1 CONTACT Rory Nevard rory.nevard@sydney.edu.au © 2024 The Author(s). This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http:// creativecommons.org/licenses/by-nc/4.0/), permitting all noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Citation line: Clinical Theriogenology 2024, 16, 10415, http://dx.doi.org/10.58292/CT.v16.10415 Case Report Modified partial posthectomy surgery for chronic preputial prolapse in a Bos indicus bull Rory Nevard,a,b Marco Lopes,b Heidi Lehmann,b Chris Quinn,b Cassandra MacDonalda aSydney School of Veterinary Science, The University of Sydney, Camden, NSW, Australia bVeterinary Clinical Centre, School of Agricultural, Environmental and Veterinary Sciences Charles Sturt University, Wagga Wagga, NSW, Australia Abstract Preputial prolapses in bulls are frequently encountered by bovine reproductive practitioners and are common physical conditions impairing a bull’s ability to copulate. Marked chronicity or unsuccessful medical management warrant surgical correction. Preputial resection/circumcision (also known as ‘reefing procedure’) or preputial amputation are 2 well-documented procedures performed to restore penile function. It is widely believed that preputial resection is considered superior to amputation, as with the latter procedure, strictures and wound contracture stenosis are common reported sequelae. Therefore, surgery should aim at preserving tissue and resolving the prolapse without interference to complete penile extension. We adapted novel surgical features in a bull with a chronically prolapsed prepuce: an updated preputial amputation technique (i.e. modified posthectomy) and used a sin- gle-layer closure pattern with rapidly absorbable suture (not reported for bulls). There was total resolution and bull returned to service. This case illustrated that severe and chronically prolapsed prepuces can be successfully repaired using this updated modifi- cation of a historical technique. Keywords: Beef bull, chronic preputial prolapse, preputial amputation, modifed posthectomy Background Injuries to the prepuce of breeding beef bulls are common, particularly those of Bos indicus influence as a result of cer- tain anatomical arrangements.1,2 Although the etiology of this condition may appear straightforward, a variety of fac- tors have been linked to preputial prolapse occurrence in bulls: genotype,3,4 breed,5–7 innate sheath conformation,8–10 bovine herpes virus (BHV-1) associated balanoposthitis,9 and potentially bulls that may preferentially evert preputial skin when relaxed (remains speculative).11,12 In general, however, trauma usually occurs to prepuce during breed- ing1,3,13 or when tissue is not maintained within the sheath and therefore exposed to noncoital injury such as inciden- tal lacerations and inadvertent selfinjury.3 Bos indicus sub- species bulls are renowned for sustaining injuries to the prepuce at breeding due to anatomical traits such as pendu- lous sheaths and substantial preputial skin.1,4 Some Angus bulls may also have similar problems, with a horizontal sheath opening being another additional association.14–16 Certain Bos taurus breeds of the polled phenotype have also been historically linked to a higher predisposition of pre- putial injuries possibly due to incompletely developed caudal retractor preputial muscles.6,7 These anatomical associations may be unduly represented as the original paper that cited this association misinterpreted preputial eversion as preputial prolapse.16,17 Since then, it has pre- vailed in literature. For instance, there is no completely conclusive evidence that preputial eversion is directly related to prolapses in Bos taurus bulls specifically, despite seeming a plausible cause to practitioners and produc- ers.14,16,18 Also, it is generally considered that minor lacera- tions or injury to the prepuce in Bos taurus breeds seldom leads to fulminant preputial prolapse as in Bos indicus type.13 Depending on the chronicity and extent of injury, either medical management or surgical correction may be attempted.4,19 A scale initially