Unusual presentation of a periurethral abscess following infection with Neisseria gonorrhoea

We describe an unusual case of a male patient presenting with penile and testicular swelling following an unprotected and traumatic sexual encounter. It was suspected that an isolated penile injury occurred during intercourse; however, ultrasound imaging identified an intact tunical layer and right-sided epididymo-orchitis. Following screening for sexually transmitted infections (STIs), he was discharged with antibiotics and advice to attend the Sexual Health Centre for contact tracing. He represented with a periurethral abscess and an antimicrobial-resistant (AMR) strain of Neisseria gonorrhoea was identified. Appropriate antibiotic treatment was initiated. Examination-under-anaesthesia, following abscess drainage, revealed a contained collection with no urethral fistula; however, a flat urethral lesion was seen during urethroscopy. Repeat urethroscopy and biopsy of the lesion indicated polypoid urethritis. Periurethral abscess secondary to gonococcal urethritis is a rare complication, but one that we should be suspicious of, especially with the growing incidence of AMR-STIs.

Prepuce Transillumination: A Safety Tool in Forceps-guided Circumcision

Background: Injury or even amputation of the glans or the penile shaft occurs rarely but can be a tragic circumcision-related complication. The forceps-guided technique can cause this complication due to an inability to visualize the glans before incising. This study was designed to solve this problem by transilluminating the prepuce before the incision, thus exploring whether it contains any tissue between its layers and visualizing what is being done rather than performing the procedure blindly. Methods: Forceps-guided circumcision was done on 432 males, from August 2018 to July 2019.The mean age of patients was 15.57 (1–348) days. The pulled prepuce was transilluminated, showing the prepuce and verifying that no glanular or penile tissue was involved in the forceps lock before incising. Results: The mean follow-up period was 12.45 (2–35) days. Twenty-one patients had postoperative bleeding, and six patients had a hematoma. Fourteen of the 21 patients were managed using a tight bandage; the remaining 7 patients needed surgical exploration. None of the patients had glanular or penile injury. Conclusion: Transilluminating the prepuce as a modification of forceps-guided circumcision is a protective safety step before cutting the prepuce, to eliminate the incidence of glanular or penile injuries. Keywords: Circumcision, Prepuce, Transillumination, Forceps, Complication

Penile Entrapment Syndrome in Young Children

Introduction Entrapment syndromes can occur in extremities like the genitalia, the penis, toes and fingres and mostly due to hair shed by the mother mostly in young children but may be other materials are involved specially in adults. Penile hair Entrapment syndrome is an uncommon health problem that leads to devastating injuries to the urethra and penis including urethral fistula up to urethral complete transaction and penile injury up to penile amputation. We are going to discuss our experience with the problem. Materials and Methods All 15 patients between 2018 and 2020 had been operated upon for various degrees of Penile hair Entrapment syndrome from simple single urethral fistula, and complete urethral transection, their ages ranged between 1.5 years to 4.6 years. Follow up ranged between 6 months to 1.4 years. Each patient was invstigated and examined at the emergency room for other entrapment syndromes and the causative agent was removed and the patients were admitted for managing their urethral and penile injuries. Results All 15 patient but 1 had complete healing with fistula healing and normal voiding with no meatal stenosis or urethral divritculum. One patient had incomplete urethral Closure wit redo operation and fistula closure. Discussion There are multiple reports and literature that address the problem yet nobody took into account how to prevent it. There should be public awarence about the problem, the mother should examine her child for any entrapment syndrome and if any suspicious finding she sholud seek medical advice. Conclusion Penile entrapment syndromes are uncommon urological health problems that can face the urologist but he should be aware of the problem that can affect young children and he should put in mind the problem to manage it as early as possible to prevent further damage of the valuable urethra and penis.

Urethral polyembolokoilamania: not a bread-and-butter issue

Urethral polyembolokoilamania, the self-insertion of a foreign body into the male urethra for sexual gratification and autoerotism, is an uncommon urological emergency with potentially severe consequences. We present the case of a 27-year-old male who presented to our emergency unit after apparently sustaining a penile injury during sexual intercourse. Clinically, a foreign body was thought to be palpable, extending from the mid-shaft of the penis to the penoscrotal junction. Pelvic X-rays confirmed a radiopaque penile foreign body in the region of the anterior urethra. Cystoscopy confirmed the presence of an encrusted foreign body in the anterior urethra. It noted that the surrounding mucosa was very inflamed with areas of necrosis, suggesting that the foreign body had been present in the urethra for some time. To avoid further urethral trauma, we approached the foreign body via an external urethrotomy and removed a plastic knife in three parts. The urethra was repaired over a 16F catheter. The patient had an uneventful postoperative course, and a peri-catheter urethrogram 6 weeks after the procedure showed no signs of contrast extravasation or urethral stricture.

Diagnosis and treatment of penile injury: ten years experience of an emergency department

Introduction: To evaluate the imaging accuracy in the diagnosis and clinical management of penile injury.Materials and methods: From January 2010 to January 2020, 20 men (median age 40.2 years) were admitted to our Emergency Department with the diagnosis of penile injury; the penile trauma was related to sexual intercourse in 16 cases, masturbation in 3 cases and injury caused by the partner in 1 case. All the patients underwent accurate medical history, clinical examinations and diagnostic imaging. Color Doppler ultrasound (CDU) evaluation was performed by Logiq E9 ecograph (General Electric; Milwaukee, WI) supplied with a linear probe small (7.5-10 MHz); magnetic resonance image (MRI) examination was performed within 3-24 hours from the trauma using a 1.5 Tesla scanner, (ACHIEVA 3T; Philips Healthcare Best, the Netherlands) performing pre-contrast and post-contrast multi-planar turbo spin-echo T1 and T2-weighted sequences. Results: 15/20 (75%) men with high suspicion of the tunica albuginea rupture underwent surgical exploration; conversely, 5/20 (25%) patients underwent conservative management. CDU detected 11/15 (73%) fractures of the penis and in 8 of them the length of the rupture was underestimated (more than 5 millimeters). On the contrary, MRI diagnosed all the albuginea ruptures showed by surgical exploration, but underestimated the length of the lesions in 9/15 (60%) cases. The IIEF-5 score administered six months later penile trauma demonstrated a good performance in all the patients. Conclusions: In our series, all the patients with a tunica albuginea rupture < 5 mm. diagnosed by MRI were submitted to conservative management with a complete functional restitutio ad integrum.

Penile Fracture-Report of Two Cases and Review of Current Literatures

Penile fracture is an uncommon urological emergency especially in Bangladesh. The other name is traumatic rupture of the tunica albugenia and corpora cavernosa in erect penis. It occurs when an erect penis face to buckle under the pressure of a blunt sexual trauma. Patient gives the typical history of immediate detumescence, severe pain, swelling and eggplant deformity of the penile shaft due to penile injury. Immediate surgical exploration and repair of corpora Cavernosa with tunica albugenia is the most effective treatment modality. In normal cases diagnosis is made from history, physical examination alone. In some special cases ultrasonogram, radiological images, including retrograde urethrography or cavernosography are mandatory for proper diagnosis.Herein, we report 2 cases of penile fracture with review of current literature regarding treatment options. Bangladesh Journal of Urology, Vol. 19, No. 2, July 2016 p.98-102