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Surgical Restoration of Breeding Bulls

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Surgical Restoration of Breeding Bulls Surgical Restoration Of Breeding Bulls (Q) n 0 "O David E Anderson, D. V.M., MS, Diplomate ACVS '< .....'""I College of Veterinary Medicine {IQ The Ohio State University s:' Columbus, Ohio 43210 ► ~ .....'""I (') § Surgical Pathology of the Reproductive Organs Preputial lacerations may be treated medically or rJl► rJl by a combination of medical and surgical therapy. The 0 (') Injury or disease involving the reproductive tract most common mistake in surgical treatment is perform­ ~-..... of bulls is a significant cause of economic and genetic ing surgery too soon after injury (since essentially all 0 loss to cattle producers. An abattoir survey of 550 bulls injuries are infected by the time they are diagnosed). I i:i 0 in Northern Australia found that preputial (prolapse prefer to treat preputial wounds for anywhere >-+i t:o 3.1 %, abscess 0.54%, papillomatosis 0.18%) and penile from 10 to 60 days before performing surgery. Pa­ 0 injuries (persistent frenulum 0.36%, hematoma 0.54%, tient selection for surgery is the primary determinant s·< fractured penis 0.18%, abscess 0.18%) were common. of the success of the procedure. The bull is sedated (1) 'i::I Spitzer et al examined 862 yearling bulls and found that (xylazine, acepromazine, etc), a local block done (ring p5 109 failed breeding soundness examination. Abnormali­ block, pudendal nerve block, xylazine epidural, etc) and ('),....,. ,....,...... ties in the 109 yearling bulls included persistent penile restrained or is placed under general anesthesia (triple frenulum (16.5%), fibropapilloma (1.8%), and penile ab­ drip, halothane, etc). The penis is extended and grasped ~r (1) '""I normalities (1.8%). Chenoweth et al found breed with towel forceps placed between the apical ligament rJl differences in the occurrence of abnormalities of the re­ and the tunica albuginea proximal to the glans penis. 0 "O productive tract. Herefords had larger and firmer Small lacerations may be locally excised and sutured (1) i:i seminal vesicles, Brahmans had testicular hypoplasia closed. Larger lacerations and circumferential scars re­ ~ more frequently, Brahmans had smaller seminal quire circumferential posthioplasty. Posthioplasty is (') (1) rJl vesicles, Shorthorn Hereford cross cattle had more performed by dissecting the superficial epithelium and rJl preputial ulcerations, and Brahman cross cattle had damaged tissue free from the underlying elastic layer &. rJl,....,. preputial prolapse more frequently. of the prepuce. Two circumferential incisions are made, '""I one proximal and one distal to the damaged tissue. Then, ;.: Surgical Patholology of the Prepuce these incisions are connected by a longitudinal incision a..... 0 and the epithelium elevated. The two remaining end of p Injury of the prepuce is most commonly observed the prepuce are sutured together using No 2-0 PDS or in pasture breeding bulls, but bulls maintained in se­ chromic gut. In cattle with extensive preputial damage men collection facilities occasionally suffer these injuries which prevents exteriorization of the penis, a circumci­ as well. The prognosis for bulls with preputial injury sion, or preputial amputation, is indicated. Preputial varies greatly with the location and type of injury. The amputation is done by placing overlapping mattress most common lesions include preputial prolapse, lac­ sutures around the based of the affected portion of the eration, abscess, trauma, avulsion, and adhesion or prepuce after which the damaged segment is amputated. fibrosis. Congenital lesions include persistent frenulum After surgery, a preputial retaining tube is taped onto and preputial stenosis. Desrochers et al found that suc­ the prepuce and is left in place for 10 to 14 days after cess rate for surgical correction of preputial injury was surgery. Antibiotics are administered for 10 days after best when the penis could be extended at surgery (88% surgery. vs 36% if extension was not possible), if a posthioplasty Kasari et al described a decision analysis model could be performed (90% vs 43% when circumcision was for the cost-effectiveness of treatment of bulls with required), and when surgery was performed under gen­ preputial problems. Based on an assumed success rate eral anesthesia in a clean surgery suite (100% vs 63% of 59% for medical therapy and 85% for surgical treat­ for surgeries performed under injectable or local anes­ ment, the decision to cull was more economically thesia). Sexual rest of at least 60 days is enforced by advantageous. This model makes several critical as­ isolation housing. sumptions that should be considered when using it for SEPTEMBER, 1998 79 clinical decision analyses. These include that the bull's days). Monitoring should include observation for prepu­ genetic value can be replaced, that the injured bull will tial prolapse secondary to venous congestion and only be used for 2 breeding seasons after recovery, that dependent