We had an opportunity to treat a rare case of foreign body in the corpus cavernosum in a patient with cleft glans penis. The foreign body was a 13 cm wire, which was inserted by the patient himself for masturbation, and was removed surgically. To our knowledge, such a case has never been reported in the literature

Aoki, Hikaru

Banya, Yoshiaki

Fujioka, Tomoaki

Kubo, Takashi

Matsuzaka, Junichi

Nagane, Yutaka

Kyoto University Research Information Repository

TitleA foreign body of the corpus cavernosum in a patient with cleftglans penis: a case reportAuthor(s)Matsuzaka, Junichi; Aoki, Hikaru; Banya, Yoshiaki; Fujioka,Tomoaki; Kubo, Takashi; Nagane, YutakaCitation泌尿器科紀要 (1994), 40(6): 545-547Issue Date1994-06URL http://hdl.handle.net/2433/115280RightType Departmental Bulletin PaperTextversionpublisherKyoto UniversityActa Urol. Jpn. 40: 545-547,1994 545 A FOREIGN BODY OF THE CORPUS CA VERNOSUM IN A PATIENT WITH CLEFT GLANS PENIS: A CASE REPORT Junichi Matsuzaka, Hikaru Aoki, Yoshiaki Banya, Tomoaki Fujioka and Takashi Kubo From the Department of Urology, [wate Medical University School of Medicine Yutaka Nagane From the Department of Urology, Keijinkai Sanai Hospital We had an opportunity to treat a rare case of foreign body in the corpus cavernosum in a patient with cleft glans penis. The foreign body was a 13 cm wire, which was inserted by the patient himself for masturbation, and was removed surgically. To our knowledge, such a case has never been reported in the literature. (Acta Uro!' Jpn. 40: 545-547, 1994) Key words: Penis, Foreign body, Cleft glans penis INTRODUCTION Foreign bodies in the corpus caverno-sum other than therapeutic penile prosthe-sis have not been reported to our knowl-edge. We report a case of a foreign body in the corpus cavernosum of a patient with cleft glans penis, which is a rare disease in the literature. CASE REPORT The patient was a 63-year-old man, whose wife had deceased one year ago. He had a long history of habitually inserting a wire into his penis for the purpose of masturbation. Three days prior to his hospital visit, the patient inserted the usual wire while drinking, but after masturba-tion, he could not pull out the wire by himself. Therefore, he visited our hospital for its removal. Physical examination re-vealed the presence of a iengthwise halved glans penis (cleft glans penis) and a tattoo covering the entire glans penis and exten-ding 3 cm. along the shaft (Fig. I). How-ever, there was no definite evidence of the wire visually, and we were unable to lo-cate a puncture hole. The wire could not be demonstrated by palpation either. The patient claimed that he inserted the wire through the groove of the cleft glans. La-boratory studies indicated an inflammatory response (WBC II,BOOjmm3, CRP (5+)J, but the patient was afebrile (36.B C). Roentgenological examinations were made; plain pelviography revealed a wire shadow near the right pubic bone. Ure-thrography was taken to delineate the rela-tionship of the wire shadow to the urethra. The wire was found to be located outside the urethral space (Fig. 2). The patient was then taken to surgery under our im-pression that the wire was present inside the corpus cavernosum. Operation was performed under spinal anesthesia. After a I cm skin incision was made in the right penile root region, the intracavernous wire could now be felt via tunica albuginea. The wire was extracted with a forcels through a small window made on the tunica albuginea without dif-ficulty. Both tunica albuginea and the skin were silk-sutured to finish the opera-tion. