尿道塞珠造成陰莖尿道創傷及尿道狹窄 病例報告及文獻回顧

楊欣庭  唐靖

國泰綜合醫院 外科部 泌尿科

Traumatic injury of the penile urethra secondary to metallic urethral plug dislodgment: A case report and review of literature

Hsin-Ting Yang, Chin Tang

Division of Urology, Department of Surgery, Cathay General Hospital, Taipei, Taiwan

Abstract

   We present a case of a 34-year-old Chinese-Singaporean male with a history of genital condyloma and syphilis coming to our outpatient urologic clinic complaining dysuria for 5 days. According to his statement, he had been wearing a custom-made metallic urethral plug since several years ago for sex appeal and sexual pleasure enhancement. However, the anchoring piece of the urethral plug was broken 5 days ago, presumably due to sexual activity, with part of the urethral plug dislodging into the urethra. He then suffered from progressive difficulties urination and micturition pain, with milky urethral discharge in recent 2 days. Urine analysis showed severe pyuria and X-ray of the kidney-ureter-bladder (KUB) showed a 1.5cm long hyperdense lesion at the anterior urethra. Under the impression of urethral foreign body, emergent urethro-cystoscopy with an attempt of retrieval was arranged. 2 pieces of the urethral plug were successfully taken out with grasping forceps, yet severe local adhesion with pus formation of the anterior urethra was noted. The patient was discharged the very next day without clinical sequala. Unfortunately, just one month after the initial surgery, the patient complained progressive slow stream of urine. Uroflowmetry showed obstructive pattern of the urinary flow with a Qmax of 5.3ml/s. Repeated urethroscopy showed anterior urethral stricture with pin-hole lumen, and urethral sounding was performed. The patient is currently under regular follow-up and anterior urethroplasty may be considered if repeated stricture were to occur.

 Urethral plugs are specialized devices designed for insertion into the penile urethra. They feature a long hollow shaft that allows bodily fluids to flow freely, delivering mind-blowing sensations. The diverse motivations for insertion, range from psychiatric illness, autoeroticism, intoxication, to perceived contraception. However, when dislodgement occur, patients are often symptomatic at presentation and the intra-urethral trauma may sometimes lead to long-term sequelae, including urethral false lumens, membrane lacerations, urethritis, and urethral strictures. Prompt and skillful retrieval, as well as subsequent management of any associated complications, are crucial. To the best of our knowledge, this is the first case of a urethral trauma secondary to urethral plug dislodgement being reported in Taiwan. We present this case to share our experience of diagnosis and management of such peculiar disease.