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Date:   16 December, 2009  
Focus: Small animals - dogs, cats, hamsters, guinea pig & rabbits.

Toa Payoh Vets Clinical Research
Making veterinary surgery alive
to a veterinary student studying in Australia
using real case studies and pictures

IS THERE A CURE FOR PARAPHIMOSIS?
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
First written: Dec 11, 2009

 
This article may be of interest to 4th year vet students. The 4th year is said to be the hardest year, according to one Murdoch University graduate.

Paraphimosis
- protrusion of the penis with an inability to retract the penis into the prepuce.
Causes:
1. Idiopathic - No known causes
2. Small preputial orifice
3. Weakened preputial muscles
4. Trauma
5. Shorter prepuce

Possible medical conditions
1. Posthitis - Inflammation of the prepuce.
2. Phalitis - Inflammation of the penis.
3. Balanitis - Inflammation of the head of the penis (glans penis).
4. Balanoposthitis - Inflammation of the head of the penis and the internal layer of the prepuce.

Treatment:
1. Surgery to prevent balanoposthitis in this case. Which surgical approach? How many approaches are there?
2. Medical treatment. Retract prepuce to the level of the bulbus glandis and wash it with soap and water every day.
3. Others?
Can you think of any?
Cavalier King Charles 5 years, male, neutered. Paraphimosis, balanoposthtitis. Toa Payoh Vets Cavalier King Charles, Male, Neutered, 5 years. Paraphimosis. Balanoposthitits. Singapore. Toa Payoh Vets  
  Cavalier King Charles, Male, Neutered, 5 years. Paraphimosis. Balanoposthitits. Singapore. Toa Payoh Vets Cavalier King Charles, Male, Neutered, 5 years. Paraphimosis. Balanoposthitits. Singapore. Toa Payoh Vets
  Cavalier King Charles, Male, Neutered, 5 years. Paraphimosis. Balanoposthitits. Singapore. Toa Payoh Vets

What is the best surgical approach? To just enlarge the preputial orifice or make a longer incision to the level of the bulbus glandis as drawn in my surgery plan?

Dec 16, 2009.
The case is being reviewed for the next 2 weeks as the dog is given medication.

The small preputial orifice got swollen 6 weeks after the first treatment. This could be due to the dog's lifestyle - humping on cushion though he is neutered at 2 years of age (belated) and sunbathing for 15-20 minutes a day nowadays.

When the inflammation is gone, surgery may be the only option as daily pulling back of the internal layer of the prepuce to wash away the smega and pus may be too much work for the young working lady owner.  Presently, the lady is cleaning the glans penis after the dog pees. The dog may wait for the lady to come home from work before peeing. During the first treatment, he had no problem peeing. But at other times, he seemed to take a long time before he could pee. "This means he has had pain in his penis," I said. "So, he could not pee easily unlike after his first treatment in October."

So, what to do now?   "This is not a common surgery," I inform the young couple. It is not like sterilisation of the dog. So, the outcome is not so well known. There is circumcision surgery in human males but is this the approach for paraphimosis in the dog?      

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