Veterinary Medicine - January 2008 - (Page 24)

A challenging case PEER-REVIEWED 5. To avoid the formation of new adhesions, the exposed free edges of the visceral penile mucosa were carefully apposed (arrows). (50 µg/hr) was immediately applied. The patient was given subcutaneous hydromorphone (0.01 mg/kg every four hours) for the initial 12 hours after surgery to provide pain relief until the fentanyl patch took effect. Cold packs were placed on the incision sites every four hours for the remainder of the dog’s time in the hospital. The dog wore an Elizabethan collar for the next two weeks. The day after surgery, the dog was bright and alert but in pain, and the indwelling urinary catheter was removed. The dog’s prepuce was slightly swollen, and the patient was passing bloody urine with dif culty. The dog was not interested in food. Because of patient discomfort, the penis could only be extruded and lubricated with sterile jelly once or twice a day, instead of every four to six hours. Amoxicillin trihydrate-clavulanate potassium (22 mg/kg given orally twice a day for 14 days) was started that morning, and carprofen (1.7 mg/kg given orally twice a day for seven days) was started that evening. Topical 2% lidocaine jelly was used instead of sterile lubricating ointment to provide additional local pain relief during the extrusion of the penis. Two days after surgery, the patient’s prepuce appeared more swollen and painful, although the incisions were intact. When urinating, the patient would extrude its penis from its sheath and produce a normal urine stream, but after nishing the main stream, the dog would occasionally strain to produce a few drops of bloody urine. Often the dog would whimper as 6. Seven days after surgery, mild preputial swelling was present (arrow), and urine pooling had markedly decreased. its penis receded into the prepuce. The dog was discharged to a foster home with an Elizabethan collar in place, the medications described above, and instructions to extrude the penis from the prepuce every six to eight hours or as much as possible for one to two weeks. The caregiver was also instructed to remove and dispose of the fentanyl patch ve days after placement. FOLLOW-UP The patient remained in foster care for the next week. It was reported that the hematuria resolved by day 6 after surgery. Preputial swelling and urine pooling had markedly decreased by day 7 but was still present (Figure 6). Over the seven days, the dog’s penis was extruded twice daily. Patient comfort increased over the week; however, the dog remained mildly uncomfortable during the extrusions. The shelter reported that the dog was able to urinate normally. The dog was adopted about a month after its surgical wounds had completely healed. DISCUSSION Phimosis has been recorded in most domestic species.2 Some sources de ne it as an inability to protrude the penis from the prepuce because of a stenotic or an absent preputial ori ce1-3; however, another de nition is simply the inability to protrude the penis from the prepuce.4-7 This latter de nition is preferable because an inability to pro- trude the penis has many causes, both acquired and congenital, and may even be species-dependent. Acquired phimosis in dogs most commonly results from lacerations after trauma, preputial sucking by littermates, or licking by the dam. In addition, neoplasia such as mast cell tumors, transmissible venereal tumors, squamous cell carcinoma, and perianal gland adenomas accounts for many cases.1 Congenital phimosis has been described in young dogs, cats, and stallions4 and can result from a developmental anomaly of the penis or prepuce. Such anomalies include a short penis or retractor penis muscle, persistent adhesions connecting the prepuce to the penis, or stenosis or absence of the preputial ori ce.2 Congenital stenosis of the preputial ori ce has been reported to be breed-related in German shepherds, golden retrievers, Bouvier des Flandres, and Labrador retrievers.1,2 In normal dogs, cats, bulls, or horses, the penis is fused with the prepuce throughout its length at birth. During prepubertal development, the penis grows and the relationship between the penis and the peripenile tissues changes.2 In addition, the connective tissue joining the penis and prepuce breaks down.2 This breakdown is mediated by androgens produced by the testis, which are also responsible for sexual differentiation of the male genitalia, the descent of the testis into the scrotum, and keratinization of the preputial epithelium.4 For this rea- 24 January 2008 VETERINARY MEDICINE

Table of Contents Feed for the Digital Edition of Veterinary Medicine - January 2008

Veterinary Medicine - January 2008 Contents Digital Extra Letters Toxicology Brief Idea Exchange A Challenging Case: Phimosis in a Young Adult Dog The Indications and Technique for Continuous Ambulatory Electrocardiographic Recording in Dogs A Review of Selected Systemic Antifungal Drugs for Use in Dogs and Cats CE Form Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - January 2008

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