purpose of this procedure is to allow the surgical wound to heal in a longitudinal plane and to maintain normal elastic tissue function. Since no elastic tissue or preputial skin is removed with this procedure, first intention healing should reduce the risk of preputial stenosis and allow subsequent penile extension. Most bulls require 60–120 days for the penis to freely extend following this procedure. Do not forcefully extend the penis during the convalescent period as the potential trauma increases the likelihood of excessive scar formation. Most bulls begin to masturbate within a few weeks following surgery and will stretch contracted tissues without permanent damage.
Phimosis
Preputial injuries that occur on B. taurus breeds typically result in phimosis rather than prolapse and therefore represent a different sort of challenge. If the penis is forcefully extended and then not repaired and replaced within the sheath at the same time, paraphimosis may result. The prepuce can be lavaged with an antiseptic solution. Then apply an ointment of your choice and allow second intention healing to occur. If there is extensive swelling, infection, and inflammation (phelgmon), it is usually best to allow the bull one to three months to heal as much as possible on its own before attempting surgical correction. Continued treatment attempts in the face of extensive inflammation as described is virtually always unrewarding. Ascertain the extent of fibrosis and whether or not the penis can be extended (some bulls that can extend will still require surgery). In addition, it is common to encounter one or more abscesses. Scar tissue often must be removed to allow easy, painless, and full extension of the penis. Unlike B. indicus influenced bulls, these bulls rarely have enough preputial tissue to allow for a circumcision. A scar revision technique as previously described can usually be utilized.
Creation of Preputial Stoma
Occasionally bulls with preputial injury or frostbite develop extensive scar tissue such that there is insufficient length of healthy prepuce for scar revision and preputial reconstruction or circumcision. Creation of a stoma from the preputial cavity through the sheath may allow sufficient penile protrusion for semen collection. In my experience (Wolfe), two bulls were able to successfully complete coitus following this surgical procedure. With the bull adequately restrained and following preparation for aseptic surgery, make an elliptical incision through the skin. This incision is made on the ventral sheath sufficiently proximal to the scar tissue to penetrate the lumen of the preputial cavity (Figure 19.46). The diameter of the stoma should be sufficiently large to allow the free portion of the penis to extend, but not sufficiently large that the remaining prepuce may prolapse. Following removal of the elliptical skin, continue dissection through the peri‐penile elastic layers and elevate the prepuce through the opening in the sheath (Figure 19.47). Incise the prepuce (Figure 19.48) and exteriorize the free portion of the penis through the incision (Figure 19.49). Using #0 absorbable suture, appose the skin of the prepuce to the skin of the sheath with a simple interrupted pattern (Figure 19.50). Suture a 2.5‐cm Penrose drain over the free portion of the penis to allow postoperative urine drainage away from the incision (Figures 19.51–19.53). Remove the Penrose drain 10 days postoperatively and allow 60 days’ sexual rest prior to attempted semen collection (Figure 19.54).
Figure 19.46 Triangular flap of skin removed from sheath (apex of triangle oriented toward scrotum).
Figure 19.47 Prepuce elevated through incision in sheath.
Figure 19.48 Incision into preputial cavity to create stoma.
Figure 19.49 Free portion of penis exteriorized through preputial stoma.
Figure 19.50 Preputial epithelium apposed to skin of sheath with interrupted absorbable sutures.
Figure 19.51 Penrose drain sutured over free portion of penis.
Figure 19.52 Penrose drain over penis through preputial stoma for urine drainage.
Figure 19.53 Postoperative image of bull with preputial stoma. (Note Penrose drain is through natural sheath opening.)
Figure 19.54 Completely healed preputial stoma ready for attempted semen collection.
Paraphimosis
Paraphimosis with resultant injury from penile exposure can be managed with a combination of medical and surgical therapy. Because of the inability to completely retract the penis, significant damage to the epithelial layers of the penis occurs (Figure 19.14).
Soaking the affected areas, as described previously for preputial prolapse, should occur immediately and be continued daily until there is a return to the normal appearance of the tissue. In between the therapeutic soaking the penis is covered with stockinette that has been coated in a suitable ointment (the authors’ preference is one of the commercially available “bag balms”). Realize that three to four weeks of medical management is often required before the tissue is healed and surgery can be performed. Once the superficial layers are healed, a scar revision procedure as previously
