sending trabeculae into the spaces to form a supporting framework within the spaces

Front 27

What are the CCP and CSP lined with?

Back 27

endothelial cells and longitudinal bundles of smooth muscle

Front 28

What maintains the non-erect penis in the prepuce?

Back 28

Tone in smooth muscles of the CSP and CCP and the retractor penis muscle

Front 29

What is the corona glandis?

Back 29

circular edge of the glans penis

Front 30

What is the collum glandis?

Back 30

constriction behind the corona glandis

Front 31

What is the fossa glandis?

Back 31

deep depression in the glans penis from which the urethra protrudes

Front 32

What is the urethral sinus?

Back 32

dorsal diverticulum in the fossa glandis

Front 33

Describe erection:

Back 33

Parasympathetic input dilates and straightens the coiled branches of the deep artery of the penis and relaxes smooth muscle, enabling blood to flow into the spaces within the CCP and CSP. Engorgement of the CCP and CSP is restricted by the tunica albuginea and the trabeculae. Venous return is restricted to maintain engorgement of the CCP and CSP. Contraction of the ischiocavernosus muscle, stimulated by the pudendal nerves, elevates the penis and compression against the ischium forces blood into the CCP and impedes venous return from the CCP. During peak erection, the arterial supply is also occluded in the manner, making the CCP a completely closed space. Increased arterial flow into the CSP and contraction of the bulbospongiosus muscle increase pressure in the CSP. The CSP remains an open system during erection because vessels entering are not compressed against an osseous structure and blood can exit out of the dorsal veins. Contraction of the ischiourethral muscle impedes venous return by compressing the dorsal veins.

Front 34

Location of the ischiocavernosus muscle:

Back 34

arise from the tuber ischii and attach to the crura and the proximal aspect of the shaft

Front 35

Location of the ischiourethral muscle?

Back 35

extends from the ventral surface of the ischium, goes around the ischial arch, and end at the ventral aspect of the urethralis muscle

Front 36

Describe ejaculation:

Back 36

Contraction of the urethralis muscle forces release of seminal fluids. Contraction of the bulbospongiosus muscle causes a pressure wave down the CSP expelling semen from the urethra.

Front 37

Location of the retractor penis muscle:

Back 37

arise on the floor of the coccygeal vertebra, forming a loop under the rectum and anus, but extending distally with the bulbospongiosus muscle to end at the glans penis

Front 38

Arterial supply to the penis:

Back 38

from the internal and external pudendal arteries and the obturator artery

Front 39

What does the external pudenal supply?

Back 39

the dorsal artery of the penis, the major source of blood during erection and supplies the caudal superficial epigastric artery, which is the arterial supply to the prepuce

Front 40

What does the obturator artery supply?

Back 40

deep arteries of the penis, which supplies blood to the CCP

Front 41

What does the internal pudendal supply?

Back 41

pelvic urethra and the CSP

Front 42

What are the accessory glands?

Back 42

paired seminal vesicles, bulbourethral, and ampulla of the ductus deferens and the unpaired prostate

Front 43

Where is the ampulla of the ductus deferens?

Back 43

widen portion with walls thickened with secretory glands, located near the midline of the pelvic floor

Front 44

Where are the seminal vesicles located?

Back 44

on the dorsal surface of the neck of the bladder, lateral to the ampullae

Front 45

Where do the seminal vesicles and ampullae drain?

Back 45

open with or near the ampulla on the colliculus seminalis through the ejaculatory duct, a rounded prominence on the dorsal aspect of the urethra

Front 46

Wher is the prostate located?

Back 46

dorsal aspect of the neck of the bladder, caudal to the seminal vesicles

Front 47

Where do prostratic secretions exit?

Back 47

through small slit-like prostatic ducts, located lateral to the colliculus seminalis

Front 48

Where are the bulbourethral glands located?

Back 48

dorsolateral to the urethra at the level of the ischial arch, 2-3 cm caudal to the prostate

Front 49

What supports the prepuce?

Back 49

suspensory ligament, within the external lamina, the is derived from the abdominal tunic

Front 50

What is the plica preputialis/ preputial fold?

Back 50

When the penis is retracted, the internal lamina doubles on itself

Front 51

What is the preputial ring?

Back 51

opening of the plica preputialis

Front 52

How is the pudendal nerve blocked?

Back 52

3 to 5mL lidocaine is injected 2cm dorsal to the ischial arch and 2 cm lateral to the anus

Front 53

Treatment of Preputial lacerations:

Back 53

sutured to prevent infection and cellulitis

Front 54

Treatment of penile wounds?