developed by Wolfe & Carson20 has been updated in recent texts1 to classify and predict the prognosis for resolution of preputial injuries in bulls1 (Table 1). Additionally, there are variations on anatomical terminol- ogy for the prepuce in large animals,6,21,22 and it is para- mount that examining veterinarians understand preputial anatomy of bulls, particularly during circumstances of injury where confusion can occur. Authors’ recommend mailto:rory.nevard@sydney.edu.au http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.58292/CT.v16.10415 2 Citation line: Clinical Theriogenology 2024, 16, 10415, http://dx.doi.org/10.58292/CT.v16.10415 and prefer to use that described by Ashdown et.al.6,22 when considering the definitions of portions of the preputial tis- sue involved in injury so to avoid confusion or inadvertent incorrect anatomical descriptions. Further, it is also import- ant to highlight that although the preputial tissue is contin- uous with that of the penile integument, and may resemble that of a mucous membrane, it is in fact lined with stratified squamous epithelium and the preputial wall contains inner and outer concentric fibrous layers that are organized dif- ferently to penile mucosa.6,22 Regardless of the technique for medical management, core principles of nonsurgical treatment involve managing edema, improving lymphatic drainage, reducing inflammation, and preventing further injury. This may include topical hydro- therapy with daily cold water hosing in acute stages, bandag- ing the prolapsed tissue around a placed urinary egress tube, applying topical emolients, placing a sling, and treating with nonsteroidal antiinflammatories and antimicrobials system- ically.1,5,9 Failing successful medical management, or for cases of chronic prolapse, either surgery or salvage slaughter is gen- erally indicated.4 Known surgical repair techniques include either simple laceration repair, preputial resection (i.e. ‘reef- ing’ procedure) or preputial amputation.4,5,13 Due to the advent of farm animal insurance in some countries outside of US, bulls with prolapses that are not amenable to medical management are often culled or claimed for reproductive loss of use. Additionally, due to financial limitations and concerns over use of prolonged general anesthesia in rumi- nants,23 surgical procedures may be limited to certain institu- tions or simply not elected by owners. This may result in either salvage slaughter, or potentially even the adoption of salvage procedures such as ring amputation that are not com- pletely restorative.24 Ultimately, this may dissuade producers from electing for fully corrective surgical procedures in future, and therefore exploring and/or revisiting alternate procedures are of value to bovine practitioners. Detailed pre- surgical (assessment, medical management, restraint, and anesthesia) and surgical descriptions are provided in this report. Case presentation An 8 year, ~ 900 kg Brahman bull, was presented for surgical management of a Grade III20 prolapsed prepuce of ~ 6 months duration. Bull was identified with this condition by the owner after deployment in a large paddock for breeding of ~ 40 heif- ers. Bull had previously sired calves successfully in previous seasons with no evidence of prior injuries. Owner pursued treatment and surgery due to amiable and calm temperament of the bull despite the severity of injury. Treatment Examination Bull was initially examined while restrained in a crush to determine the extent of injury. Bull was bright, alert and responsive, and in good body condition (BCS 4/5). Careful inspection and palpation of the prepuce revealed prolapse severity (Figure 1). Attempts to exteriorize the penis were not initially successful that was attributed to narrowing of the preputial lumen by the swollen prolapsed tissue and/ or retraction of retractor penis muscles. Prolapse was pal- pated and internal channel of prolapse was also examined to determine if there was evidence of strictures or if penis could be exteriorized. Other incidental findings included overgrown