2.1 Case 1 – Feline phimosis
A thirteen-month old, male neutered, client-owned, domestic shorthair
cat presented with a seven-month history of prolonged urination with a
high-pressure stream and dribbling of urine for some tome afterwards.
Physical examination revealed a pinpoint preputial opening and inability
to extrude the penis. The cat was sedated with methadone (0.3mg/kg IM)
and medetomidine (10µg/kg IM). An intravenous 22G catheter was placed in
the right cephalic vein and general anaesthesia was induced with
alfaxalone intravenously. Cephazolin 22mg/kg was administered
intravenously at induction and repeated every 2 hours throughout the
procedure. Intravenous fluid therapy consisted of Hartmann’s solution
delivered at 3ml/kg/hr. The prepuce was clipped and aseptically
prepared. A plain, right lateral, caudal abdominal radiograph was
performed initially (Fig. 1). A preputiogram (contrast radiography of
the preputial cavity) was performed by inserting a 5French x 6inch
Tomcat catheter into the preputial orifice and injecting 3ml of diluted
contrast medium (2.5ml iohexol 330mg/ml diluted in 2.5ml 0.9%NaCl) to
distend the preputium. Ventrodorsal oblique and lateral contrast
radiographs were performed (Fig. 2,3). The preputial cavity was dilated
measuring 1.6cm x 1.0cm, with a 0.4cm penile length and no evidence of
adhesions. Ultrasound of the penis and prepuce were performed using a
12MegaHz linear transducer (Esaote - MyLabTwice) revealing similar
findings, with the penis measuring 0.45cm x 0.31cm and no evidence of
adhesions. Surgical correction of phimosis was then performed via a
preputioplasty. The cat was positioned in dorsal recumbency with the
hind-limbs pulled cranially. The prepuce, perineum and caudoventral
abdomen were clipped and aseptically prepared with chlorhexidine
gluconate 4% scrub solution and alcohol. A 24G IV catheter was inserted
into the preputial orifice. The ventral surface of the prepuce was
incised 6mm with a No. 15 scalpel blade, using the catheter as a guide.
An ellipse of skin was resected from one edge of the incision. The
mucosa was then sutured to the skin using 4-0, non-absorbable suture
(nylon) in a simple-interrupted pattern to create a new preputial
opening. The penis was able to be extruded post-operatively through the
new preputial orifice. Post-operative analgesia included methadone
(0.2mg/kg IM q4-6hrs) according to the short-form Glasgow composite
measure pain scale and oral meloxicam (0.1mg/kg).7 The
cat was discharged from hospital the following day with ongoing oral
meloxicam 0.05mg/kg q24hrs for five days. At the fourteen-day follow up
examination carried out by the operating surgeon, the owner reported the
cat had normal urination habits at home. The preputial region appeared
clean and dry and the preputial opening appeared adequate. The incision
had healed and sutures were removed. A six-month follow up phone
conversation with the owner was conducted. The owner reported complete
resolution of clinical signs.