Penile Strangulation by Self‐Placement of Metallic Nut: Corporal Cavernosa Tissue Showed Resilience to Thermal Burns Sustained at Removal

Abstract

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.

Retrocaval ureter in a child presenting at a regional referral hospital in South-Western Uganda: A case report

“…This condition usually presents in the third and fourth decades of life but in our case, it was a rare presentation in which the patient was in a second decade of life [ 3 ]. It is more common in males than females, with a ratio of 4:1 globally, but in Uganda, so far a female with this rare type of condition has not been documented [ 4 ].…”

“…Though it is normally described as retrocaval anatomically, it's misleading about its development; since it is not an abnormality in ureteral development but rather an anomaly in inferior vena cava development [ 2 ]. It usually presents in the third and fourth decades of life and hence a rare presentation in the pediatric population [ 3 ]. It's more common is males compared to females at a ratio of 4:1 [ 4 ].…”

Circumcaval Ureter: An Extremely Rare Vascular Anomaly Causing Hdroureteronephrosis: Case Report

“…Circumcaval ureter is a rare congenital anomaly described for the first time by Hochstetter in 1893 (Kyei et al, 2011). The incidence of Circumcaval ureter is about 1 in 1500 cadavers; male to female ratio is 3 or 4:1.…”

“…The anomaly predominantly involves the right ureter, as was observed in these reported cases. If it involves the left ureter, then it is usually associated with either partial or complete situs inversus or duplication of the IVC (Kyei et al, 2011;Rubinstein et al, 1999;Watanabe et al, 1991) Although it is a congenital anomaly, it presents in the third and fourth decade of life as typified by the ages of the presented cases. The majority of patients presenting with symptoms, present with flank or abdominal pain that can be intermittent, dull, and aching and is commonly due to ureteric obstruction and associated hydronephrosis.…”

“…Renal calculi and pyonephrosis may complicate the condition. Some cases are found incidentally during radiographic imaging for other conditions (Kyei et al, 2011). Circumcaval ureter is classified into two types based on its radiographic appearance and the site of narrowing of ureter (Akolekar & Dharap, 2011;Bateson & Atkinson, 1969;Kenawi & Williams, 1976).…”