claws (possibly due to reduced sexual activity as a result of preputial injury). Prolapsed tissue was cleaned, cold water hosed and bandaged around a ~ 40 cm urine egress tube made from plastic garden tubing. A sling using shade-cloth material was also placed to aid in recti- fying the remaining edematous tissue prior to surgery (Figure 2). Treatment with a broad-spectrum antimicro- bial (intramuscular oxytetracycline 10 mg/kg once a day, Alamycin®, Norbrook) and a nonsteroidal antiinflamma- tory (subcutaneous meloxicam (Metacam®, Boehringer) 0.5 mg/kg once every 3 days) was initiated. Bull was not fed for 36 hours prior to surgery and had water restriction for 12 hours. Anesthesia and restraint Bull was initially restrained in a tip-table crush. Intravenous sedation (via caudal coccygeal vein) consisted of 0.02 mg/kg xylazine hydrochloride (Xylazil-100, Ilium) and 0.02 mg/kg butorphanol tartare (Butorgesic, Ilium); caudal coccygeal epi- dural anesthesia was induced (4.5 ml of 2% lignocaine hydro- chloride [Lignocaine 20, Ilium]). Bull was then tipped into right lateral recumbency on the tip table and pudendal nerve block was induced.25,26 Ischiorectal fossa region was clipped and surgically prepared on both tail sides. After creating 3-4 ml Table 1. Preputial injuries categories: description, treatment, and prognosis1 Category Description Treatment and prognosis I Simple preputial prolapse with slight to moderate edema without laceration, necrosis, or fibrosis Either conservative or surgical treatment with good prognosis II The prolapsed prepuce has moderate to severe edema, may have superficial lacerations or slight necrosis, but has no evidence of fibrosis Surgery is the usual course of therapy with a good to guarded prognosis III There is severe edema of the prolapsed prepuce with deep lacerations, moderate necrosis, and slight fibrosis Surgery is indicated and the prognosis is guarded IV The prolapsed prepuce has been exposed for quite some time and has severe edema, deep lacerations, deep necrosis, fibrosis, and often abscess Surgery and salvage by slaughter are the only options, and a guarded to poor prognosis follows surgery http://dx.doi.org/10.58292/CT.v16.10415 Citation line: Clinical Theriogenology 2024, 16, 10415, http://dx.doi.org/10.58292/CT.v16.10415 3 bleb of 2% lignocaine hydrochloride (Lignocaine 20, Ilium), a spinal needle (18 gauge, 4 inch) was inserted through a hypodermic needle (14 gauge 1.5 inch) that was used as a cannula and guide. Point of the spinal needle was directed (while palpating transrectally) toward the lesser sacro-sciatic foramen, 30 ml of 2% lignocaine hydrochloride (Lignocaine 20, Ilium) was deposited immediately cranial and caudal to the lesser sciatic foramen A cannula (20 gauge, 32 inch) was placed in the left auricular vein (pulse rate, respiratory rate, mucous membrane color, and rectal temperature were moni- tored during the procedure). Immobilization was achieved with 3 mg/kg intravenous ketamine hydrochloride (Ketamil, Ilium); butorphanol, ketamine, and xylazine boluses were given during the procedure. Nasal oxygen (12 liters/minute) was given and bull was blindfolded during recumbency. After pudendal nerve block, 50 ml of lidocaine infiltrated at the proximal prepuce, further sedation allowed good surgical condition. Penis was fully extended from prepuce and the entire preputial tissue was examined to plan for surgical inci- sions (Figure 3). Sheath skin was clipped, skin and preputial and penile mucosa were scrubbed with dilute chlorhexidine and sterile water routinely. Distal portion of the prolapsed preputial tissue was tied with a long gauze for immobiliza- tion. A disposable plastic drape was then placed over the sur- gical field. Surgery First, 2 stay sutures were placed on cranial and caudal aspects of prolapsed skin proximal to planned amputation site to ensure correct anatomical tissue apposition after amputation. Using a size 22 scalpel blade, a transversely positioned oblique circumferential incision was created on the exposed tissue, ~ 2 cm distal to the