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    Surgical Management of Paraphimosis in Dog: A Case Report

    Article in Global Veterinaria · January 2016


    DOI: 10.5829/idosi.gv.2016.16.01.101160

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    Global Veterinaria 16 (1): 49-51, 2016
    ISSN 1992-6197
    © IDOSI Publications, 2016
    DOI: 10.5829/idosi.gv.2016.16.01.101160

    Surgical Management of Paraphimosis in Dog: A Case Report


    1
    Babalola Samuel Adeola and 2Henshaw Enobong

    Department of Veterinary Surgery and Theriogenology,


    1

    Michael Okpara University of Agriculture, Umudike, Abia State, Nigeria


    2
    Divine Veterinary Clinic, Ikot Ekpene, Akwa Ibom State, Nigeria

    Astract: This clinical case report described the management of an acquired acute penile paraphimosis in a 4
    month old Germanshepherd breed of dog presented to Divine Veterinary Clinic, Ikot Ekpene in Akwa Ibom State
    of Nigeria. This condition was noticed following sexual excitement and an attempt to mount an adult bitch on
    heat housed together with it. Physical examination revealed oedematous, hyperaemic and non-retractile
    protruding penis with “napkin ring” on gentle palpation. Following sedation of the dog, the penis was
    massaged gently using hypertonic sugar solution aiming at reducing the oedema. Despite the reduction in size
    of the penis and the application of topical penicillin with gentle manipulation of the protruded penis, retracting
    the penis back into the prepuce was unsuccessful as a result of narrow prepucial orifice compounded by the
    “napkin-ring”. The condition was then surgically treated by a tension-release incision on ventral border of the
    prepucial sheath. The dog recovery was uneventful with no reoccurrence observed in 8 weeks follow up period.

    Key words: Paraphimosis Sexual Excitement “Napkin Ring” Dog Tension Releasing Incision

    NTRODUCTION penis after erection. The primary sources of circulation


    to the parietal and visceral layers are the external
    Paraphimosis; A constriction preventing the penis pudendal artery and dorsal artery of the penis [1,2].
    from being withdrawn into the prepuce, it can be The visceral layer is also supplied by the artery of the
    congenital or acquired and is not uncommon in the dog bulb of the penis, albeit to a lesser degree. A small
    and is serious, for gangrene may occur unless relief is preputial orifice relative to the size of the penis can
    afforded [1]. result in phimosis (Inability to extrude the penis from
    The prepuce is a tubular sheath of skin (Parietal the preputial orifice) or paraphimosis (Inability of the
    layer) lined with mucosa (Inner visceral layer) that covers penis to retract completely into the prepuce) [1, 2].
    a portion of the penile shaft (Pars longa glandis, bulbus The most serious condition is paraphimosis with
    glandis). The mucosa reflects off the bulbus glandis, entrapment and strangulation of the penile shaft.
    forming a fornix as the mucosa reflects onto the external Paraphimosis can present as persistent or episodic
    penile surface to the urethra orifice [2]. The skin is firmly exposure of the penis; the most serious scenario is acute
    attached to and continuous with the ventral abdominal penile entrapment and circulatory compromise [2]. There
    skin, creating a sling effect to support and protect the are several causes of paraphimosis; management depends
    penis from trauma while providing reasonable mobility. on the cause(S) and viability of the penis at the time of
    The cranial 1 to 3 cm of the prepuce protrudes forward presentation [1, 2].
    from the skin reflecting off the abdominal wall. The
    preputial orifice normally permits unimpeded extrusion Case History and Clinical Examination: A 4 months old
    and retraction of the penile shaft [2]. The band-like Alsatian puppy weighing 6kg was presented to Divine
    preputial muscle, an extension of the ventral limits of the Veterinary clinic, with complaint of protrusion and
    cutaneous muscle, attaches to the cranial and dorsal persistent licking of the penis and restlessness which was
    aspect of the prepuce [1, 2]. The primary function of this noticed immediately after the puppy mounted an adult
    muscle is to draw the prepuce forward to cover the glans Alsatian bitch on heat in the same house.

