A challenging case: Phimosis in a young adult dog - Veterinary Medicine
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A challenging case: Phimosis in a young adult dog


VETERINARY MEDICINE


SURGICAL PROCEDURE

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 examination.


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.


Figure 5. To avoid the formation of new adhesions, the exposed free edges of the visceral penile mucosa were carefully apposed (arrows).
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.

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 prepuce).1

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 was removed.

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.

POSTOPERATIVE CARE

The dog recovered in the intermediate nursing-care unit, and a fentanyl patch (50 g/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.


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Source: VETERINARY MEDICINE,
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