Authors: José R. Castro, DVM, DABVP-Equine, DACVS-LA, CVA-Equine & Tricia A. Elwood
Medical Treatment of Paraphimosis in an Equine
History: This horse was a 25 y.o, American Paint Horse, Gelding, presented to DCLAH with a 24 hour history of a swollen, dry, ulcerated penis. The horse was able to urinate but the swelling had gotten significantly worse since it was discovered. The diagnosis was paraphimosis.
Paraphimosis: The inability of a horse to retract its penis back into the prepuce (sheath).
1. Swollen penis and prepuce
2. Inability to retract penis into the sheath
3. If unattended it can lead to permanent Penile Paralysis
1. Traumatic injury to the penis (ex: stallion kicked by a mare)
2. Priapism, a side effect of certain tranquilizers
3. Injury to the nerves involved in penile retraction
4. Viral infections, spinal cord injury, myelitis
5. Post-castration complication
1. Thorough examination of the penis and sheath. The wounds are treated as needed.
2. The penis is cleaned and attempts are made to replace it into the sheath.
3. Tourniquet for compression of the penis may be needed to reduce swelling
4. Penile sling may be needed to retain the penis into the sheath.
5. Anti-inflammatories/ antibiotic medications; topical and systemic
6. If the penis becomes necrotic, then amputation is needed.
7. In cases of incomplete or partial resolution, then the Boltz technique is performed to permanently retain the penis inside the sheath. Stallions will need to be gelded prior to this surgery
This patient was unable to retract his penis back into his sheath. The sheath was thoroughly cleaned. Maggots were discovered inside the sheath. The presence of the maggots was due to an unnoticed wound inside of the sheath and this later caused the paraphimosis. The sheath and penis were cleaned, the maggots removed, and an Esmarch tourniquet was applied for 30 minutes to decrease the swelling. Antibiotic ointment was applied to treat the wound and to moisturize the penis. A custom-made penile retainer was made to hold the patient’s penis inside the sheath. The horse was hospitalized for the day to monitor swelling and urinations. By the end of the day the swelling had decreased by >60%. He was able to keep his penis partially in his sheath. The patient went home on systemic and topical medications.
The owners utilized the penile retainer for another 10 days and by that time the patient was able to keep his penis in his sheath. The patient had no long-term effects and has resumed normal life with full function of his penis.