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.