A 15 year old Percheron gelding with chronic paraphimosis presented to Cornell Equine and Nemo Farm Animal Hospital Soft Tissue Surgery Service. He was a recently rescued animal and two months before presentation he had been diagnosed with paraphimosis. It was believed that the paraphimosis was due to his debilitation and weakened state. At this initial visit the owners elected a non-invasive approach and a purse string suture was placed to retain the penis within the prepuce. This did not work in the long term and the paraphimosis recurred. On presentation his penis was swollen and had a large urethral fistula on the caudal ventral aspect of his penis. The rest of his physical exam was unremarkable, with the exception of alopecia around his mane. A William’s technique phallectomy was performed under general anesthesia and a preputial purse string was placed and remained for the next week. The prognosis for return to function and decreased discomfort was felt to be favorable. After the procedure, he returned home, was maintained on antibiotics and non steroidal anti-inflammatory drug therapy for a week, and was monitored by his referring DVM. The purse string was removed and he showed no other complications. He has fully recovered and the owners are satisfied with the outcome.