The right testicle was palpable in the subcutaneous tissues of the inguinal region. A right inguinal castration was performed,
and a routine closed castration was performed to remove the left testicle. The right testicle was submitted for histologic
Figure 3. Fibrous connective tissue (arrow) was present dorsally and caudally between the parietal preputial mucosa and the
visceral penile mucosa.
Figure 4. A No. 15 blade and Metzenbaum scissors were used to separate the fibrotic tissue attachments from normal tissue.
Further examination of the preputial orifice revealed that the penile mucosa was adhered circumferentially to the preputial
orifice. A 5-F red rubber catheter was placed in the urethra, and an incision was made with a No. 10 blade on the ventral
prepuce starting 2 cm caudal to the preputial orifice and extending 9 cm caudally. On entry into the prepuce, fibrous connective
tissue between the parietal preputial mucosa and the visceral penile mucosa was present dorsally and caudally (Figure 3). The fibrotic tissue attachments were separated from normal tissue by using a No. 15 blade and Metzenbaum scissors (Figure 4). Hemostasis was maintained by using unipolar electrocautery.
To avoid formation of new adhesions postoperatively, the exposed free edges of the visceral penile mucosa were carefully apposed
by using 4-0 poliglecaprone 25 (Monocryl—Ethicon) in a simple continuous pattern (Figure 5). The same procedure was repeated for the free edges of the parietal preputial mucosa. The visceral penile mucosa and the
ipsilateral skin edges were apposed with 4-0 polydioxanone (PDS II—Ethicon) in a simple interrupted pattern.
Figure 5. To avoid the formation of new adhesions, the exposed free edges of the visceral penile mucosa were carefully apposed
The preputial orifice was reconstructed by removing a triangular wedge of tissue from the dorsal aspect of the orifice. The
triangular wedge resection was oriented with the base at the mucocutaneous junction to create a larger preputial opening.
Care was taken to not excise too much tissue, which may result in paraphimosis (an inability to retract the penis into the
The subcutaneous tissue along the ventral aspect of the prepuce was closed by using 3-0 polydioxanone (PDS II—Ethicon) in
a simple continuous pattern. The skin was closed by using 3-0 monofilament nylon in a cruciate pattern. The red rubber catheter
Immediately after closure, the patient received morphine (0.05 mg/kg) and bupivacaine (0.02 mg/kg) epidurally. An indwelling
urinary catheter was placed, and the catheter passed freely. The patient recovered from anesthesia without complications.
The dog recovered in the intermediate nursing-care unit, and a fentanyl patch (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 difficulty. 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 finishing the
main stream, the dog would occasionally strain to produce a few drops of bloody urine. Often the dog would whimper as 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 five days after placement.