junction of the sheath and prepuce (Figure 5). Using Metzenbaum scissors, careful blunt and sharp dissec- tion were alternately used to transect the subcutaneous tissue. Large vessels were ligated with USP 2-0 rapidly absorbable monofilament suture (GlycomerTM631 [BiosynTM], Covidien) while bleeding caused by transection of minor vessels was contained with a handheld electrocautery unit (Kaustolux, DLC). Using a scalpel, preputial subcutaneous tissue was tran- sected, and additional stay sutures were placed to ensure that the internal channel of tissue was correctly reattached to the preputial skin in its previous anatomical position. Apposition of edges of transected skin was then completed using USP  2-0  rapidly absorbable monofilament suture (GlycomerTM631[BiosynTM], Covidien) in a simple continuous pattern interrupted at cranial and caudal aspects of the prepu- tial circumference. While closing, internal (visceral) preputial skin was meticulously included in each bite to ensure correct apposition to parietal preputial tissue. Stay sutures were Figure 1. Close examination of prolapsed prepuce; note edema and sunburnt preputial skin. Figure 2. A. edematous prepuce tightly bandaged against a urine egress tube made from rubber tubing; B. placement of sling (rub- ber Esmarch’s tourniquet straps and shade-cloth material). http://dx.doi.org/10.58292/CT.v16.10415 4 Citation line: Clinical Theriogenology 2024, 16, 10415, http://dx.doi.org/10.58292/CT.v16.10415 removed and as prepuce was released, surgical site was immediately retracted inwards. Surgical site and entire preputial tissue were covered with 1% silver sulphadiazine (FlamazineTM, Simth & Nephew), a shortened sterilized naso- gastric tube was placed into prepuce, and prepuce was then bandaged. Bull’s feet were trimmed to correct the overgrown claws. Diagrammatic (Figure 4 [A-F] and visual representation of surgical events are provided (Figure 5 [A-D]). Aftercare After recovery from sedation/anesthesia, the shade-cloth material sling was replaced and bull was examined twice daily. Three days postoperatively, the bandage was removed, and surgical site was inspected. Transrectal palpation of acces- sory sex glands was also performed to facilitate penile relax- ation, but was unsuccessful on first attempt. Topical ointment (1% Silver sulfadiazine, FlamazineTM, Smith & Nephew) was applied and the tube and bandage were replaced. Four days after surgery, the sling, bandage and tube were removed, along with the sling. Daily observation for urination and penile extension was employed and it was apparent that the bull was able to protrude the penis beyond the hair line at the external orifice of the prepuce by the 5th day postsurgery. Bull’s claws were also trimmed for a second time during hospitalisation. Outcome After 10 days of hospitalization, bull was discharged, owner was instructed to give complete sexual rest (at least 2 months) for the bull. No evidence of stricture or tubal contraction was noted, and inspection of apposed tissues revealed no evidence dehiscence or infection. Approximately 6 months later, a fol- low up with the owner revealed that successful intromission had been observed and a number of females were successfully bred, supported by positive pregnancy diagnosis. Discussion Successful treatment of a severe and chronic preputial pro- lapse in a mature Bos indicus Brahman bull using an updated version of the preputial amputation (posthectomy) technique is reported for the first time. Lay terminologies for surgical descriptions have been used interchangeably;13,19 however, we prefer to categorize ‘reefing’ with preputial resection and anastomosis, and ‘circumcision’ with preputial amputation (or posthectomy), as indicated.27 To authors’ knowledge, there are no published reports of using a rapidly absorbable suture (such as BiosynTM) to close the internal to external preputial integument during a preputial amputation in bulls, despite being recently published in stallions.28 Preputial prolapse repair, particularly in North America, are often performed in