title: Bilateral testicular self-castration due to cannabis abuse: a case report.
abstract: BACKGROUND
  The self-mutilating patient is an unusual psychiatric presentation in the emergency room. Nonetheless, serious underlying psychiatric pathology and drug abuse are important background risk factors. A careful stepwise approach in the emergency room is essential, although the prognosis, follow-up, and eventual rehabilitation can be problematic.We present a unique and original case of bilateral self-castration caused by cannabis abuse.
  
  
  METHODS
  We report a case of a 40-year-old Berber man, who was presented to our emergency room with externalization of both testes using his long fingernails, associated with hemodynamic shock. After stabilization of his state, our patient was admitted to the operating room where hemostasis was achieved.
  
  
  CONCLUSIONS
  The clinical characteristics of self-mutilation are manifold and there is a lack of agreement about its etiology. The complex behavior associated with drug abuse may be one cause of self-mutilation. Dysfunction of the inhibitory brain circuitry caused by substance abuse could explain why this cannabis-addicted patient lost control and self-mutilated. To the best of our knowledge, this is the first case report which presents an association between self-castration and cannabis abuse.
authors.affiliation: Department of Urology, Hospital University Center Hassan II, 30000 Fez, Morocco. drahsaini@gmail.com.
authors.forename: Mustapha
authors.initials: M
authors.lastname: Ahsaini
authors.forename: Fadl
authors.initials: F
authors.lastname: Tazi
authors.forename: Abdelhak
authors.initials: A
authors.lastname: Khalouk
authors.forename: Karim
authors.initials: K
authors.lastname: Lahlaidi
authors.forename: Abderahim
authors.initials: A
authors.lastname: Bouazzaoui
authors.forename: Roos E
authors.initials: RE
authors.lastname: Stuurman-Wieringa
authors.forename: Mohammed Jamal
authors.initials: MJ
authors.lastname: Elfassi
authors.forename: My Hassan
authors.initials: MH
authors.lastname: Farih