Management of preputial prolapse in bulls


Have you ever noticed that when someone has confidence or trust in you in regard to doing something, it turns out fine or you do it successfully?
I noticed when I was a new vet that almost all the animal cases I encountered and where the owners entrusted them in my care without doubting me, recovered. And most of the ones whose owners had any doubt, would have complications.
One of these successful cases was the first time I did surgery on a bull all by myself to correct a Prolapsed Prepuce (sheath covering the penis that becomes loose). Any surgery in bulls is usually something daunting, especially if the value of the bull is like buying a two-bedroom house in Katutura. One has to prepare themselves well before the surgery and pray that nothing goes wrong.
I was kind of shaken but luckily, it was my uncle Obed’s bull and he encouraged me saying, “Baby, I have confidence that you will take care of this bull, because you know that my whole livelihood depends on it”. What a responsibility on my shoulder! Although the bull recovered well, I was stressed for days over its post-surgical recovery as it is as important as the surgery itself. I couldn’t wait to go to work every morning just to monitor its progress and I would leave work late fussing over it.
This week, we will discuss Preputial Prolapse in detail, concentrating on the causes and simple non-surgical (conservative) treatment. I realised that if farmers understood the importance of early treatment, surgery might not be necessary in some Prolapsed Prepuce cases in bulls.
The main factor that predisposes to this disease is physical injury to the sheath (“penis skede” in Afrikaans). These injuries mostly occur in bulls with structural faults such as when the sheath is too pendulous and loosely attached; the sheath/penis is too heavy and large, or when a bull has a protruding prepuce.
In Namibia, Preputial Prolapse is common in Brahman bulls that especially have a penis hanging close to the ground, which increases the risk of being injured by thorns, sharp grasses or even ticks. Actually, the closer the sheath is to the ground, the more likely it is for the sheath to be irritated or injured. It is even possible for the bull to step on its own sheath when getting up.
This disease, if left untreated while fresh, leaves the infected area dry, dirty, and swollen. This is a serious problem as it prevents the bull from mating. The condition can become permanent or so bad that surgery wouldn’t help and the bull might need to be slaughtered.  
Treatment options depend on the nature of the injury, presence of infection, ability to extend the penis and the value of the animal. For conservative treatment, it is crucial that as soon as you notice symptoms of Prolapsed Prepuce, you have to retain and treat the bull. This is where most of our farmers go wrong; they delay to treat or call a vet until the condition worsens. (I don’t know how many times I have come across bulls in the village with protruded prepuces as big as my head).
The following steps can be followed in case of a fresh Preputial Prolapse: After restraining the bull securely in a manga, put an antiseptic solution (like Betadine, Savlon or Dettol), in lukewarm water and wash the preputial and penis area thoroughly severally. If the protruded sheath has become dry, try to gently scrap away the dead scabs as much as possible. Apply a copious amount of wound salve/oil (Acriflavin or Agrisalf) to treat the wound. Make sure the whole sheath is covered well. Put a big cotton wool with gauze bandage on the treated sheath/penis. An old T-shirt would do just fine.
The sheath can then be bandaged using a Hessian rug or a shade net or big cotton sheet around the belly that is tied with strings at the back of the animal. The rationale behind tying the sheath up is to prevent further injury and dirt while at the same time lifting the sheath and thus reducing swelling caused by the gravity pull.
This treatment should be repeated daily until the swelling has subsided or at least after every second day. If the bandage is not changed regularly, the urine might also cause irritation around the sheath and predisposes to infection. If the swelling has gone down, the sheath should then be replaced manually.
Antibiotics (such as penicillin) as well as an anti-inflammatory drug should be obtained with a veterinary prescription in severe cases to fight the infection and reduce swelling. The bull should be well rested for at least two months before it is allowed to mate.
Surgical intervention (similar to circumcision) is required where the medical treatment fails to improve the condition, or if the scar tissue prevents normal movement of the prepuce and/or penis.
Due to the complications and subsequent loss of production of bulls with Preputial Prolapse, it is important for our farmers to avoid buying bulls with long sheaths or any other structural problems. Unfortunately, the risk of injuries and prolapse to sheaths worsen with age so that if they are apparent in young bulls, they will probably become more so as the bulls age.