specialist referral hospitals under controlled theatre condi- tions and with meticulous hospital aftercare. It is therefore clinically relevant to explore alternate techniques that can be performed in field conditions and reduce postoperative han- dling. In a case series of 51 surgical repairs5 it was identified that success rates of preputial injuries were higher if a prepu- tial resection could be performed compared to amputation (90 versus 43% success). Surgical success rate was also reported to be higher when the procedure was conducted under full general anesthesia in an operating theatre, as expected, com- pared to injectable or local anesthesia. Generally, preputial amputation is reserved for chronic prolapse cases where com- plete extension of the penis is not possible, and the preputial resection/reefing technique is often considered to yield more favourable outcomes than amputation.19,29 Higher incidence of wound contracture stenosis was reported13 for preputial amputation (or posthectomy). However, in a different case series, preputial circumcision (i.e. amputation) indeed resulted in somewhat favourable outcomes, with 76% of bulls repro- ductively sound for ≥ 1 year after surgery.30 Reefing procedure may not always be feasible in scenarios where sterile theatre conditions are not available or replicable, particularly in ani- mals of high anesthetic risk, those with behavioral limitations or for clients with cost constraints. Additionally, other factors such as location of injury, ability to exteriorise the penis, and breed/subspecies may further influence decision making on surgical technique.27 For instance, bulls of the British Bos taurus subspecies may not have enough preputial skin to facilitate amputation or posthectomy.13,27 Nonetheless, it is indeed valu- able to reconsider alternate procedures that can provide simi- lar success rates to those reported in texts,13 along with shortening surgical time and minimizing postprocedural han- dling. Although complete penile extension was achieved in this case, it was decided to perform a preputial amputation (circumcision) technique similar to that described earlier31 and later32 using rapidly absorbable suture material for the apposition of the preputial skin on closure. Suture material (2-0 BiosynTM) used may lose up to 50% of tensile strength at 2-3 weeks and is completely absorbed at ~ 3 months,33 as opposed to other suture materials such as polydioxanone (PDS) suture that has minimal absorption within this same time frame.34 Previous reports on surgical prolapse have sug- gested using absorbable suture materials such as polydioxa- none,35 and even nonabsorbable sutures such as Supramid® and wound staples.13 However, given that the internal visceral layer of skin in the prepuce is delicate, there is a possibility of irritation when using longer absorbing sutures that may result in undesirable sequalae such as further inflammation and wound breakdown. Other key aspects of this technique is that the amputation line is oblique, rather than straight/transverse which results in a postamputation orifice that is oval as opposed to circular.31 This may mitigate the need for an addi- tional ‘V’ incision to be incorporated into the closure that has been advocated by some practitioners, but lacks substantial evidence.19,36 Additionally, horizontal mattress sutures were not placed proximal to the line of amputation as described,27,31 and may not be necessary for most cases. Distal amputated Figure 3. Fully extended penis after pudendal nerve block; note the extent of preputial skin damage and tissue to be removed. http://dx.doi.org/10.58292/CT.v16.10415 Citation line: Clinical Theriogenology 2024, 16, 10415, http://dx.doi.org/10.58292/CT.v16.10415 5 portion was also removed in its entirety without staged inci- sion and closure in ‘thirds’.13 Both these modifications reduced surgical time considerably as closure was performed in halves as described.27 However, substantial hemorrhage was encoun- tered during the procedure. Therefore, without appropriate hemostasis, it is