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We present a case report of a 22-year-old Nigerian student who presented to the accident and emergency unit of a Nigerian Teaching Hospital with a history of self-inflicted genital injury following a suicide attempt. He had background history of predisposition to depressive illness, a current diagnosis of a major depressive disorder, and had had two attempted suicidal episodes in the last 3 months prior to this event. The clinical finding shows a patient with sad affect, feeling of hopelessness, and worthlessness; however, the vital signs remained fairly stable. At examination under anesthesia, the testes were exposed and the right already self-castrated. The penis was degloved to the level of the Buck's fascia with intact corpora cavernosa and urethra. He had surgical excision of the hanging self-castrated right testis with debridement and primary closure of the genital laceration. He was promptly reviewed by the psychiatrists who co-managed appropriately.

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Though self-insertion of a foreign body in the male urethra is an infrequent urologic emergency, a weird variety of self-inserted foreign bodies have been reported. Most of these are attributed to autoerotic stimulation, a consequence of mental illness or the result of drug intoxication. We report an unusual case of a 65-year-old African man who self-inserted a broken transistor radio antenna into his urethra to serve as an improvised ‘itchstick’ to ease a bothersome itchy urethral condition. The foreign body subsequently migrated proximally out of reach. He presented a week after with urethral bleeding following nocturnal penile erections and we describe his evaluation and the challenge of retrieval. The reasons for self-inserting objects into the urethra may be as varied as the foreign bodies themselves and may include objects being used as an improvised ‘itchstick’ for itchy urethral conditions. The urologist's creative tendencies will often be required in safely removing these objects.

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Objective:To report the experience with our technical modification of the trigone-bladder neck complex management in the prevention of bladder neck stenosis (BNS) following open simple retropubic prostatectomy.Materials and Methods:It was a retrospective review of data of patients that underwent open simple retropubic prostatectomy with technical modification of the trigone-bladder neck complex in two Nigerian tertiary hospitals, by a single surgeon, from January 2007 to December 2011. The data analysed included the demographic variables, the modes of presentation, need for blood transfusion, duration of catheterization and the duration of hospital stay. The primary end-point was the development or otherwise of BNS.Results:Eighty-seven patients’ data were available for analysis from a total of 91 patients. The mean age (±standard deviation [SD]) was 65.14 years (±10.55). Preoperative urinary retention was present in 58% of the patients. The maximal flow rate (Qmax) was 12.05 ml/s among the 20 patients that had preoperative uroflowmetry. The transfusion rate was 35%, but almost two-third of them had only one unit of blood transfused. The mean weight (±SD) of the enucleated adenoma was 82.64 g (±36.63). Bladder irrigation was required in 14% of the patients, majority of the patients had urethral catheter removed after 96 h and the mean hospital stay was 6.52 days. No patient developed BNS after a mean follow-up duration of 16.39 months.Conclusion:Bladder neck stenosis can be a distressing complication of prostatectomy. The result of our technical modification of managing the trigone-bladder-neck complex looks promising for prevention or delaying the onset of BNS. A long-term observation and a prospective randomised control trial to ascertain this initial experience is needed.

January 2011 • Volume 7 • The AnnAls of AfricAn surgery by the abdominal distension and discomfort. He neither had history of trauma nor urethral instrumentation. He was not a known peptic ulcer disease patient and no ingestion of non-steroidal anti-inflammatory drug. There was no fever or other constitutional symptoms. He was a known patient, of the unit, who had histological confirmation of benign prostate hyperplasia two and a half years earlier, but declined prostatectomy on financial ground. Physical examination showed a middle-aged man in distress. He was tachypnoeic and tachycardic with respiratory rate of 34 cycles per minute and pulse rate of 124 beats per minute respectively. The blood pressure was 170/90mmHg. Abdomen was notably distended, tense and tender with no differential fullness of the suprapubic region. The prostate was clinically enlarged with benign features on rectal examination. The chest was clinically clear. A clinical diagnosis of spontaneous intraperitoneal urinary bladder rupture was made. Abdomino-pelvic ultrasound scan revealed extensive sonolucent intra-abdominal fluid with the bowel loops freely floating. There was a wide rent of the bladder wall with mucosal to serosal bridging posteriorly leading to free communication between fluids in the urinary blad