Veterinary Medicine - January 2008 - (Page 26)

A challenging case PEER-REVIEWED son, it is important to fully evaluate a patient with suspected congenital phimosis for additional congenital problems. are positive contrast radiographic examination and cytologic examination, uid analysis, and bacterial culture and antimicrobial sensitivity testing of the uid accumulating in the prepuce. Clinical signs The clinical severity of disease can vary from no clinical signs in a nonbreeding animal to complete obstruction of urinary ow leading to death, which may be seen with an absent preputial ori ce.8 The most common presenting signs are abnormal urination and preputial swelling. Abnormal urination can include a small stream or dribble due to urine accumulating in the preputial cavity. This collection of uid can lead to preputial irritation and secondary balanoposthitis.5 Another clinical sign is the inability to copulate in breeding animals.4 Treatment overview Phimosis caused by in ammatory or infectious disease can be treated with antibiotics and supportive care such as a warm compress, urine diversion through a catheter, or saline lavage to prevent urine scalding.5 Surgery is often indicated to correct a developmental anomaly or an acquired preputial stricture and usually leads to a successful outcome.1 In cases of uncomplicated phimosis (no adhesions), a simple wedge tissue resection is usually adequate. However, in this patient, the adhesions required a more aggressive procedure. Postoperative complications may include either paraphimosis or postsurgical brosis and scar tissue formation. Multiple surgeries may be needed to correct brosis or paraphimosis. Additional surgeries may be required once the animal reaches sexual maturity. To avoid these complications, the surgical plan should be as aggressive as possible without creating paraphimosis.9 Additionally, especially in patients in which surgical breakdown of adhesions is required, mucosal layers must be reapposed to avoid postoperative adhesions from forming. To avoid adhesion formation, postoperative manual extrusion of the penis should be included in all recovery plans. Pain management was a challenge. Diagnostic tests Only minimal laboratory tests were performed in this case because of monetary constraints; however, a complete blood count, serum chemistry pro le, and urinalysis should be included in a comprehensive work-up.7,8 Other presurgical diagnostic procedures that might be valuable but that were not performed in this case Pain management In this case, the pain management protocol included preoperative carprofen, postoperative epidural analgesia, hydromorphone for the rst 12 hours after surgery, a fentanyl patch, and topical lidocaine jelly. It is questionable whether the lidocaine jelly provided marked relief; however, in theory, it should have provided more comfort than sterile lubricating jelly alone. Pain management in dogs undergoing surgery to correct phimosis has not traditionally been described in the veterinary medical literature. However, in this case, pain management was a particular challenge despite an aggressive approach and should be an important consideration in any case of phimosis that requires surgical intervention. REFERENCES 1. Papazoglou LG, Kazakos GM. Surgical conditions of the canine penis and prepuce. Compend Contin Educ Pract Vet 2002;24(3):204-218. 2. Arthur GH, Noakes DE, Pearson H, et al. Veterinary reproduction and obstetrics. 7th ed. London: Saunders, 1996;714-724. 3. Kahn CM, ed. The Merck veterinary manual. 9th ed. Whitehouse Station, N.J.: Merck & Co, 2006;1159. 4. Roberts SJ. Veterinary obstetrics and genital diseases (theriogenology). 3rd ed. Woodstock, Vt: David and Charles Inc, 1986;793-794,796,800-802,805. 5. Fossum TW. Small animal surgery. 2nd ed. St. Louis, Mo: Mosby Inc, 2002;666-668. 6. Johnston SD, Root Kustritz MV, Olson PNS. Canine and feline theriogenology. 1st ed. Philadelphia, Pa: Saunders, 2001;358-365. 7. Olsen D, Salwei R. Surgical correction of a congenital preputial and penile deformity in a dog. J Am Anim Hosp Assoc 2001;37:187-192. 8. Sarierler M, Kara ME. Congenital stenosis of the preputial ori ce in a dog. Vet Rec 1998;143:201. 9. Slatter D. Textbook of small animal surgery. 3rd ed. Philadelphia, Pa: Saunders, 2003;1539-1541. 26 January 2008 VETERINARY MEDICINE http://www.thecvc.com http://www.thecvc.com

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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