possible for incorrect anatomical apposition of tissues and excessive postoperative swelling. Nevertheless, minimal postoperative swelling was reported and sponta- neous full penile extension was achieved within 1 week post- surgery, eliminating the need to perform daily bandage changes or considerable ongoing intervention. Specific steps of the procedure are outlined in Figure 5. A key aspect worth mentioning by the surgeons in this case report is that the inter- nal linings of the prolapsed portion of the prepuce were spared by bluntly dissecting distally to the initial incision site (Figure 5B) which may have preserved more skin that is less likely to be involved in the inflammatory process and hence avoided removing too much tissue to prevent full penile extension in future.19,27 Postoperative complications such as incisional dehiscence, suture abscesses and focal incisional hernias were Figure 4. Sequence of events during surgery: A. incised and dissected preputial skin down to the internal (visceral lamina); note the bleeding despite attempts at meticulous hemostasis, B. proximal aspect of prepuce after prolapsed section removal; note exposed tissue that had to be joined by placing sutures from internal to external preputial tissue, C. closure of the surgery incision using 2/0 BiosynTM absorbable suture material in a simple continuous fashion; semi-circular half of the ovoid orifice was closed at a time, D. finished closure of the surgery site prior to prepuce retraction into sheath, and E and F. application of compressive ban- dage to assist with postoperative swelling. A B DC E F http://dx.doi.org/10.58292/CT.v16.10415 6 Citation line: Clinical Theriogenology 2024, 16, 10415, http://dx.doi.org/10.58292/CT.v16.10415 not encountered as mentioned.27,30 Further, no evidence of wound contracture stenosis was apparent throughout hospi- talization and neither was there any impediment to full penile extension, erection, and intromission as visually confirmed by the owner during paddock service. Other benefits to perform- ing amputation as opposed to resection (i.e. ‘reefing’) are that it negates the need for full penile extension, and could mini- mize trauma to penis which needs to be fully exteriorized to perform the latter technique. Interestingly, alternatives to resection and anastomosis technique have just been recently described28,36 further suggesting this updated technique as a viable option. This amputation technique has only received limited mention in some salient texts on reproductive sur- gery,32 despite others reporting reasonable outcomes.27,30 Besides minimizing surgical trauma, surgeons’ commitment to key components of Halstead’s principles such as aseptic technique, attention to hemostasis, minimization of dead- space, and use of rapidly absorbed small diameter monofila- ment suture may have contributed to the positive outcome. Further, reported sequelae (wound contracture and stenosis) to amputation technique can be overcome by employing the aforementioned techniques. This case served as an example for successful resolution of a Grade III chronic preputial prolapse through a slightly modified approach to the typical preputial amputation techniques.13,20,31,35 Learning points • Preputial amputation is a reasonable alternative to prepu- tial resection (‘reefing’) for surgical repair of chronic prepu- tial prolapses. • Use of rapidly absorbable suture may assist in reducing ongoing irritation and facilitate rapid healing; some steps in previous procedures may be bypassed to reduce surgical time. • Modifications to historical techniques for preputial amputation may allow for surgery to be performed Figure 5. A. intended incision (dotted line) site and location (cranial and caudal aspect of the section to be removed) of stay sutures, B. circumferential incision (using a scalpel blade) in an angled plane and removal of tissue using Metzenbaum scissors and dissected distally to the closure site to allow more skin within the internal channel of the prolapse to be apposed during the closure, C. after amputation, recognize