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Case report
Surgical treatment of hypospadias.
Techniques and results in six dogs
M. Galanty, P. Jurka, P. Zielińska
Department of Clinical Sciences,
Faculty of Veterinary Medicine, Warsaw University of Life Sciences,
Nowoursynowska 159, 02-787 Warsaw, Poland
Abstract
Various types of hypospadias and methods of surgical treatment of this anomaly in 6 dogs was
described in this article. Methods of surgical treatment were set up individually for each case and
depended on the type of hypospadias and coexisting anomalies. Shortening of the penis was per-
formed in two dogs, amputation in three cases and an urethral reconstruction in one patient. Castra-
tion was performed in three cases. Persistent frenulum of the prepuce was found in two dogs.
Additionally three patients were submitted to the plastic surgery of the prepuce anomalies. In one
dog, the loose and free falling part of the prepuce was suspended and attached to the abdominal
integument according to the original own method. In all dogs, uncomplicated wound healing was
observed. Surgical procedures resulted in improved cosmesis with reducing clinical signs of hypos-
padias and other coexistent anomalies.
Key words:dog, hypospadias, penis, prepuce, surgery
Introduction
Hypospadias is an uncommon developmental
anomaly, in which the urethral opening is abnormally
located. Depending on the location of the urethral
orifice, glandular penile, penile-scrotal, scrotal and
perineal type of hypospadias are described (Hardy
and Root Kustritz 2005). Clinically, the glandular type
of hypospadias is classified as mild, the penile form as
moderate, while other forms of hypospadias are classi-
fied as severe (Jurka et al 2008). This abnormality is
accompanied by clinical symptoms of different inten-
sity, mainly associated with urination disturbances and
changes in the penile and prepuce area. The degree of
hypospadias progression depends on the coexistent
disturbances such as: cryptorchidism (most frequent-
ly), malformations of the prepuce, hermaphroditism,
Correspondence to: M. Galanty, e-mail: marek-galanty@sggw.pl., fax: (+048) 22 847 58 18
testicle underdevelopment, persistent frenulum or
scrotum cleft (Hayes and Wilson 1986, Arnold 2003).
According to Hobson (1993), hypospadias results
from the partial or total fusion failure of the urethra
folds. Etiology of this anomaly in dogs (in contrast to
humans) has not been explained so far. Due to the
description of the highest incidence of hypospadias
cases for Boston Terriers, it is supposed that the gen-
etic changes in this breed may predispose for occur-
rence of this anomaly. Treatment of hypospadias de-
pends on its type. There is no need to treat the ani-
mals without clinical signs (Hardy and Root Kustritz
2005). Due to possibility of inheritance, animals with
such anomaly should be subjected to castration (Hed-
lung 2002, Arnold 2003). When it is impossible to per-
form surgery for different reasons, animals should be
excluded from reproduction. Treatment of hypos-
Polish Journal of Veterinary Sciences Vol. 11, No. 3 (2008), 235-243
padias involves surgical correction of the penis
and prepuce malformations. The important factors in
preplanning of the treatment, are accompanied with
anomaly signs, which are the real cause of the owner;s
visit to the veterinary clinic. The surgical treatment
depends also on the coexistence of other developmen-
tal abnormalities. Each case must be treated individ-
ually, adjusting the way of treatment and an appropri-
ate surgical technique.
The aim of this work was to define the accurate
way of surgical treatment of hypospadias in dogs.
Materials and Methods
The surgical treatments of hypospadias at the cli-
nic were performed in six dogs from January 2001 to
May 2007. Study material consisted of two Yorkshire
Terriers, one Boxer, one Dachsund, one German
Shepherd and one Chihuahua.
These dogs were at the age of 9 weeks to 3 years
5 months. In all animals, the surgery was preceded by
standard preparation. The dog No. 2 was
premedicated with acepromazine (Calmivet;
Vetoqinol), and general anaesthesia was performed
with the use of mixture infusion of medetomidine
(Domitor; Orion) and ketamine (Narkamon; Spofa).
Other dogs were premedicated with medetomidine
(Domitor; Orion), butorfanol (Butomidor; Richter)
and the anaesthesia was induced with thiopental
(Tiopental; Sandoz) and maintained with halothane
(Narkotan; Zentiva). The performed surgery depend-
ed on the type of hypospadias in particular patients.
