A challenging case: Phimosis in a young adult dog

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Jan 01, 2008



A 2-year-old 32.1-lb (14.6-kg) intact male mixed-breed dog from a local animal shelter was presented to the Cornell University Hospital for Animals soft tissue surgery service for castration and surgical treatment of phimosis due to a congenitally stenotic preputial orifice.

HISTORY

The shelter officials had noted the stenotic preputial orifice and preputial swelling when the dog was initially presented to them. Fine-needle aspiration of the swelling had revealed suppurative fluid and urine pooling in the prepuce. Repeatedly aspirating fluid from the prepuce had not resolved the problem.

PHYSICAL EXAMINATION


Figure 1. A large, fluctuant swelling of the prepuce was noted on physical examination. Fine-needle aspiration revealed suppurative fluid and urine pooling in the prepuce.

Figure 2. The tip of the dog's penis was hyperemic and slightly swollen; the penis could not be extruded from the stenotic preputial orifice. Additionally, the mucosæ of the penis and prepuce were adhered.
On presentation to the hospital at Cornell, the dog was bright and alert and had a body condition score of 4/9. A large, fluctuant swelling of the prepuce (Figure 1) and a retained right testicle were noted. Additionally, the visible tip of the penis was hyperemic and slightly swollen and could not be extruded from the stenotic preputial orifice (Figure 2). The penile mucosa was adhered to the preputial mucosa at the preputial orifice. Urination was observed, and the dog urinated a normal amount in a constant stream and had no stranguria. The urine was normal color. Physical examination results were normal except for flea infestation.

PRESURGICAL TESTING AND PREPARATION

Before surgery, the results of the dog's packed cell volume, blood glucose concentration (measured by using a glucometer), total solids concentration (measured by refractometry), and rapid estimation of blood urea nitrogen concentration (by using a dipstick) were normal.

Oral nitenpyram (Capstar—Novartis Animal Health) was administered to treat the flea infestation. The patient was premedicated with subcutaneous acepromazine and hydromorphone. The preputial swelling was aspirated, and 78 ml of purulent fluid was obtained. Since previous analysis showed a nonseptic suppurative fluid, the shelter officials declined fluid analysis, cytologic examination, and bacterial culture and antimicrobial sensitivity testing. Anesthesia was induced with intravenous propofol, an endotracheal tube was placed, and anesthesia was maintained with isoflurane. Carprofen (4 mg/kg) was also administered subcutaneously.

The dog was placed in dorsal recumbency. Its ventral abdomen and prepuce were clipped, aseptically prepared, and draped in the standard fashion. Perioperative antibiotic therapy consisted of intravenous cefazolin (22 mg/kg every two hours). Plasmalyte A (Baxter Healthcare) was administered intravenously at 10 ml/kg/hr for the first hour and at 5 ml/kg/hr every hour thereafter throughout the procedures.