Penile Strangulation by self-Placement of Metallic Nut.
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 peno-scrotal 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.
Urology Unit, Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P.O. Box 4236 , Accra, Ghana.
M Y
MY
Kyei
Urology Unit, Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P.O. Box 4236 , Accra, Ghana.
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EK
Asante
Urology Unit, Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P.O. Box 4236 , Accra, Ghana.
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JE
Mensah
Urology Unit, Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P.O. Box 4236 , Accra, Ghana.
G O
GO
Klufio
Plastic Surgery Unit, Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P.O. Box 4236, Accra, Ghana.
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A
Paintsil
Urology Unit, Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P.O. Box 4236 , Accra, Ghana.
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S
Gepi-Atee
Korle Bu Teaching Hospital, P.O. Box 77 Korle Bu, Accra, Ghana.
B
B
Morton
Plastic Surgery Unit, Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P.O. Box 4236, Accra, Ghana.
K
K
Ampadu
Korle Bu Teaching Hospital, P.O. Box 77 Korle Bu, Accra, Ghana.
B
B
Toboh
D000328:Adult; D003252:Construction Materials / Q000009:adverse effects*; D005402:Fistula / Q000209:etiology*; D005832:Genital Diseases, Male / Q000209:etiology*; D006801:Humans; D008297:Male; D008670:Metals; D009061:Mouth Mucosa / Q000601:surgery; D010413:Penis / Q000293:injuries* / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods; D012611:Scrotum / Q000293:injuries / Q000601:surgery; D016728:Self-Injurious Behavior / Q000150:complications*; D016896:Treatment Outcome; D014525:Urethral Stricture / Q000209:etiology
D008670:Metals
Corpora Cavernosa; Metallic Nut; Penile Strangulation; Thermal Burns; Urethrocutaneous Fistulae