Back 54

Fresh penile wounds should be sutured. Chronic infected wounds should be cleaned and treated with topical antimicrobials without repair

Front 55

Treatment of urethral lacerations?

Back 55

should be reapposed or if complete, penile amputation should be considered

Front 56

Consequences of untreated urethral injuries?

Back 56

cutaneous-urethral or cavernourethral fistulas

Front 57

Consequences of laceration into cavernous regions?

Back 57

may result in shunt and lead to impotence

Front 58

Treatment of lacerations into CCP or CSP?

Back 58

tunica should be repaired

Front 59

Treatment of Penile hematomas:

Back 59

compression wrapping repeatedly until the maximal decrease in size is achieved. The penis is then supported within the prepuce or against the abdomen until resolution of swelling

Front 60

Paraphimosis:

Back 60

inability to retract the protruded penis

Front 61

Causes of paraphimosis:

Back 61

Trauma leads to edema, the weight of the edema tires the smooth muscles that maintain the penis within the prepuce or administration of phenothiazine tranquilizers blocking motor innervation to the retractor penis muscle

Front 62

What is balanoposthitis?

Back 62

inflammation of the penis and prepuce

Front 63

What complicates paraphimosis?

Back 63

Pooling blood within the CCP of the protruded penis occurs within 2-5 hours, leading to further edema, impaired venous drainage, and fragility to exposed tissues. Exposed tissues become excoriated, leading to further inflammation and cellulitis. Chronic inflammation results in fibrosis of the penile skin and permanent impairment of the normal telescoping action of the penis and prepuce. The weight of the penis can cause damage to the pudendal nerves

Front 64

Treatment of acute paraphimosis:

Back 64

controlling edema and preventing further trauma. The penis can be retained within the prepuce or if too swollen to be retained in the prepuce, it can be retained against the abdomen with a support or within a bandage

Front 65

Treatment of chronic paraphimosis:

Back 65

fibrosed preputial ring can be incised longitudinally (preputiotomy), cicatrical tissue can be resected with segmental posthectomy, or the horse salvaged for non-breeding purposed with bolz procedure, extensive posthectomy, or partial phallectomy

Front 66

Phimosis:

Back 66

inability to protract the retracted penis from the prepuce due to stricture of the preputial orifice or the preputial ring

Front 67

Consequences of phimosis:

Back 67

Urine exposure in the preputial cavity exacerbates inflammation leading to further scarring

Front 68

Treatment of preputial orifice phimosis:

Back 68

wedge of the external preputial lamina can be resected and the internal and external lamina are joined with a row of interrupted sutures

Front 69

Treatment of preputial ring phimosis:

Back 69

wedge is removed from the internal preputial lamina and segmental posthectomy is performed

Front 70

Priapism:

Back 70

persistent erection without sexual excitement, from disturbance of wither arterial inflow or venous outflow to the CCP

Front 71

Causes of priapism:

Back 71

after administration of phenothiazine (alpha anatagonist) medication, general anesthesia, EPM, and pelvic canal neoplasia

Front 72

What is high flow priapism?

Back 72

occurs when arterial flow into the CCP is increased, likely from arteriocavernosal shunt, with inability of the venous drainage to compensate for the increase

Front 73

What is low flow priapism?

Back 73

result of altered neural impulses controlling venous drainage, results in blood stasis within the CCP, with arterial flow continuing in the early phases of formation, which becomes static with formation of blood clots, edema, and chronically, fibrosis

Front 74

What flow of priapism affects horses?

Back 74

Low flow

Front 75

Consequences of priapism:

Back 75

penis and internal lamina will become edematous resulting in paraphimosis. Chronic priapism results in damage to the pudendal nerves from compression against the ischium, resulting in paralysis of the penis

Front 76

Medication treatment of acute priapism:

Back 76

topical therapies aimed at preventing preputial edema, support against the abdomen, and re-establishing normal circulation to the erectile tissue

Front 77

Drugs administered to affect circulation to erectile tissues in acute priapism:

Back 77

benztropine mesylate, a combination of atropine and diphenhydramine, working through anticholinergic effects. Terbutaline and clenbuteral, both beta-2 adrenergics. Alpha adrenergic agents into the CCP or CSP such as phenylephrine, ephedrine, or epinephrine by promoting contraction of cavernous and arterial smooth muscles

Front 78

Most common alpha agonist used in acute priapism:

Back 78

Phenylephrine

Front 79

Options for acute priapism if medical therapies are unsuccessful:

Back 79

CCP should be lavaged with heparin containing saline

Front 80

Describe lavage of the CCP:

Back 80

12 gauge needle is inserted distally and 1-2 12 gauge needles are inserted caudal to the scrotum. The lavage is continued until fresh blood appears. Phenylephrine can be instilled into the CCP at the end of lavage

Front 81

What is indicated if fresh blood does not appear after lavage of CCP?

