Paraphimosis in dogs after neutering

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Paraphimosis in dogs after neutering is a common occurrence that can be easily diagnosed by digital rectal examination (DRE). The most frequent causes are hypertrophy of the perineum and/or the perineal ligament, or an entrapment of the dartos muscle.^[@bib1],[@bib2]^ Other rare causes include congenital, traumatic, and postsurgical. In humans, the most common causes of para- or perineal webbing are entrapment of the superficial inferior epigastric vessels,^[@bib3]^ congenital entrapment of the dartos muscle,^[@bib4]^ and, in particular, congenital entrapment of the deep superior gluteal artery and vein.^[@bib5]^

The clinical significance of para- or perineal webbing is still controversial, and the diagnosis is often overlooked. Occasionally, patients with para- or perineal webbing are reported to have recurrent urinary tract infections (UTI) and/or stranguria.^[@bib6]^ Other authors report no relation between para- or perineal webbing and recurrent UTI.^[@bib2],[@bib7],[@bib8]^ This report describes a case of para- and perineal webbing, with a review of the literature, and a comparison of different treatment strategies.



A 4-year-old male Shih Tzu dog weighing 12 ,kg was referred to our clinic with a 4-week history of recurrent episodes of stranguria and fever. The dog had been under the care of a veterinary surgeon for 3 ,months before referral. The episodes of stranguria and fever had been successfully treated with oral antibiotic therapy (amoxicillin/clavulanic acid 3 ,mg/kg PO q12h). There were no other clinical abnormalities reported by the veterinary surgeon.

On physical examination, the dog was restless, with a temperature of 41.5 ,°C. The physical examination was otherwise unremarkable.



The dog was anesthetized with propofol/oxygen/isoflurane (1:1:2) via face mask. Following the induction of anesthesia, the dog was intubated and ventilated with 100% oxygen, and a venous catheter was placed. Anesthesia was mntned with sevoflurane (3% in 100% oxygen). All vital signs were within normal limits. A digital rectal examination was performed to rule out prostatic disease and revealed a 2--3 ,cm diameter swelling of the proximal rectum, located 10 ,cm from the anal sphincter. The rectum was packed in moist gauze and the dog was sent for radiographs.

Thoracic radiographs, including an AP and lateral view, revealed a mild diffuse enlargement of the thoracic r spaces ([Fig. ,1](#f0005){ref-type="fig"}). Both caudal lobes were poorly marginated. A soft tissue opacity was located along the right lateral aspect of the diaphragmatic crus. The ventral thorax appeared mildly depressed in comparison to the dorsal thorax, with a mildly effaced costodiaphragmatic margin. However, the right costovertebral angle appeared sharp. The cardiac silhouette was normal. The lung fields were unremarkable.Fig. ,1AP (left) and lateral (right) thoracic radiographs of the dog. Radiographs of the thorax of a dog with sepsis-induced respiratory flure. The lung fields appear normal, and there is a mild diffuse enlargement of the thoracic r spaces. There is a diffuse opacity (*arrow*) extending from the caudal lateral diaphragmatic margin to the cardiac apex, resulting in the left costovertebral margin not well-demarcated.

The next day, the dog was re-evaluated and became severely dyspneic and tachycardic. Respiratory effort was required to perform auscultation and mucous membranes were pink and edematous. Complete blood count, serum biochemical and serum cortisol analysis, and urinalysis were unremarkable. Urinalysis included protein, hemoglobin, and leukocyte esterase examination. Urinalysis was within reference intervals except for a positive dipstick for leukocyte esterase (10+). Erythrocytes and bacteria were not seen on urinalysis. Hemodilution was suspected due to the presence of hemoglobinuria.

In the following days, he became septic, showing signs of increased serum alkaline phosphatase activity (>,1000 IU/L, reference range, 50--140 IU/L), and mild elevation of the serum alanine transaminase (ALT) and aspartate transaminase (AST) activities. Bacterial culture and biopsy of the liver were not performed at that time.

In view of the suspicion of hemolytic anemia, an anti-Rh antibody titer was performed in serum. The titer was negative (1+).

One week after the initial consultation, the dog was admitted to the referral hospital. The dog had been discharged the day before with a stable clinical condition. On examination, the dog was very lethargic, tachycardic (heart rate: 160 beats per minute), and tachypneic (respiratory rate: 56 breaths per minute). There was clinical evidence of mild hepatomegaly and mild splenomegaly. No rheumatoid or rheumatic lesions were apparent on the joints.

The dog received two intravenous doses of 15 mg/kg doxycycline. The next day, the hematocrit (HCT) increased from 22.8% to 26.3%, and urine specific gravity decreased from 1.063 to 1.030. After 24 hours, the HCT decreased to 22.5%. An additional doxycycline dose of 20 mg/kg was given and the dog's HCT was measured every 2 hours during the first 48 hours and every 8 hours from the third day of hospitalization. The serum biochemical parameters remned stable, and the serum bilirubin concentration decreased from 3.0 mg/dL (at the first admission) to 1.0 mg/dL. An abdominal ultrasound performed at day 4 of hospitalization revealed no evidence of portal vein thrombosis.

On hospital day 4, the dog's general condition began to improve, with a heart rate of 106 beats per minute and a respiratory rate of 31 breaths per minute. The dog was discharged, and a follow-up examination was performed on day 8. The dog was well, with a mild tachypnea (respiratory rate: 34 breaths per minute) and hepatomegaly. No jaundice was present, and the biochemical parameters and serum bilirubin concentration had normalized.

#### Comment.

The dog described in this case report had a severe thrombotic splenic and portal vein thrombosis that resolved after treatment with doxycycline. The owner reported no recurrence of clinical signs and an ongoing response to doxycycline treatment until a reevaluation 4 weeks later. The resolution of clinical signs and the continued response to doxycycline treatment were confirmed by the owner during the follow-up examination.

Doxycycline has been used in dogs as a single-dose, acute treatment of *R. equi* pneumonia ([@bib1

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  1. Shandy

    the Incomparable subject, it is interesting to me :)

  2. Nemo

    Yeah, guys came off: o)

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