Medical management of preputial laceration and prolapse is aimed at control of tissue sepsis, reduction of edema, and the eventual return of the damaged tissues to the preputial cavity. Application of emollients to prevent desiccation and topical antibiotics should be combined with light bandaging. Careful cleansing and flushing of the wound with dilute antiseptic solutions and debridement of devitalized tissues is necessary. Topical antibiotic therapy is sufficient if wound management is adequate, and systemic antibiotic therapy is not often required.
Application of a circumferential bandage to protect the wound, prevent desiccation, and apply mild compression of the damaged tissues is useful. To apply a bandage following cleansing and application of an emollient antibiotic ointment, first place a short length of latex tubing into the preputial orifice and position it with one end in the preputial cavity proximal to the torn epithelial tissues and the other end exiting the preputial orifice to allow urine egress from the prepuce. Then place a piece of clean 5‐cm orthopedic stockinette over the exposed preputial tissues and snugly apply an elastic tape bandage over the stockinette, prepuce, and urine egress tube beginning at the distal end of the prolapsed tissue, overlapping the tape as it advances up the prepuce to the preputial orifice, where it can be secured to the haired skin of the sheath (Figure 15.6). Following bandaging, the edematous prepuce may sometimes need to be suspended by application of a bib or sling made of net material or burlap supported by straps encircling the bull's abdomen (Figure 15.7). Frequent bandage changes are necessary, and the wound should be treated locally each time it is exposed. Cold water hosing for 10–15 minutes at each bandage change will reduce edema and remove necrotic debris. With diligent treatment many bulls may be returned to service without surgery [18] but repeat injury is common.
Figure 15.6 Bandaging of the prolapsed preputial tissues following application of an emollient and topical antibiotics. Placement of a urine egress tube to evacuate urine from the prepuce, a light stockinette to protect the exposed tissues (a), and an overlapping elastic tape pressure bandage secured to the preputial hairs and urine egress tube distally and to the skin of the haired sheath proximally (b).
Figure 15.7 Burlap “bib” applied to the bull's abdomen to suspend the edematous preputial tissues.
Source: Image courtesy of Chance Armstrong.
Surgical treatment following preputial laceration can improve outcome [19] and is indicated when the bull's value and remaining breeding life justify the expense [19, 20]. Surgery must always be preceded by preoperative wound management. Excellent descriptions of the surgical options appear elsewhere in this book (see Chapter 19).
Retropreputial Abscess
Preputial injury and laceration are not limited to B. indicus influenced breeds. In B. taurus bulls, preputial injury may occur at the time of breeding in a manner identical to that described for B. indicus bulls, but the outcome is often altered by phenotype. B. taurus breeds are more likely to retract all the damaged tissues into the preputial cavity following injury and as a result the wound is less likely to be noticed early. The visible preputial swelling may be confined to a well‐defined area adjacent to the bull's sheath, or may be more diffuse and occasionally extend from the preputial orifice caudally toward the scrotum. Because the compromised elastic tissues within the preputial cavity are contaminated with bacteria, cellulitis and phlegmon develop rapidly, often progressing to abscess formation.
Retropreputial abscess formation is more likely in bulls of B. taurus than B. indicus influenced breeds due to lack of redundant skin and generally tighter sheath conformation. Affected bulls present with an obvious swelling visible through the overlying skin of the sheath that may be accompanied by the presence of pus or blood at the preputial orifice. Diagnosis is based on physical examination and palpation, sometimes augmented by ultrasound imaging of the tissues. The differential diagnosis for preputial inflammation with visible disruption of the normal contour of the sheath must include the enlargement of the elastic tissues seen following rupture of the tunica albuginea of the penis. In contrast to the lesion seen with rupture of the tunica albuginea, retro preputial abscesses are usually non‐symmetrical and located distal to the sigmoid flexure nearer the level of the preputial fornix (Figure 15.8). Retropreputial abscess formation is associated with poor prognosis for future breeding. Destruction and impairment of the elastic tissues frequently result in adhesion formation within the elastic tissues of the prepuce and the overlying skin, or in compromise of the diameter of the preputial lumen, either of which may prevent extension of the penis [17].
Figure 15.8 Retropreputial abscess following preputial laceration in a young bull. Note location of the swollen tissues in the distal sheath.
Therapy for retropreputial cellulitis, phlegmon, and abscessation relies on systemic antibiotic administration and local wound management. Daily flushing of the preputial tissues with dilute antiseptic solutions and cold water hosing of the sheath aid in resolution of cellulitis. Drainage of a retropreputial abscess into the preputial lumen at the site of the original injury may facilitate recovery but is difficult to accomplish. No attempt should be made to drain a retropreputial abscess through the overlying skin of the sheath as inflammation and sepsis of the underlying elastic tissues are inevitable and subsequent formation of peripenile adhesions will decrease the chance of a successful outcome [17, 18]. Even with aggressive therapy the prognosis is guarded to poor and many affected bulls never return to service [17].
Phimosis
Phimosis, the inability to extend the penis, effectively prevents the bull from breeding and may be diagnosed at the time of an observed breeding or by induction of erection with an electroejaculator. Phimosis may be due to stenosis of the preputial opening or lumen, adhesions within the elastic layers of the prepuce and surrounding skin, or occasionally abnormalities of the distal penis