Case Reports
Dog No. 1
Male, Boxer, aged 7 months, glandular hypos-
padias. The dog was diagnosed with concurrent aber-
rations: insignificant scrotum cleft and shortening of
the penis and the prepuce, which caused constant pro-
trusion of penile glans from the prepuce. Addition-
ally, the caudal part of the prepuce (6 cm in length)
did not adhere to the abdominal wall, resulting in the
prepuce descent together with the penis (Fig. 1). This
condition caused wetting of medial sides of limbs dur-
ing urination, which in turn demanded additional care
from the owners. In this dog the penis was shortened
to the height of the external urethra orifice. The slant-
ing incision was made on penile mucous membrane,
tunica albuginea,corpus spongiosum and cavernal cor-
puses in order to reshape the penis apex into a cone
and to redirect the external urethra orifice on its tip.
It was necessary to shorten the penis bone in order to
close the penis skin using monofilament, 4-0 absorb-
able suture material (Maxon; Tyco). Additionally, the
loose and free falling part of the prepuce was sus-
pended and attached to the abdominal integument.
From the apical part of the descending prepuce and
the neighboring abdomen, a part of skin in a form of
elongated rhombus was excised. Subsequently, the pe-
nis was lifted dorsally together with the prepuce so
that the formed skin losses (on the abdomen and on
the prepuce) covered each other (Fig. 2). Then, the
subcutaneous prepuce fascia was sutured with simple
stitches to the abdominal fascia, using 2-0 absorbable
suture material (Dexon; Tyco). The subcutaneous tis-
sue and skin were sutured on the both sides of the
prepuce adhering to the abdomen.
Dog No. 2
Male, Yorkshire Terrier, at the age of 6 months,
penile hypospadias. Additionally, enlargement of the
prepuce orifice and persistent frenulum was causing
bending of the glans (Fig. 3). This made the hygienic
care of this area difficult, both by the dog and by the
owners, subsequently leading to the secondary pre-
puce and penis inflammation. This caused anxiety and
constant interest in this area by the animal. Amoxicil-
lin (Betamox; No.rbrook) was administered for 5 days
before the surgical treatment in order to decrease in-
flammation of the prepuce and the penis, and lavage
of this area with antiseptic fluids was administered.
Additionally, this area was prevented from licking by
the use of a collar and a jacket for the abdomen. The
procedure started with releasing of the penis with an
incision of the persistent frenulum which connected to
the abdominal part of the penis and the prepuce mar-
gins. After incision of the frenulum and elongation of
the penis it was found that it extended beyond the
enlarged prepuce and the external urethral orifice was
located about 1.5 cm from the tip of the penis. An-
other stage of the procedure involved (as in the dog
No. 1) shortening of the penis (Fig. 4). Additionally
the edges of the prepuce ring were narrowed. The
mucous membrane was separated from the skin, and
the mucous membranes were sutured with simple con-
tinous suture (Maxon: Tyco, 4-0), while the prepuce
skin was sutured with simple stitches using 4-0 nonab-
sorbable material (Amifil; Sinpo) (Fig. 5).
Dog No. 3
Male German Shepherd, at the age of 3 years and
5 months, penile hypospadias. Other coexistent aber-
rancies were: persistent frenulum, enlarged urethral
opening, shortening of the penis and the prepuce to-
gether with scrotum cleft (Fig. 6, 7). The procedure
started with incision of the frenulum along the whole
length of the prepuce cavern. Subsequently, the miss-
236 Galanty M. et al.
Fig. 1. Glandular hypospadias in dog No. 1. Visible descending, nonadherent to the abdomen, prepuce with the penis.
Fig. 2. The schema of resection of rhombus shaped part of the prepuce and abdominal skin (apical part of descending prepuce
and abdomen area). The arrow shows the direction of displacement and attaching prepuce to the abdomen.
Surgical treatment of hypospadias... 237
Fig. 3. Penile hypospadias with persistent frenulum (dog No. 2).
Fig. 4. The slanting incision of glans penis to the external urethra orifice (dog No. 2).
238 Galanty M. et al.
Fig. 5. Prepuce after surgery in dog No. 2.
Fig. 6. Penile hypospadias with enlarged urethral opening, shortening of the penis and the prepuce together with the scrotum
cleft (dog No. 3).