Back 81

arterial supply to the CCP is permanently damaged

Front 82

What are the options in acute priapism if lavage and medical therapies fail?

Back 82

shunt created between the CCP and the CSP, or phallectomy

Front 83

Benefits of CCP CSP shunt in priapism:

Back 83

Since the CSP is not a closed system, shunt will allow outflow of blood from the CCP through the CSP

Front 84

Describe creation of CCP CSP shunt:

Back 84

15 cm incision is made along the perineal raphe, 4-8 cm caudal to the base of the scrotum. The retractor penis muscle is retracted, the bulbospongiosus muscle is elevated to exposed the edge of the urethral groove. A 3cm incision is made into the tunica albuginea of the CCP, allowing stagnant blood to be evacuated. A second 3 cm incision is made into the tunica albuginea of the CSP. The medial edge of the CCP tunica albuginea is sutured to the lateral edge of the CSP tunica albuginea and the lateral edge of the CCP tunica albuginea is sutured to the medial edge of the CSP tunica albuginea to create the shunt. The bulbospongiosus is sutured to is origin on the CCP tunica albuginea and the SQ and skin are closed

Front 85

Complications of surgically created cavernous shunt:

Back 85

urethrocavernous or urethrocutaneous fistulas, penile necrosis, infection, or pain during erection

Front 86

Hypospadias:

Back 86

congenital defect in which the urethral opening is on the ventral aspect of the penis, proximal to its normal location

Front 87

Cordee:

Back 87

abnormal curvature to the penis

Front 88

Treatment of hypospadias or cordee:

Back 88

amputation of the deformed portion of the penis

Front 89

Most common location of SCC:

Back 89

glans penis and the internal lamina of the prepuce

Front 90

Most common location of habronemiasis:

Back 90

preputial ring and the urethral process

Front 91

Causes of hemospermia:

Back 91

bacterial urethritis, habronemiasis, neoplasia, seminal vesiculitis, trauma, or urethral rents

Front 92

Surgical treatment for hemospermia:

Back 92

Temporary perineal urethrostomy or incision into the convex surface of the tunica albuginea of the CSP, repair of urethral rent through a perineal incision

Front 93

Causes of hematuria:

Back 93

urinary origin calculi, urinary origin neoplasia, pyelonephritis, and urethral rents

Front 94

Treatment for urethral rents:

Back 94

temporary urethrostomy, incision into the convex surface of the tunica albugina of the CSP, or repair through a perineal incision

Front 95

Synonyms for Segmental posthectomy:

Back 95

posthioplasty or reefing

Front 96

Describe segmental posthectomy:

Back 96

Parallel circumferencial incision are made through the epithelial layer, proximal and distal to the lesion. A longitudinal incision connects the 2 circumferential incisions. 4 equidistant sutures are placed around the penis to appose the proximal and distal epithelial edges. The tissue between the 2 circumferencial incisions is undermined circumferentially and removed. The portions of the unopposed epithelium are apposed in an interrupted or continuous pattern.

Front 97

Where are incisions made if segmental prosthectomy is to retain the penis in the prepuce:

Back 97

proximal incision is made close to the prepuce orifice and the distal incision is made where the internal preputial lamina inserts on the free body of the penis

Front 98

How is apposition of the proximal and distal incision of segmental posthectomy modified is they are of different sizes?

Back 98

2 triangular portions of the proximal incision can be removed, with the base of the triangle the proximal circumferential incision. The sides of the triangle are closed, making the proximal circumferential incision smaller and easier to appose to the distal circumferential incision

Front 99

Indications for Boltz phallopexy:

Back 99

permanently retract the penis in the prepuce

Front 100

When is the Boltz phallopexy technique not indicated?

