We report a case of a 37-year-old male who presented with a 12-hour history of a strangulating 2cm wide by 0.8 cm thick metallic nut on the penile shaft at the peno-scrotal junction. Unlike instances where these metallic objects are placed to enhance sexual stimulation this nut was rather placed to prevent intercourse. A Bosch electric circular grinder was successfully used for removal but a thermal burn to the penile tissues was sustained in the process as the hardness of the nut required a high energy to cut and its thickness did not allow for effective cooling during the process of removal. This resulted in a circumferential denudation of penile skin, a urethro-cutaneous fistula at the penoscrotal junction and a mid-bulbar urethral stricture. The penile wound was subsequently covered with a split skin graft with a delayed closure of the urethrocutaneous fistula and a buccal mucosa patch urethroplasty for the mid bulbar stricture. Despite the degree of thermal burns sustained the patient has maintained good erectile function with grade four rigidity. The tunica albuginea and the underlying corpora cavernosa have shown a significant degree of resilience to thermal burns compared to the corpora spongiosum where the thermal burns led to a urethrocutaneous fistula.
Background: Suprapubic catheter insertion is a common urological procedure, which is often considered to be simple and safe even in inexperienced hands. The objective of our study was to determine the peri-operative morbidity associated with Stab Suprapubic Catheter Insertion (SSPCI) (i.e. stab suprapubic cystostomy)Patients and Methods: A total of 429 patients who had suprapubic catheter insertion using the stab method (with trocar and sheath) at the Korle-Bu Teaching Hospital, Accra, between January 2010 and June 2014 were identified and their case notes reviewed todetermine the peri-operative complication rate in relation to the categories of doctors who undertook the procedure.Results: The commonest indication for a stab suprapubic catheter insertion was acute/chronic retention of urine secondary to benign prostatic hyperplasia (BPH). The overall complication rate was 3.5% with bowel perforation constituting 0.7% of the complications.Conclusion: Stab suprapubic catheter insertion is a safe and effective bedside procedure for bladder drainage when urethral catheterization fails or is undesirable, and can be performed by all grades of surgeons/medical doctors, in selected patients.Complications associated with the procedure can be reduced to a minimum by strict attention to some technical details.
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