tissues to be reapposed in correct anatomical plane; note it is crucial that any bleeding vessels are dealt with using appropriate haemostatic techniques (electrocautery or ligation), and D. closure is achieved using rap- idly absorbable 2-0 GlycomerTM631 [BiosynTM] suture in a continuous fashion semicircularly from the distal stay suture to the cranial stay suture. Bites should be taken from the inside of the preputial skin to the outside, so to ‘roll’ the tissue outwardly. After one-half of the closure is completed, the same is done for the other semicircle of the closure. A C B D http://dx.doi.org/10.58292/CT.v16.10415 Citation line: Clinical Theriogenology 2024, 16, 10415, http://dx.doi.org/10.58292/CT.v16.10415 7 without the need for general anesthesia or a sterile surgi- cal suite. • Meticulous hemostasis, conservative resection, gentle tissue handling, and accurate anatomical apposition of tissues are key to ensuring surgical success. Acknowledgement Authors thank Dr. Cassandra MacDonald for surgical illustrations. Conflict of interest None to report and no funding is associated. Author contributions RN conceived the idea, RN wrote majority of manuscript, ML,  CQ and HL reviewed it, and all authors approved submission. References 1. Maxwell H: Inability to breed due to injury or abnormality of the external genitalia of bulls. In: Hopper RM: editor. Bovine Reproduction. Ist edition, Hoboken, NJ; Wiley-Blackwell: 2021. p. 155–172. 2. Memon M, Dawson L, Usenik E, et al: Preputial injuries in beef bulls: 172 cases (1980-1985). J Am Vet Med Assoc 1988;193: 481–485. 3. Parkinson TJ, McGowan M: Abnormalities affecting reproductive function of male animals. In: Noakes DE, Parkinson TJ, England GCW: editors. Veterinary Reproduction and Obstetrics. 10th edi- tion, St. Louis, MO; WB Saunders: 2019. p. 635–668. 4. Anderson DE: Surgery of the prepuce and penis. Vet Clin North Am Food Anim Pract 2008;24:245–251. doi: 10.1016/j. cvfa.2008.02.002 5. Desrochers A, St-Jean G, Anderson DE: Surgical management of preputial injuries in bulls: 51 cases (1986-1994). Can Vet J 1995;36:553–556. 6. Ashdown R, Pearson H: Anatomical and experimental studies on eversion of the sheath and protrusion of the penis in the bull. Res Vet Sci 1973;15:13–24. doi: 10.1016/S0034-5288(18)33846-3 7. Lagos F, Fitzhugh Jr H: Factors influencing preputial prolapse in yearling bulls. J Anim Sci 1970;30:949–952. doi: 10.2527/ jas1970.306949x 8. Koziol JH, Edmondson MA, Wolfe DF, et al: Successful resolution of a preputial prolapse in an alpaca using medical therapy. Can Vet J 2015;56:753–755. 9. Wolfe DF: Review: abnormalities of the bull – occurrence, diagno- sis and treatment of abnormalities of the bull, including struc- tural soundness. Animal 2018;12:s148–s157. doi: 10.1017/ S1751731118000939 10. Prado TM, Dawson LJ, Schumacher J: Surgical procedures of the genital organs of bulls. Vet Clin North Am Food Anim Pract 2016;32:701–725. doi: 10.1016/j.cvfa.2016.05.009 11. Irons PC: Applied anatomy, pathophysiology and a revised scor- ing system of bull sheaths. Aust Vet J 2020;98:48–52. doi: 10.1111/ avj.12900 12. Long SE, Hignett P, Lee R: Preputial eversion in the bull: relation- ship to penile movement. Vet Rec 1970;86:192–194. doi: 10.1136/ vr.86.7.192 13. Hopper RM, Wolfe DF: Restorative surgery of the prepuce and penis. In: Hopper RM: editor. Bovine Reproduction. Ist edition, Hoboken, NJ; Wiley-Blackwell: 2021. p. 210–229. 14. Long SE, Rodríguez Dubra C: Incidence and relative clinical signif- icance of preputial eversion in bulls. Vet Rec 1972;91:165–169. doi: 10.1136/vr.91.7.165 15. Bertram JD: Structural and behavioural characteristics of repro- ductive performance in tropically adapted bulls. Master of Rural Science thesis. University of New England: 1999. 16. Norman S, Bertram J, McGowan M: The poll gene and bull fertil- ity. Proc Australian Cattle Veterinarians 2009;131–141. 17. Venter HA, Maree C: Factors affecting prolapse of the prepuce in bulls. J S Afr Vet Assoc 1978;49:309–311. 