Using drug therapy to treat priapism in two dogs - Veterinary Medicine
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Using drug therapy to treat priapism in two dogs
Instead of surgically treating two patients with priapism, this practitioner tried a novel pharmacologic therapy with a successful outcome. Here he shares details of these cases—and advises you on how to treat affected dogs.


VETERINARY MEDICINE


Treatment

The penis was washed with a dilute chlorhexidine solution. Because of the hematuria and bacteriuria, the dog was given enrofloxacin (5 mg/kg intramuscularly). Diphenhydramine (2.2 mg/kg intramuscularly) was also administered, and an Elizabethan collar was placed on the dog. The dog was released to the owner, and she was instructed to administer enrofloxacin (5 mg/kg orally) once a day and chlorpheniramine (2 mg/kg orally) three times a day and to apply an antibacterial-plus-cortisone ointment to the dog's penis twice daily to manage inflammation and prevent infection. The owner was advised to bring the dog back to the hospital the next morning to recheck its condition.

The next day, the penis was still out of its sheath. At that time, the decision was made to administer atropine sulfate (0.022 mg/kg intravenously) to see if that would have any effect on the parasympathetic stimulation. An intravenous catheter was placed, and an intravenous dose was administered at 10 a.m. and at 12:30 p.m. The patient's heart rate was measured after atropine administration. The heart rate increased from 140 beats/min before atropine administration to 170 beats/min at 11:10 a.m., 170 beats/min at 12:10 p.m., and 150 beats/min at 3 p.m. Because of the prerenal azotemia, the dog was administered Normosol-R (Hospira; 200 ml subcutaneously) since it was still eating and drinking at home.

Since the two days of chlorpheniramine therapy along with the atropine given throughout the day had little immediate effect on the priapism, the decision was made to treat the dog with a beta-adrenergic agonist and the dog was discharged back to its owner for treatment at home. In addition to the enrofloxacin, chlorpheniramine, and antibacterial-plus-cortisone ointment, the dog was prescribed terbutaline sulfate (Brethine—Novartis; 1.25 mg orally b.i.d.) at the dose recommended for chronic bronchitis5 in a dog for one week to be started immediately that evening. The owner was counseled that if medical treatment of this condition did not quickly yield results, the dog would need surgery (penile amputation, perineal urethrostomy) to alleviate the condition and that typically medical therapy is not successful when instituted this late in a patient's condition. A recheck examination was scheduled for five days later.

Follow-up

Two days later, we received a telephone call from the owner reporting that the dog's penis was 90% back in its sheath. We asked her if she had started the terbutaline immediately the evening of discharge and she indicated that she had. We instructed her to continue administering all of the medications, including the terbutaline, at their prescribed intervals, to keep the Elizabethan collar on the dog, and to come in for the scheduled recheck appointment.

At the recheck appointment, the dog appeared less lethargic. The owner reported that the dog was eating and drinking and reported no adverse effects that would be expected with sympathomimetic agents such as excitability, increased heart rate, or tremors. Aside from an elevated body temperature (104.1 F [40 C]), the physical examination results were normal (heart rate = 160 beats/min) except for slight priapism (the penis was 95% in its sheath).

We questioned the owner about the dog's condition at home because of the fever and recommended a repeat CBC and possibly a urine culture, but she reported that the dog was behaving normally and declined any further tests. The owner was instructed to continue the terbutaline for seven days as well as all other medications, and we scheduled another recheck appointment in one week. We explained that the dog's increased temperature could mean that it still had an ongoing urinary tract infection, so the antibiotic therapy should be continued, and if the dog's condition worsened, she should let us know immediately.

The dog was examined one week later. It was bright and alert, and its temperature was normal (101 F [38.3 C]). The penis was completely in its sheath, and the owner reported that the dog was eating, drinking, urinating, and defecating normally. The owner was instructed to continue the enrofloxacin for two weeks until gone.

At the writing of this article, this dog has completely recovered without any need for surgery.


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Source: VETERINARY MEDICINE,
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