Surgical treatment of hypospadias... 239
Fig. 7. Persistent frenulum in dog No. 3.
Fig. 8. Perineal hypospadias in dog No. 4.
240 Galanty M. et al.
ing part of the urethra was reconstructed using the
mucous membrane of the penis. In order to do this,
two parallel incisions of the mucous membrane, 8 mm
distant, were performed from the external urethral
orifice to the end of the penis. Then, two incisions
were gently prepared obtaining four wound ends. Two
middle ends were sutured, creating a tubular structure
consisting of an elongation of the urethra until the
end of the penis. Then, other wound ends were
sutured, covering the elongation of urethra from the
outside. The last stage of the procedure was narrow-
ing of the prepuce opening, which was carried out as
in the dog No. 2.
Dog No. 4
Male Chihuahua, aged 4 months, perineal hypos-
padias. It was accompanied by fusion failure of the
prepuce and scrotum raphe (Fig. 8). During the pro-
cedure, the changed part of the penis and the prepuce
was cut out up to sciatic bending. The skin incision in
the groin area was divided bluntly towards both in-
guinal rings in order to remove the present testicles.
The procedure was finished by suturing subcutaneous
tissue with continuous stitch using 3-0 Dexon; (Tyco).
The skin was sutured with simple stitches using 2-0
Amifil; (Sinpo). The opening of the urethra was left in
the same condition as before the procedure, leaving
also 1.5 cm. part of the urethral mucous groove.
Dog No. 5
Male Dachshund, aged 9 months, perineal hypos-
padias. It was accompanied by bilateral inguinal
cryptorchidism and scrotum cleft. In this patient the
treatment involved the same surgical procedure like in
the case No. 4.
Dog No. 6
Hermaphrodite, Yorkshire Terrier, aged 11
months, scrotal hypospadias. It was accompanied by
left scrotal cryptorchidism, the right testicle was not
found. The dog was admitted to the Clinic at the age
of 10 months due to the lengthwise structure protrud-
ing from the dog’s vulva, observed by the owner from
its birth. During the clinical examination the presence
of vulva with blindly-ended vestibule of the vagina was
found. The bone protruding from vulvae made uri-
nation difficult. In the beginning of the surgical pro-
cedure the urethral catheter was passed into the
urethral orifice, which was located above the penis
basis. After incision of the dorsal mucous membrane
to its basis, the penile bone 4.5 cm long was exposed
and subsequently removed at the basis. The length of
the clitoris was corrected and sutured using 3-0 Dex-
on; Tyco. During the clinical examination at the sur-
gery no testicles in the scrotal or the inguinal area
were found.
During the following visit at the clinic, which
took place two years later, gonad was found in the
left inguinal area. The ultrasonographic examination
confirmed the presence of a testicle in the left in-
guinal area as well as the presence of the structure
resembling an ovary in the abdominal cavity. Addi-
tionally, the presence of the hypoechogenic, 3 cm
long and 4 mm wide structure with a liquid content
was found in the caudal part of the abdominal cavity
above the bladder. The dog was qualified for diag-
nostic laparotomy accompanied by castration. The
incision of the abdominal wall was performed in mid-
line, beginning from the umbilicus and ending at the
pubic symphysis. After opening the abdominal cavity,
the examination of the internal organs was per-
formed. The presence of an underdeveloped uterus
ending with the right ovary, with the left disappear-
ing horn of the uterus ending in the left inguinal
canal was found (Fig. 9). The left horn of the uterus
contained liquid. The skin and subcutaneous tissue
was separated from the abdominal muscles towards
the left groin. In this area a testicle covered with
a common vaginal coat was found, which had a cord
ending at the inguinal canal. First, the common vag-
inal coat was cut, the testicle and the spermatic duct
together with testicular artery and vein were ex-
posed. Separate ligatures were placed onto the blood
vessels and the spermatic duct and the testicle was
cut out. Then, vessels and the spermatic duct ending
in the inguinal area were moved to the abdominal
cavity. The excess of the vaginal coat protruding
from the inguinal canal was removed and 1 knot was
sutured. Next, the uterus was removed together with
theovaryontheleftsideandthebodyofuteruswas
cut at the cervix, preceded by 2-0 Dexon; (Tyco) liga-
tion. The procedure was finished by closure of the
abdominal muscles (continuous suture, 2-0 Dexon;
Tyco). Next, 3 irregular stitches were placed in the
left groin connecting the bluntly loosened (to remove
the testicle) subcutaneous tissue using 3-0 Dexon;
Tyco to deeper tissues. The subcutaneous tissue was
sutured with continuous suture using 3-0 Dexon;
(Tyco) and the skin was sutured with 3-0 Amifil;
(Sinpo).
