Polyembolokoilamania: Self-insertion of transistor radio antenna in male urethra
A 65-year-old African man presented to our surgical emergency with a week history of bleeding per urethra following nocturnal penile erections. He admitted to have introduced a broken transistor radio antenna into his urethra a week before to serve as an improvised ‘itchstick’ to ease a bothersome itchy urethral condition. The object subsequently migrated proximally out of reach. He made several unsuccessful attempts at self-retrieval prior to presentation and remarkably reported no difficulty with voiding. He had no history of psychiatric disorder, alcoholic or drug intoxication and had no prior history of similar or other self-injurious behaviour. He, however, had a bothersome perineal and itchy urethral condition which was worse at nights.\nPhysical examination revealed a hard rod-like mass in the proximal part of the penis extending to the perineum; the mass had only minimal mobility. A pelvic X-ray done showed a rod-like radio-opaque foreign body in the region of the penile and bulbar urethra []. A diagnosis of foreign body in the male urethra was made. After obtaining informed consent, removal of the foreign body was planned. Under caudal regional block with 2% Xylocaine gel instilled into the urethra, an attempt at ‘milking out’ the foreign body was made but failed. Endoscopic removal was considered but deemed inappropriate as the distal end of the object was jagged (irregular) and appeared impacted in sub-urethral tissue. External urethrotomy of the anterior urethra was performed with the incision made into the proximal penile urethra at the distal tip of the foreign body which was then easily extracted []. The extracted foreign body, an aluminium tube transistor radio antenna measured 13 cm in length [], urethral swab for microscopy and culture was taken and urethrotomy closed over a 16 Fr Foley's catheter. The patient was discharged after 48 hours and the catheter removed after a week at the clinic. The urethral swab grew Klebsiella pneumoniae and he was treated with sensitive antibiotics, tabs Augmentin for 2 weeks. At 1 month follow-up, he complained of a decreased but persistent urethral itch. Four-bottle urine microscopy revealed numerous pus cells, few epithelial cells and spermatozoa and only scanty growth of K. pneumoniae. No worm or ova was found. Antibiotics (Augmentin) were continued for a further 2 weeks and empirical treatment for pin worm infestation was given (Albendazole) resulting in resolution of symptoms. A psychiatric evaluation revealed him psychologically normal. At 9 month follow-up, he had no recurrent itch and normal voiding with good uroflow.