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.