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


FOLLOW-UP


Figure 6. Seven days after surgery, mild preputial swelling was present (arrow), and urine pooling had markedly decreased.
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 define it as an inability to protrude the penis from the prepuce because of a stenotic or an absent preputial orifice1-3 ; however, another definition is simply the inability to protrude the penis from the prepuce.4-7 This latter definition is preferable because an inability to protrude 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 orifice.2 Congenital stenosis of the preputial orifice 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 reason, it is important to fully evaluate a patient with suspected congenital phimosis for additional congenital problems.

Clinical signs

The clinical severity of disease can vary from no clinical signs in a nonbreeding animal to complete obstruction of urinary flow leading to death, which may be seen with an absent preputial orifice.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 fluid can lead to preputial irritation and secondary balanoposthitis.5 Another clinical sign is the inability to copulate in breeding animals.4

Diagnostic tests

Only minimal laboratory tests were performed in this case because of monetary constraints; however, a complete blood count, serum chemistry profile, 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 are positive contrast radiographic examination and cytologic examination, fluid analysis, and bacterial culture and antimicrobial sensitivity testing of the fluid accumulating in the prepuce.

Treatment overview

Phimosis caused by inflammatory 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 fibrosis and scar tissue formation. Multiple surgeries may be needed to correct fibrosis 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.


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Source: VETERINARY MEDICINE,
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