Apart from iatrogenic causes, many of the foreign bodies in the bladder and urethra are self-inserted through the urethra as a result of psychiatric disturbances, sexual gratification, or erotic curiosity while intoxicated. Despite the reports on the presentation of urethrovesical foreign bodies in the medical literature, the insertion of foreign bodies through the urethra for the purpose of erotic satisfaction remains an enigma. Here, we report a case of a knotted earphone jack as an urethrovesical foreign body inserted for erotic reason by a 32-year-old man with no history of psychiatric disturbances. He could not retrieve it, and the bladder foreign body remained in this position for about 8 h. He was referred to the accident and emergency unit of our hospital, and open surgery was performed to retrieve it.
To assess the immediate (14 days) outcome of management and to determine the predisposing factors (PF) to acute epididymorchitis in this rural community. Materials and methods: This is a retrospective study. All men who were diagnosed as having acute epididymorchitis within the study period of 5 years were included. Those with epididymorchitis secondary to testicular tumors were excluded. Information related to age, HIV infection and other PF, organisms isolated, duration of hospital stay, antibiotic treatment, adjunct treatment, and duration of symptoms before presentation were documented. Immediate outcome was graded as good if symptoms and signs resolved within 2 weeks of treatment or poor if this took more than 2 weeks. Findings were analyzed using simple statistical methods and statistical package for the social sciences (SPSS-17). Results: A total of 58 men met the selection criteria and were included in the study. The risk factors included two (3.4%) prostatitis, 36 (62.1%) bladder outlet obstruction, three (5.2%) trauma/instrumentation, and ten (17.2%) multiple sexual partners. No risk factor was documented in seven (12.1%). One (1.7%) of the men, who also had bladder outlet obstruction, was HIV positive. When age was cross tabulated with risk factors, there was a significant correlation (P=0.000) but it had no significant effect on immediate management outcome (P=0.442). Immediate outcome was considered good in 40 (69%) and poor in 18 (31%). Independent factors that affected outcome included the duration of symptoms before presentation (P=0.000), presenting symptoms (P=0.000), and the need for adjunct treatment (P=0.018). Ciprofloxacin was the antibiotic used in 57 (98.28%), while cefuroxime was used in one (1.7%). These drugs had no statistically significant correlation with outcome. Conclusion: Many patients with epididymorchitis have PF that need to be treated to avoid its recurrence and complications. It would then mean that the diagnosis "acute epididymorchitis" is incomplete without including the PF. In this study, ciprofloxacin was not uniformly effective (69%) using the aforementioned criteria, indicating the need for prospective studies to identify cost-effective antibiotics.
Blunt scrotal trauma results in different forms of injuries such as hematoma, rupture of the testis, and testicular torsion. The diagnosis of trauma-induced testicular torsion in patients with blunt scrotal trauma requires a high index of suspicion. As early diagnosis and management of traumatic testicular torsion obviate testicular losses, an urgent testicular scan is necessary in cases of suspected traumatic torsion, and if not readily available or indeterminate, scrotal exploration is promptly indicated. Reported herein is a case of traumatic testicular torsion which was managed as a straightforward blunt scrotal trauma in a private health facility. He eventually had an orchidectomy when he presented to us 4 months later on account of a marked reduction in testicular volume. This case report reiterates the need to look beyond the obvious in patients with blunt scrotal trauma and the necessity of testicular scan and scrotal exploration in testicular salvage in suspected trauma-induced testicular torsion.
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