edema caused by the hematoma. Vascular the bull is used in a single breeding season per year, shunting of blood out of the corpus cavernosum penis or (Q) and that treatment will be performed at a hospital fa­ occlusion of the CCP may cause failure of penile erec­ n 0 cility (potentially higher costs than on-farm treatment). tion and impotence. Vascular shunts are diagnosed by "O '< positive contrast corpus cavernosography. Surgical treat­ ....."'"I Surgical Conditions of the Penis ment of vascular shunts is difficult but Young et al had {IQ a 50% return to service after resection of the affected s:' Persistent frenulum and penile hematoma are the portion of the tunica albuginea. However, several of these ► ~ two most common abnormalities for which surgery is bulls required multiple surgeries to achieve success. ....."'"I (') indicated. Vascular shunts and penile deviations are less Penile deviations may include spiral, ventral, and § common. Resection of a persistent frenulum can be per­ S-shaped deviations, all of which are caused by abnor­ C/) formed with the bull standing or recumbent. I prefer to malities of the apical ligament of the penis. Two surgical C/)► 0 perform this surgery with the bull recumbent and re­ techniques have been described for reinforcement of the (') strained on a tilt table. The bull may be held off feed for apical ligament: 1) apical ligament splitting and inter­ ~-..... 12 hours prior to surgery and sedated withxylazine HCL weaving and 2) fascia lata autografting. I do not 0 i:i (0.05 mg/kg body weight, IV) and acepromazine (0.03 recommend apical ligament splitting and interweaving 0 >-+i mg/kg, IV). The penis is extended and the frenulum (longitudinal incision in the apical ligament followed by t:o 0 grasped at its attachment to the penis and prepuce. isolation of a 2 mm wide portion of the ligament which < Then, the frenulum is resected using Mayo scissors. is threaded onto a needle and passed through the tu­ s· (1) Bleeding is usually minimal, but may be controlled us­ nica albuginea in a bootlace or interweaving pattern) 'i::I ing electrocautery or suture ligation. The bull should be because this technique may result in the formation of p5 ('),....,. rested for 10 to 14 days before breeding activity is re­ vascular shunts. I use the fascia lata autograft because ,....,...... sumed. Penile hematoma is usually seen in the technique is simple, easy to perform if the bull is ~r inexperienced bulls and is caused by impact of the pe­ anesthetized, has a good success rate, does not promote (1) "'"I nis with the cow's perineum during maximal vascular shunts, and has worked well for me (thanks to C/) 0 engorgement. This causes dorsal bending of the penis Dr. Wolfe who has advised me in the use of this tech­ "O (1) particularly opposite the attachment of the retractor nique!). A 2-cm wide, 20-cm long segment of fascia lata i:i penis muscles. This results in extremely high pressures is obtained from the craniolateral aspect of the thigh. ~ (') within the corpus cavernosum penis (exceeding 400 lb/ Then, the apical ligament is divided on the dorsal mid­ (1) C/) in2) occasional rupture of the CCP. The rupture arises line to expose the tunica albuginea. The autograft is C/) from the dorsal or crural canal and tunica albuginea of customized to the dorsal penis and sutured to the tu­ &. ,....,.C/) the CCP (not the dorsal artery of the penis). nica albuginea using 3-0 monocryl (or 2-0 PDS). The ;.:"'"I A penile hematoma forms dorsal to the distal sig­ apical ligament is sutured back and anchored to the a..... moid flexure and is located proximal or immediately autograft. Sexual rest of a minimum of 60 days is en­ 0 cranial to the base of the scrotum. Rarely, penile he­ forced for all surgeries of the prepuce and penis. p ma toma may be seen ventral to the penis, at the mid-body of the penis, or may cause disruption of the Seminal Vesiculitis urethra. The penile hematoma prevents extension of the penis initially because of the space occupying mass and Seminal vesiculitis is a common finding in young later because of adhesions to the penis. Surgical inter­ bulls during pre-breeding soundness examinations. Sep­ vention has proven most successful for large penile tic seminal vesiculitis (wbc's in semen, positive bacterial hematomas. Musser et al reported success rates of ap­ culture, poor semen characteristics) has a low response proximately 80% for either surgical or medical treatment to medical therapy (parenteral antibiotics, intravesicular of penile hematomas < 20 cm diameter. Hematomas that antibiotics, intravesicular caustic agents). Therefore, were> 20 cm diameter had success rates of 75% after methods for surgical treatment have been developed. surgery and 33% after medical treatment. Surgical man­ Surgical removal of the seminal vesicles has resulted in agement is best performed with the bull under general a fair prognosis for return to breeding soundness. anesthesia to optimize sterility. If the penile hematoma becomes infected, the prognosis decreases to near 0%.
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