3. DISCUSSION
Phimosis is a rare condition in juvenile dogs and cats that has
infrequently been reported in the veterinary literature. One study
reported that 0.5% of cases of canine penile and preputial lesions were
due to phimosis.3,4 The condition has largely been
diagnosed by physical exam alone, with inability to extrude the penis
and an abnormally small preputial opening present.1,2To our knowledge, the gross features of phimosis as well as surgical
techniques have been described, however there is only one study in the
literature describing radiological examination of this condition in
dogs.6 The purpose of the present case series was to
describe radiographic protocols for diagnosing phimosis in both the dog
and cat. A novel term, preputiogram, has been proposed to define
contrast radiographs of the preputial cavity. In both cases, a
preputiogram using diluted iohexol yielded radiographs of diagnostic
quality, revealing a dilated prepuce and no penile abnormalities. Whilst
physical exam is sufficient to make a diagnosis of phimosis, it cannot
always identify the presence of underlying adhesions between the
preputial mucosa and the penis. Vlaming et. al 2019, developed a
classification system for phimosis based on the gross and pathological
lesions, with type I defined as generalized preputial swelling and urine
pooling without adhesions and type II as focal preputial swelling and
urine pooling in the presence of penile-preputial
adhesions.5 The surgical technique was different
depending on the type of phimosis present, attributing to whether or not
adhesions were present. Penile-preputial adhesions limit visual
assessment of the penis and may limit the available preputial mucosa to
perform a preputioplasty. Therefore, it was deemed a preputioplasty is
appropriate for type I phimosis whereas a modified preputial
utrethrostomy is proposed for type II phimosis. The use of a
preputiogram is therefore important in identifying presence of
penile-preputial adhesions prior to surgery to allow appropriate
surgical planning. The preputiograms performed in the two cases
presented here did not identify any preputial adhesions. A limitation
therefore of this study was the inability to compare radiographic
appearance of cases with and without preputial adhesions. The use of
ultrasound confirmed the findings of the radiographs (normal penile
length and absence of adhesions) in Case 1, however poor resolution was
a limitation in such a small patient when using a 12MHz probe. Whilst
ultrasound was used for completeness of the study, the author does not
believe it adds more information for surgical planning than performing a
preputiogram alone. In conclusion, the study defines a novel
radiographic technique for diagnosing phimosis and suggests a
preputiogram should be incorporated into the diagnostic investigation of
phimosis in the dog and cat to allow for surgical planning and therefore
improve patient outcomes.