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Occasionally bulls with preputial injury or frostbite develop extensive scar tissue such that there is insufficient length of healthy prepuce for scar revision and preputial reconstruction or circumcision. Creation of a stoma from the preputial cavity through the sheath may allow sufficient penile protrusion for semen collection. In my experience (Wolfe), two bulls were able to successfully complete coitus following this surgical procedure. With the bull adequately restrained and following preparation for aseptic surgery, make an elliptical incision through the skin. This incision is made on the ventral sheath sufficiently proximal to the scar tissue to penetrate the lumen of the preputial cavity (Figure 19.46). The diameter of the stoma should be sufficiently large to allow the free portion of the penis to extend, but not sufficiently large that the remaining prepuce may prolapse. Following removal of the elliptical skin, continue dissection through the peri‐penile elastic layers and elevate the prepuce through the opening in the sheath (Figure 19.47). Incise the prepuce (Figure 19.48) and exteriorize the free portion of the penis through the incision (Figure 19.49). Using #0 absorbable suture, appose the skin of the prepuce to the skin of the sheath with a simple interrupted pattern (Figure 19.50). Suture a 2.5‐cm Penrose drain over the free portion of the penis to allow postoperative urine drainage away from the incision (Figures 19.51–19.53). Remove the Penrose drain 10 days postoperatively and allow 60 days’ sexual rest prior to attempted semen collection (Figure 19.54).

Figure 19.46 Triangular flap of skin removed from sheath (apex of triangle oriented toward scrotum).

Figure 19.47 Prepuce elevated through incision in sheath.

Figure 19.48 Incision into preputial cavity to create stoma.

Figure 19.49 Free portion of penis exteriorized through preputial stoma.

Figure 19.50 Preputial epithelium apposed to skin of sheath with interrupted absorbable sutures.

Figure 19.51 Penrose drain sutured over free portion of penis.

Figure 19.52 Penrose drain over penis through preputial stoma for urine drainage.

Figure 19.53 Postoperative image of bull with preputial stoma. (Note Penrose drain is through natural sheath opening.)

Figure 19.54 Completely healed preputial stoma ready for attempted semen collection.