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Cazuri clinice Jurnalul de Chirurgie, Iaşi, 2011, Vol. 7, Nr. 3 [ISSN 1584 – 9341] LONG ELECTRIC WIRE IN URETHRA –AN UNUSUAL PARAPHILIA. CASE REPORT Chattopadhyay SD, Das R, Panda N, Mahapatra RS, Biswas R, Jha A Department of General Surgery, Nilratan Sircar Medical College and Hospital, Kolkata, India. LONG ELECTRIC WIRE IN URETHRA – AN UNUSUAL PARAPHILIA (ABSTRACT): Introduction:- Insertion of foreign body in urethra as a paraphilia is fraught with complications. Our objective was to highlight a case of long wire insertion in urethra and bladder along with its management and literature review to make emergency surgeons more aware of this type of cases. Case report: A 60 cm long wire introduced per urethra for sexual gratification got stuck inside and caused heamturia and pain. It was removed by open cystoscomy after cystoscopic removal failed. Patient also reqired psychiatric help with antidepressant to prevent any further similar episodes. Conclusions urethral foreign body insertion as paraphilia can cause major complications and emergency surgeons need to be aware of the problem and its management. KEY WORDS: URETHRAL FOREIGN BODY, URINARY BLADDER, PARAPHILIA. Correspondence-to: Dr. Nilanjan Panda, address: P 318B CIT Road, Scheme 6 M, Kankurgachi, Kolkata, West Bengal, India pin 700054, e-mail: drnilanjanpanda2002@yahoo.co.in * . INTRODUCTION The variety of foreign bodies inserted into or externally attached to the genitourinary tract defies imagination and includes all types of objects [1,2]. The most common motive is sexual or erotic in nature and is frequently associated with mental health disorders or drug intoxication [2]. Most self-inflicted foreign bodies of the urethra and bladder can be removed endoscopically [2,3]. The primary goal is extraction of the foreign body using minimally invasive techniques and preservation of urinary voiding and erectile functions. However, in some cases open surgery becomes necessary. We present a rare case where an electric wire inserted into the urethra could not be extracted per urethra due to a knot in the bladder, thereby requiring suprapubic cystostomy. CASE REPORT A twenty-five year old male goldsmith presented in the emergency department with a history of bleeding and pain in the urethra and suprapubic region for a few hours following insertion of an electrical wire in his urethra. He was also unable to control micturation. The malleable wire, almost 60 centimeter long and five millimeter in diameter was introduced for sexual gratification. * received date: 18.03.2011 accepted date: 21.07.2011 437
Cazuri clinice Jurnalul de Chirurgie, Iaşi, 2011, Vol. 7, Nr. 3 [ISSN 1584 – 9341] However, later when he tried to remove it there was pain, bleeding from the urethra followed by incontinence. The wire could not be removed. The patient was not married and his socioeconomic status was of lower middle class. It was the first time he had ever self-inflicted a foreign body in his urethra and he had no history of drug addiction or psychiatric illness. Examination revealed an electrical wire with one end protruding about eight cm out of the penis (Fig 1). The patient was dribbling urine. Abdomen was soft and elastic. Suprapubic swelling suggestive of distention of the urinary bladder was absent and there was mild suprapubic tenderness. There was no injury in the ano-scrotal region. During rectal and perineal region examination, the wire was palpable. Other physical examinations were normal. Fig. 1 Electrical wire protruding out of the penis. Fig. 2 X-ray showing coiled wire in the bladder. Initial attempts in the emergency department to remove the foreign body failed. A plain X-ray of the abdomen including pelvic region was advised anticipating surgical intervention which revealed a radio-opaque, smooth and coiled wire in the urethra and urinary bladder (Fig. 2). Cystoscopic removal was unsuccessful as the protruded wire obstructed the pathway and suprapubic cystostomy had to be done (Fig. 3). The foreign body was removed intact followed by urethral catheterization (Fig. 4). Haematuria subsided within two days. The patient was discharged on the 7-th postoperative day and the urethral catheter was removed after two weeks. He was on intravenous antibiotics for five days and on oral regimen for another ten days. Post operative recovery was uneventful. The patient reported no voiding problems or erectile dysfunction in further follow-up. No urethral stricture was seen by the urethrogram performed in the follow-up. After discharge he was advised psychiatric consultation where he was diagnosed with depression and anxiety disorder for which he is receiving medication. 438
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