After the surgical treatment all dogs were admin-
istrated antibiotics for six days. The dogs No. 1, 3 and
4 received amoxicillin (Betamox: ScanVet) 15 mg/kg
b.w. every 48 h., the dog No. 2 amoxicillin with
clavulanic acid (Synulox; Pfizer) 12.5 mg kg/b.w.
everyday. The dog No. 6 received penicillin G after
first surgery (Duplocilina; ScanVet) 15000 j.m/kg b.w.
every 72 h, and after the second surgery – lincomycin
with spectinomycine (Lincospectin; Pharmacia)
5 mg/kg b.w. everyday. The daily care of the surgical
Surgical treatment of hypospadias... 241
Fig. 9. Intraoperative view into abdomen in dog No.. 6. Visible uterus with right ovary. Left horn ending in the left inguinal canal
(dog No. 6).
area with rivanol solution was recommended and for
the dog 1 and 2 – washing of the prepuce cavity with
chlorhexidine solution (Manusan; Polfa). The surgical
wound was protected from licking by the use of
post-surgical clothes. The skin sutures were removed
9 days after the surgical procedures.
Results
Four types of hypospadias were found among all
cases: glandular form (1 dog), penile (2 dogs), scrotal
(1 dog) and perineal (2 dogs). The persistent
frenulum of the prepuce was found in two dogs as
coexistent with the hypospadias. In the treated group
of dogs, genetic disturbances were corrected by surgi-
cal procedures. All patients were subjected to the sur-
gical treatment of the penis, shortening of the penis
was performed in two cases, penis amputation in three
cases and an urethra reconstruction in one case. Cas-
tration was performed in three cases. Additionally,
the plastic surgery of anomalies of the prepuce was
performed in three patients. In five cases the wound
was healing with no complications. Only in one pa-
tient (No. 2) several crusts at suture removal re-
mained. The dogs had been observed for 8 months
(dog Nr 3), 11 months (dog No. 2, 6), 17 months
(dog No. 4), 24 months (dog No. 5), 32 months (dog
No. 1) after surgery. In dogs No. 1, 4 and 5, pos-
toperative controls during 2 months time were done
on the basis of clinical examination, and later on the
basis of phone call with their owners. At the rest of
the dogs postoperative controls were done only at the
basis of clinical examination.
Satisfactory appearance in the operated area of
the dog No. 1, 2 and 3 was accomplished and the
operation region did not differ from the healthy dogs.
Surgical procedures in cases No. 4, 5 and 6 resulted in
improved cosmesis with reduced clinical signs of hy-
pospadias and other coexistent anomalies. The ani-
mals cut their interest in the penile area. No. pus in
the prepuce and no frequent urgencies were observed
in patients in comparison to the state before the sur-
gery. After the procedure of shortening of the penis
and relocation of the penis together with the prepuce
to the abdominal wall (dog No. 1), no wetting of the
medial sides of the limbs was observed and the urine
stream was directed forward. After castration in three
cases, significant decrease of temperament and in-
crease in body mass were observed.
Discussion
When making a decision on the surgical treatment
of hypospadias it is necessary to take into account the
existing clinical symptoms, which usually result from
problems with hygiene or from drying and injuries to
242 Galanty M. et al.
the penis and the prepuce caused by their abnormal
structure. In the case of the mild form (glandular hy-
pospadias) disturbing clinical signs are not usually ob-
served and this form does not demand any surgical
treatment. Other abnormalities frequently coexistent
with hypospadias additionally intensify clinical signs,
which is an indication for a surgical treatment (Hob-
son 1993).
In case of the dog No. 1, in which a mild form of
hypospadias was recognized, the presented clinical
signs were intensified by other coexistent signs, such
as shortening of the prepuce and the penis together
with previously not described in the literature anom-
aly in which prepuce and the penis were pointing
downwards. In this patient an original own method of
fixing of the descending prepuce to the abdomen was
used in order to remove the clinical signs. Even
though this dog showed a mild of form of hypospadias
– usually not demanding any surgical interventions
– due to the glans protrusion outside the prepuce ring
it was necessary to perform slight shortening of the
penis.