Back 100

If the internal lamina of the prepuce is damaged, unless it is first removed with a segmental posthectomy, or if the horse is still capable of maintaining an erection

Front 101

Describe boltz phallopexy:

Back 101

10 cm incision is made on the preputial raphe caudal to the scrotum. The penis is bluntly separated from fascia and retracted through the incision until the reflection of the internal preputial lamina is seen through the incision. The penis is anchored with heavy, non-absorbable suture on either side of the incision, from the skin, through the annular ring of the lateral surface of the penis, back through the skin. A roll of gauze is place over the pexy site and the suture is tied. The SQ and skin are closed in separate layers. Post-operative the pexy sutures can be adjusted so that the glans penis is just flush with the preputial orifice. The pexy sutures can be removed in 10-12 days after adhesion formation maintains the new position of the penis.

Front 102

Describe Amputation of the urethral process:

Back 102

urinary catheter is placed in the urethra and the urethral process is retracted out of the fossa. Small gauge needles are placed at 90 degree angles through the urethra and the urinary catheter proximal to the site of amputation to maintain traction on the urethra. A circumferential incision is made around the base of the urethra process proximal to the lesion and distal to the anchoring needles. The mucosa of the urethra is apposed to the epithelium of the stump in a simple interrupted or continuous pattern, compressing the tissue of the CSP

Front 103

Complications of amputation of the urethral process:

Back 103

Hemorrhage can be seen from the stump for several days after amputation

Front 104

options for partial phallectomy:

Back 104

vinsot’s technique, the william’s technique, the scott technique, en bloc resection with retroversion, and en bloc resection without retroversion

Front 105

early complications of partial phallectomy:

Back 105

hemorrhage from CSP of the penile stump especially with urination for several days post-operatively, dehiscence, hematoma formation, pain, infection, edema, and urinary obstruction for edema or inflammation of the urethra

Front 106

Long term complications of partial phallectomy:

Back 106

chronic recurrent cystitis, urine induced dermatitis, dysuria from stricture, and recurrence of neoplasia

Front 107

Describe Vinsot’s technique:

Back 107

2.5 cm by 4 cm triangular section of the ventral penis is created proximal to the intended amputation, with the base of the triangle proximally. The urethra is incised and sutured to the epithelial border of the triangle, including the tunica albuginea of the CSP. The penis is amputated in a wedge shaped incision 4-5 cm distal to the triangle incision. Dorsal vessels are ligated. The CCP and the CSP are compressed with suture through the tunica albuginea, and the stump is closed with suture through the penile or preputial skin

Front 108

How can vinsot’s technique be modified?

Back 108

placement of a fixation ligature or a tight latex calf banding loop at the site of amputation and allowing the segment to necrosis and heal by second intension. Triangular incision can be replaced with a linear incision, with apposition of the urethral mucosa to the epithelium, incorporating the tunica albuginea of the CSP for compression

Front 109

Advantages of the William’s technique over Vinsot’s:

Back 109

urethral stricture and urine dermatitis

Front 110

Describe william’s technique?

Back 110

triangular incision is made on the ventral surface of the penis but the base of the triangle is part of the amputation incision. The mucosa of the urethra on the sides of the triangle are sutured to the penile epithelium, in a simple continuous or interrupted pattern, incorporating the tunica albuginea of the CSP. The penis is amputated and large vessels ligated. At the base of the amputation, the tunica albuginea of the CSP is compressed by suturing to the urethra mucosa. The remainder of the stump is closed by suturing the urethral mucosa at the base to the epithelium, incorporating the tunica albuginea of the urethral groove and the CCP, in 2 or 3 layers. 3 layers through the mucosa ensures good compression on the canvernous tissue

Front 111

describe scott’s technique:

Back 111

circumferential incision is made through the epithelium to the level of the urethra. A 4 cm segment of the urethra distal to the circumferential incision is freed from the stump before transection. The CCP is closed by suturing the outer CCP tunica albuginea to the inner CCP tunica albuginea with interrupted sutures. The CSP is closed with suture from the CSP tunica albuginea to the submucosa of the urethra in a continuous or interrupted pattern. The urethral stump is divided into 3 equal triangular segements and sutures to 3 similarly prepared segments of preputial or penile epithelium in a simple interrupted pattern or the urethral mucosa can be folded back over and sutured circumferentially to the penile or preputial epithelium and tunica albuginea

Front 112

describe en bloc partial phallectomy with penile retroversion:

