Penile Amputations: Multitude of Choices but How to Choose and Perform Properly

The most common indication for penile amputation is extensive neoplasia that cannot be managed using local therapy. The second most common indication is permanent paraphimosis. Postoperative erection can lead to hemorrhage and/or suture dehiscence therefore the surgeon should consider castrating a stallion 3-4 weeks prior to phallectomy if possible. In my opinion, penile amputation is best performed under general anesthesia with the horse in dorsal recumbency. Perioperative antimicrobials and NSAIDs can be used at the discretion of the surgeon. Once the horse is under anesthesia and positioned on the surgery table the urethra should be catheterized using a stallion catheter. Once the penis and prepuce are prepped for surgery a tourniquet can be placed proximal to the proposed surgery site to aid in controlling hemorrhage. Once the procedure is complete the tourniquet should be removed. Typically a urinary catheter is not needed post operatively.

There are three main techniques for partial phallectomy: Scott Technique, Vinsot Technique, & Williams Technique. In the Scott technique, the penile skin is incised circumferentially at the proposed amputation site. The incision is continued through the corpus cavernosum penis (CCP) to the urethral groove. The corpus spongiosum penis (CSP) is incised to expose the urethral mucosa. The urinary catheter will aid in identifying the urethra. A 4-5cm long section of urethra should be dissected from the amputated portion. The CCP is closed using absorbable suture placed in an interrupted pattern. The suture bites should be through the outer most tunica albuginea to the tunica albuginea of the urethral groove. The CSP should be closed using absorbable suture placed in an interrupted pattern. The suture bites should secure the tunica albuginea surrounding the CSP to the submucosa of the urethra. The urethra can be divided into three equal triangular sections with the apex of each triangle pointing distally. Each triangular section of tissue is sutured to the penile integument using absorbable suture placed in a continuous pattern. Instead of dividing the urethral tissue into sections the urethral stump can be stretched and folded back over the stump of the penis. The edge of the urethra is sutured to the skin of the penis using absorbable suture placed in an interrupted pattern or in sections of a continuous pattern.  [...]