The procedure of the penis shortening was also
carried out for the dog No. 2 (with the penile hypos-
padias). In this case, the persistent frenulum and en-
larged ring of the prepuce were the reasons of surgical
intervention. During the procedure, after incision of
the persistent frenulum, it occurred that the
straightened penis significantly protrudes from the
prepuce. In this case, similarly as for the dog No. 1,
the procedure of partial amputation of the penis was
performed (to the level of the external urethral ori-
fice). However, the penis shortened in this way was
still exposed in the wide opening of the prepuce and
there was still at risk of further drying and irritation.
Therefore, it was necessary to perform an additional
plastic operation of too big prepuce orifice. In this
patient a classical, described in the literature, pro-
cedure of the prepuce constriction from the pos-
terior-ventral side was carried out, without additional
need to enlarge the prepuce opening from the anter-
ior-dorsal side (Smith and Gourley 1990, Hayes 1994).
An alternative for the removal of the penis may be
a reconstruction of the lacking part of the urethra
using the penile mucus membrane. This procedure
was carried out in the dog No. 3 with a recognized
penile hypospadias, coexisting persistent frenulum
and an enlarged prepuce ring. Although the pro-
cedure of the urethra reconstruction is much more
difficult then the shortening of the penis, this pro-
cedure allows to save the whole penis and it can be
performed in a mild form of the hypospadias.
In the treated group of dogs, the persistent
frenulum of the prepuce, described by (Hobson 1993)
was found in two dogs as coexistent with the hypos-
padiasis.
The total removal of the penis was performed in
a severe form of hypospadias, which was recognized in
two dogs (No. 4 and 5). In this case we resigned from
the procedure of suturing out of the urethra (Hobson
1993, Hedlung 2002), since it was sufficient to leave
the natural (although still unphysiological) opening of
the urethra localized in the area of the sciatic bending.
A natural groove of the urethral mucosa was used for
a natural passage of the urethra into the skin in order
to minimize any skin irritation by the flowing urine.
In the last described case (No. 6), hypospadias was
diagnosed in addition to hermaphroditismus. In this
dog all surgical treatments were carried out in two
phases. First treatment involved the plastic surgery of
the vagina and removal of the penis, thus eliminating
the risk of irritation by the protruding penis and en-
abling to urinate normally. The second treatment (ad-
ditional) was laparotomy and patient;s sterilization.
Both procedures enabled the patient to function nor-
mally.
The performed procedures showed that surgery is
very useful for the treatment of hypospadias. The type
of the procedures was set up individually for each case
and depended on the type of hypospadias and coexist-
ing anomalies.
References
Arnold S (2003) Choroby prącia i napletka. In: Niemand
HG, Sutter PF (ed) Praktyka Kliniczna: Psy. Pro-Trade,
Bratislava, pp 898-901.
Hayes HM, Wilson GP (1986) Hospital incidence of hypos-
podias in dogs. North America. Vet Rec 118: 605-606.
Hayes AG (1994) A preputial splitting technique for surgery
of the canine penis. J Am Anim Hosp Assoc 30: 291-296.
Hardy RM, Root Kustritz MV (2005) Theriogenology ques-
tion of the month. J Am Vet Med Assoc 6: 887-888.
Hedlunng CS (2002) In: Welch Fossum T (ed) Small Ani-
mal Surgery. St. Louis, Missouri, Mosby, pp 610-774.
Hobson HP (1993) Surgical pathophysiology of the penis.
In: Bojrab MJ (ed) Disease Mechanisms in Small Animal
Surgery. Malvern, Lea & Febiger, pp. 554-555.
Hobson HP (1998) Penis and prepuce. In: Bojrab MJ (ed)
Current Techniques in Small Animal Surgery. Baltimore,
Williams & Wilkins, pp. 529-531.
Jurka P, Galanty M, Zielinska P, Max A, Sysa P (2008)
Hypospadias in dogs. Vet Rec, in press.
Smith MM, Gourley IM (1990) Preputial reconstruction in
a dog. J Am Vet Med Assoc 196: 1493-1497.
Surgical treatment of hypospadias... 243
