Case Study: Gecko Hemipene

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History

Copper, a 2-year-old male leopard gecko, presented for a suspected prolapsed hemipenis (Figure 1) of several days duration. Copper was kept on reptile sand with appropriate lighting and temperature and fed crickets regularly. During the period prior to the exam, his appetite had decreased somewhat.

Presentation

On physical exam, Copper was in very good condition overall, weighing 78.6 g, with a normal coloration and weight, and was active and strong. The only abnormality noted was a crusted, fleshy mass on the right side in the cloacal region. Careful moistening of the mass and gentle exploration showed that this was a prolapse of the right hemipenis and not of the cloaca. The left hemipenis appeared to be in a normal position and Copper seemed healthy otherwise. However, the tip of the right hemipenis showed signs of dessication and early necrosis.

Discussion Points to consider

  1. What are the treatment options for prolapsed hemipenes, especially for several days duration?
  2. What are the potential consequences of not amputating?
  3. Will amputating a hemipene affect the reptile's ability to reproduce or urinate?
  4. What is an acceptable anesthetic protocol for small reptiles?
  5. What are the risks and challenges when anesthetizing a small reptile like this?

Treatment

Copper was scheduled for surgery the next day and was prescribed Baytril® injectible mixed with cherry syrup to a dilution of 11.4 mg/ml, then given 0.07 ml BID. Copper was premedicated with midazolam 0.01 mg IM and butorphanol 0.01 mg IM, then anesthesia was induced and maintained by mask using sevoflurane/O2 to effect. The prolapsed hemipenis was clamped (Figure 2) and cleaned, and the surrounding area was disinfected with dilute chlorhexidine solution, then the base of the hemipenis was infused with 0.03 cc of 2 percent lidocaine. The base was double-ligated (Figure 3) with 4-0 PDS encircling the hemipenis, and then the hemipenis was amputated distal to the sutures (Figure 4). Recovery was uneventful. Buprenorphine was given once post-operatively at 0.01 mg/kg IM and Copper was discharged once awake and mobile. Antibiotics were continued for one week after discharge.

Overview

Penile prolapse usually occurs due to trauma while the organ is everted for copulation. In this particular case, there was no female in the enclosure, so the underlying cause is not known. The prolapsed hemipenis often suffers severe trauma and dessication, so amputation is normally the best treatment. Because the ureters empty into the cloaca, the hemipenis is considered a purely reproductive organ and excretion of urates is unaffected with amputation. Many species of reptiles have two hemipenes, so reproductive ability is usually unaffected even if one is amputated.1

Figure 1. Prolapsed hemipenis pre-operatively
Figure 2. Hemipenis clamped and extended
Figure 3. Hemipenis being ligated.
Figure 4. Hemipenis being amputated.

References

  1. Mader D. ed. Reptile Medicine and Surgery. 2nd Edition. 2006; 389.

Bio

Dr. Bern graduated from North Carolina State University in 1997. Has been with Banfield since 1999 and currently works as the Chief of Staff for the Woodstock, Ga., hospital. He has special interests in soft tissue surgery, exotics, and behavior. Dr. Bern shares his home with his wife, two children, two dogs, three cats, a bearded dragon, a rat, and a betta fish.