Preputial Reconstruction in Dogs

Injury or inherited abnormalities of the prepuce can occur in dogs, resulting in the inability to breed or urinate properly. The prepuce in female dogs is less susceptible to abnormalities requiring surgery than in males. The prepuce in male dogs is more likely by its nature to experience injury or abnormalities resulting in breeding and urinary difficulties. 

When abnormalities of the prepuce occur, surgical correction to reconstruct the prepuce tissue can be performed by your veterinarian. In the case of injury, this may be conducted to restore urinary and breeding function. In cases of a congenital defect, surgical intervention is used to restore urinary tract function only, as breeding is not recommended for dogs experiencing congenital defects. A veterinary surgeon with experience in reconstructive and urological techniques will ensure the best outcome for preputial reconstructive surgery. This procedure is performed under general anesthetic.

Prior to preputial reconstructive surgery you will be required to fast your dog so as not to cause complications during the administration of general anaesthetic. Your dog will be sedated, an intravenous line set up to provide anesthetic and supportive care, including fluids, and intubated to provide gaseous anesthesia. The area around the prepuce will be thoroughly shaved and cleaned prior to surgery. Your dog will be placed in dorsal recumbency and surgical drapes used to isolate the surgical area. Incisions are made and preputial blood vessels litigated as required.

Several surgical urological reconstructive techniques are used to address preputial abnormalities and injury resulting in urinary or reproductive dysfunction. These include:

• Advancement of preputial tissue to cover penile exposure
• Removal of tumors by wide excision of tumor and tissue surrounding tumor, may involve penile amputation if malignancy is present, and repair of remaining tissues. Tumor and excised tissue should be preserved and sent to a pathologist for assessment.
• Enlargement of preputial opening with excision of a V-shaped portion of tissue
• Buccal mucosa (oral tissue) grafting to reconstruct damaged or missing preputial tissue
• Transfer of peri preputial bipedicle subdermal plexus flap to close or replace missing preputial tissues
• Reconstructive suturing techniques, including those that allow grafted or advancement of tissue to proliferate and close gaps.

After reconstruction, a catheter is commonly used to allow passage of urine while recovery takes place. Incisions and tissues are sutured to close. Your dog will be monitored during recovery from anaesthetic.

Preputial reconstructive surgery is usually very successful, with limited complications occurring, and restores urinary function. Restoration of reproductive functioning in an injured dog may be more guarded in prognosis depending on the nature of the trauma.

Additional urinary tract surgeries and castration may also be performed to address concerns with preputial abnormality or injury in addition to reconstruction.

Your dog will usually require minimal hospitalization. Analgesics, anti-inflammatories and/or antibiotics may be administered following surgery and prescribed for several days post-surgery. Dogs will need to have activity restricted at home and cage confinement may be necessary for several days. The catheter will need to be monitored while in place to ensure it does not become dislodged and your dog’s bedding changed and cleaned while the catheter is present. Your veterinarian will advise you when the catheter can be removed as this varies depending on the degree of urinary tract reconstruction required. Catheter removal should be performed by your veterinarian. Sutures present will also require follow up to remove in 10 to 14 days. To prevent your dog from interfering with the wound, an e-collar is usually recommended. Your dog's fluid intake and output should be monitored to ensure urinary tract functioning is restored. Signs of infection or excessive blood in the urine should be reported to your veterinarian at once. Confinement and restriction of activity, by maintaining your dog on a leash when outside, should be continued for a few weeks post-surgery. Your veterinarian will give you specific instructions based on the reconstructive surgery that was required for your dog.

The cost of preputial reconstruction can range from $300 to $2,000 depending on the extent of reconstructive procedures required and ancillary procedures to neuter or address urinary tract functioning. 

Supply of mucosal tissue for grafts may be limited and advancement of preputial tissue may not be possible if large extrusion is present.

Incontinence and cosmetic defect can occur. While urinary tract functioning may be successfully addressed, reproductive restoration may not be possible.

Complications such as anesthetic complications, infection and hemorrhage are present as for all surgical procedures.

Dogs with congenital abnormalities of the preputial region should be removed from breeding programs. Keeping your dog on a leash or fenced and contained when outside will reduce the likelihood of motor vehicle accidents, environmental mishaps and dog fights which could result in preputial injury.