18. Long SE, Hignett PG: Preputial eversion in the bull. A comparative study of prepuces from bulls which evert and those which do not. Vet Rec 1970;86:161–164. doi: 10.1136/vr.86.6.161 19. Larsen LH, Bellenger CR: Surgery of the prolapsed prepuce in the bull; its complications and dangers. Aust Vet J 1971;47:349–357. doi: 10.1111/j.1751-0813.1971.tb09207.x 20. Wolfe D, Beckett S, Carson R, et al: Acquired conditions of the penis and prepuce. In: Large Animal Urogenital Surgery. 2nd edi- tion, Baltimore, MD; Willians & Wilkens:1998;237–272. 21. Schumacher J, Vaughan JT: Surgery of the penis and prepuce. Vet Clin North Am Equine Pract 1988;4:473–491. doi: 10.1016/ S0749-0739(17)30624-7 22. Ashdown R: Functional, developmental and clinical anatomy of the bovine penis and prepuce. CABI Rev 2006;29:1–29. doi: 10.1079/PAVSNNR20061021 23. Seddighi R, Doherty TJ: Field sedation and anesthesia of rumi- nants. Vet Clin North Am Food Anim Pract 2016;32:553–570. doi: 10.1016/j.cvfa.2016.05.002 24. Hopper RM: Management of male reproductive tract injuries and disease. Vet Clin North Am Food Anim Pract 2016;32:497–510. doi: 10.1016/j.cvfa.2016.01.015 25. Jones R: Anaesthesia in cattle (II): regional and local analgesia. Bov Pract 1995;29:13–21. doi: 10.21423/bovine-vol1995no29 p13-21 26. Sidelinger DR: Regional anesthesia for urogenital procedures. In: Hopper RM: editor. Bovine Reproduction. Ist edition, Hoboken, NJ; Wiley-Blackwell: 2021. p. 191–199. 27. Hendrickson DA, Baird AN: Turner and McIlwraith’s Techniques in Large Animal Surgery. 4th edition, Newark; Wiley: 2013. p. 235–272. 28. Palozzo A, Celani G, Guerri G, et al: Segmental posthetomy in a four stallions case series. Animals 2021;11:1145. doi: 10.3390/ani11041145 29. Desrochers A, Jean G, Anderson D: Surgical management of pre- putial injuries in bulls: 51 cases (1986-1994). Can Vet J 1995; 36:553–556. 30. Baxter GM, Allen D, Wallace CE: Breeding soundness of beef bulls after circumcision: 33 cases (1980-1986). J Am Vet Med Assoc 1989;194:948–952. http://dx.doi.org/10.58292/CT.v16.10415 https://doi.org/10.1016/j.cvfa.2008.02.002 https://doi.org/10.1016/j.cvfa.2008.02.002 https://doi.org/10.1016/S0034-5288(18)33846-3 https://doi.org/10.2527/jas1970.306949x https://doi.org/10.2527/jas1970.306949x https://doi.org/10.1017/S1751731118000939 https://doi.org/10.1017/S1751731118000939 https://doi.org/10.1016/j.cvfa.2016.05.009 https://doi.org/10.1111/avj.12900 https://doi.org/10.1111/avj.12900 https://doi.org/10.1136/vr.86.7.192 https://doi.org/10.1136/vr.86.7.192 https://doi.org/10.1136/vr.91.7.165 https://doi.org/10.1136/vr.86.6.161 https://doi.org/10.1111/j.1751-0813.1971.tb09207.x https://doi.org/10.1016/S0749-0739(17)30624-7 https://doi.org/10.1016/S0749-0739(17)30624-7 https://doi.org/10.1079/PAVSNNR20061021 https://doi.org/10.1016/j.cvfa.2016.05.002 https://doi.org/10.1016/j.cvfa.2016.01.015 https://doi.org/10.21423/bovine-vol1995no29p13-21 https://doi.org/10.3390/ani11041145 8 Citation line: Clinical Theriogenology 2024, 16, 10415, http://dx.doi.org/10.58292/CT.v16.10415 31. Turner AS, McIlwraith CW, Hull BL: Techniques in Large Animal Surgery. 2nd edition, Philadelphia, PA; Lea & Febiger: Lippincott Williams & Wilkins: 1989. 32. Wolfe DF, Moll HD: Large Animal Urogenital Surgery. 2nd edi- tion, Baltimore; Williams & Wilkins: 1999. p. 261–263. 33. Chu CC: 11 - Materials for absorbable and nonabsorbable surgical sutures. In: King MW, Gupta BS, Guidoin R: editors. Biotextiles as Medical Implants. Woodhead Publishing: 2013. p. 275–334. 34. Dart AJ, Dart CM: 6.636 - Suture material: conventional and stimuli responsive. In: Ducheyne P: editor. Comprehensive Biomaterials. Oxford; Elsevier: 2011. p. 573–587. 35. Wolfe DF: Restorative surgery of the prepuce. In: Hopper RM: edi- tor. Bovine Reproduction. 2nd edition, Hoboken, NJ; Wiley- Blackwell, 2014. p. 142–154. 36. Lopes MA, Papa FO: Acrobustitis-phimosis in bulls: postoplasty technique performed with the animals in a standing position. Anim Reprod 2023;20:e20230047. doi: 10.1590/1984-3143-ar2023-0047 http://dx.doi.org/10.58292/CT.v16.10415 https://doi.org/10.1590/1984-3143-ar2023-0047