Back 112

elliptical incision is made around the preputial orifice starting 6 cm cranial and extending 10 cm caudal, to the level of the abdominal tunic. The penis is amputated 6-8 cm caudal to the fornix of the prepuce in the scott method, so that there is a 4 cm segment of urethra protruding from the penile stump. A 6 cm subischial incision is made 20 cm ventral to the anus and the penile stump is retroverted through this incision. The tunica albuginea of the CCP and the fascia of the penis are sutured to the subcutaneous tissue of the subischial incision. The urethra is incised longitudinally on the ventral surface and the urethra is sutured to the subischial skin. Penrose drains are applied deeply through the cranial incision before closure of the SQ and skin

Front 113

describe Partial phallectomy without retroversion:

Back 113

A similar elliptical incision is created around the prepuce, and dissection is continued to exposed at least 10 cm of the shaft of the penis. The penis is amputated similar to the William’s technique, with a triangular segment from the ventral aspect of the penis, closing and compressing the cavernous layers but not the urethral layer. The penile stump is sutured to the body wall. The SQ tissue cranial to the stump is apposed. Skin is sutured to the tunica albuginea and the cranial aspect of the urethra. The caudal sides of the urethra are sutured to the skin and skin caudal to the orifice is closed

Front 114

benefits of partial phallectomy without penile retroversion:

Back 114

maintains the ventral position of the penile stump, has smaller incisions, and alters the horse’s normal appearance less

Front 115

describe temporary perineal urethrostomy:

Back 115

6-8 cm vertical incision 2-3 cm ventral to the anus, tunneled down to an incision through the urethra

Front 116

Complications of temporary PU:

Back 116

hemorrhage from the external pudendal vessels if the incision is off midline

Front 117

How does the ruminant penis differ from the horse?

Back 117

has a sigmoidal flexure located just caudal to the scrotum, the urethra has a dorsal diverticulum, there is an apical ligament, and in the ram and buck the urethral process extends 4-5 cm beyond the glans penis

Front 118

What is the consequence of the ruminant urethral dorsal diverticulum?

Back 118

makes catheterization difficult or impossible

Front 119

What is the function of the apical ligament?

Back 119

holds the penis straight for intromission

Front 120

What provides diagnostic or surgical anesthesia?

Back 120

blocking either the pudendal nerve or the dorsal nerve of the penis

Front 121

How is the ruminant pudendal nerve blocked?

Back 121

approached between the caudal fold of the tail and the caudal extent of the sacrosciatic ligament, guided per rectum, for injection at the level of the lesser ischiatic formen

Front 122

Surgical treatment of ruminant seminal vesiculitis:

Back 122

removal of gland by either ischiorectal approach or an approach through the floor of the rectum

Front 123

Describe ischiorectal seminal vesicular gland removal:

Back 123

crescent shaped incision can be made in the ischiorectal fossa, with blunt dissection to the gland, blind blunt freeing of the gland, and ecraseur transection

Front 124

Complications of ischiorectal seminal gland removal:

Back 124

severe hemorrhage from the large vessels adjacent to the surgical approach and iatrogenic damage to nerve that control erection and ejaculation within in the surgical area

Front 125

Where do penile hematomas occur in ruminants?

Back 125

just distal to the distal aspect of the sigmoid curve of the penis

Front 126

Complications of hematomas in ruminants:

Back 126

abscess +/- adhesion formation

Front 127

Treatment of penile hematomas in ruminants:

Back 127

larger than 15 cm should be approached surgically to remove blood and clot to reduce the risk of adhesion formation

Front 128

When does corkscrew or deviation of the penis occur?

Back 128

when the apical ligament slips before intromission occurs, preventing intromission

Front 129

Surgical options for corkscrew penis?

Back 129

anchoring the apical ligament to the tunica albuginea or augmentation of the ligament with strips of fascia lata

Front 130

Options for production of teaser bulls:

Back 130

epididyectomy or vasectomy, preputial relocation, preputial obliteration, penile tiedown, or phallectomy

Front 131

Approaches to penile tie down:

Back 131

tacking the dorsal aspect of the penis to the ventral body wall or by attaching the penis to the skin between the scrotum and the anus

Front 132

What does relocation of the prepuce involve?

Back 132

resection of the skin and tissue surrounding the prepuce, removal of an area of skin laterally near the flank fold, tunneling from the preputial incision to the flank incision, and replacement of the prepuce in the flank incision

Front 133

When does preputial avulsion occur?

Back 133

injury common to bulls used for semen collection

Front 134

What is preputial avulsion?

Back 134

penile skin at the point of reflection of the internal preputial laminia is torn

Front 135

Treatment options for preputial prolapse:

Back 135

resection of stricture by either preputiotomy or segmental posthectomy