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.