    Corresponding Author: Babalola Babalola Samuel Adeola, Department of Veterinary Surgery and Theriogenology,
    Michael Okpara University of Agriculture, Umudike, Abia State, Nigeria.
    49
    Global Veterinaria, 16 (1): 49-51, 2016

    Plate I: Showing paraphimosis.

    solution of dextrose was wrapped around the penis and


    gently massaged to help reduce penile oedema, this
    process does not produced any significant reduction of
    the penile oedema thus a tension-release incision
    technique was employed to immediately relieve
    circumferential tension on the penile shaft by enlarging
    the preputial orifice along its ventral border (Plate II). The
    lubricated surface of a grove director was inserted
    between the prepuce and penis before incising the border
    sufficiently to relieve the circumferential tension and to
    avoid injury to the penile shaft. Topical ointment,
    Penicillin Ointment® (MIM PHARMA. IND. LIMITED.
    Klm 21, Owode Idiroko Road, Ajibawo Ogun State) was
    Plate II: Tension-release incision of preputial orifice applied on the exposed penis to prevent desiccation of
    along its ventral border. the exposed penile mucosa and the prepuce was then
    advanced forward over the penis thus replacing the penis
    On clinical examination there was swelling and into the preputial cavity. The hair around the incision and
    oedema of the protruded (Exposed) penis with a “Napkin the Prepucial orifice was shaved. Two interrupted suture,
    ring” or banding effect created by the preputial orifice as using size 2 zero nylon was applied to close the incision.
    a result of a small, restrictive preputial orifice relative to The puppy recovered uneventfully.
    penile engorgement (Plate I), the penis was also examined
    for venous and lymphatic compromise which may result Post Surgical Management: An Elizabethan collar was
    to penile necrosis. The dog was assessed for pain by applied arond the neck to prevent the dog from getting to
    gentle palpation of the exposed penis. the incision site. Topical antibiotic ointment (Penicilline
    ointment®) was used as wound dressing and the prepuce
    Surgical Management: The puppy was heavily flushed with diluted chloxecidine while moving the
    sedated with xylazine (XYL-M2®, V.M.D.s.a/n.v. Hoge prepuce gently over the penis to ensure no friction
    Mauw 900 B-2370 Arendonk Belgium) at a dose rate of between the penis and prepuce, this was done daily for 7
    0.15mg/kg and Tremadol Hydrochloride (VISKODOL®, days post surgery and the dog recovered uneventfully
    VISKO PHARMACY LTD, 9/26 Udi Road, Asata, with no reoccurrence observed in 8 weeks follow up
    Enugu, Nigeria) analgesic. Gauze soaked with hypertonic period.

    50
    Global Veterinaria, 16 (1): 49-51, 2016

    DISCUSSION REFERENCES

    The occurance of paraphimosis in this patient agrees 1. Michael, M.P., 2005. Management of Canine
    with Michael [1] and Boothe [2] that paraphimosis is most Paraphimosis. Director of Surgical Services Angell
    commonly seen in dogs younger than 1 year of age and Animal Medical Centre Boston, Massachusetts.
    diagnosis is primarily determined by physical examination 2. Boothe, H.W., 2003. Penis, prepuce and scrotum,
    of the prepuce and penis at the time of presentation. in D. Slatter (ed): Textbook of Small Animal Surgery.
    The entrapment is associated with restriction around Philadelphia, WB Saunders, pp: 1532-1541.
    the penis from a small preputial orifice relative to the 3. Fossum, T.W., 2002. Small Animal Surgery,
    diameter of the penile shaft, which results in dramatic 2nd ed. Philadelphia, Mosby. pp: 666-674.
    swelling of the exposed penis this also agrees with the 4. Hassan, A.Z. and F.B. Hassan, 2003. An introduction
    reports of Michael [1] and Boothe [2]. to veterinary practice. Ahmadu Bello University
    The immediate attempts to correct this condition and press ltd Zaria, Nigeria, pp: 47-48, 75, 77, 222-230 and
    the surgical technique are indicated by Michael [1], 238.
    Boothe [2] and Fossum [3] further delay may results to 5. Fossum, T.W. and M.D. Willard, 2007. Surgical
    prolonged entrapment and strangulation which causes infections and antibiotic selection. In: T.W. Fossum,
    venous and lymphatic compromise that leads to penile ed. Small Animal Surgery, 3rd ed. St. Louis, Missouri:
    necrosis. Mosby, pp: 79-89.
    The choice of medications was as indicated by
    Hassan and Hassan [4] and Fossum and Willard [5].

    51

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