2.2 Case 2 – Canine phimosis
A five-month old, male entire, client-owned, Golden Retriever dog presented for a one-month history of prolonged dribbling of urine after urination. Preputial examination revealed congenital phimosis with a preputial orifice diameter of 1mm. A pre-anaesthetic biochemistry blood test revealed no abnormalities. The dog was pre-medicated with medetomidine (3ug/kg IM) and methadone (0.3mg/kg IM). An intravenous catheter was placed in the left cephalic vein. General anaeshesia was induced with intravenous alfaxalone and maintained on isoflurane gaseous anaesthesia. Cephazolin 22mg/kg IV was given at induction and repeated every 2hrs and intravenous fluid therapy (Hartmann’s solution) was delivered at 6ml/kg/hr throughout the anaesthesia. A 50ug/hr transdermal patch was applied to the metatarsal skin pre-operatively and a fentanyl constant-rate infusion (CRI) was administered intra-operatively. A plain lateral abdominal radiograph (Fig. 4) and preputiogram were performed as described in Case 1, however 8ml of diluted contrast solution was injected into the preputial cavity. The lateral abdominal radiograph post-contrast revealed a small preputial orifice and normal penis and prepuce with no adhesions (Fig. 5). Surgery (preputioplasty) was then performed with the dog in dorsal recumbency. The prepuce and caudal abdomen were clipped and aseptically prepared as described above. A 24G IV catheter was introduced into the preputial orifice. The preputial cavity was entered dorsally by making a 8mm incision along the catheter. A 3mm wedge of skin and preputial mucosa was resected on either side of the incision. The skin was sutured circumferentially to the mucosa using 4-0, non-absorbable suture (nylon) in a simple interrupted pattern. The penis was extruded post-operatively confirming adequate preputial orifice diameter with no penile abnormalities present. A single injection of meloxicam 0.2mg/kg was given subcutaneously and the fentanyl CRI was weaned appropriately according to the short-form Glasgow composite measure pain scale.7 The dog was discharged from hospital the following day with five days of oral meloxicam (0.1mg/kg q24hrs). At the fourteen-day follow up examination with the operating surgeon, the owner reported the dog had been able to urinate normally without any difficulties and they had not noticed any discolouration of the urine. Examination revealed the incision had fully healed and sutures were removed. The penis was easily extruded with no signs of discomfort or inflammation present. A six-month follow up report with the owner could not be conducted as the owner was not able to be contacted, however the owner has not reported any concerns to the clinic since the 14 day follow up consultation in the meantime.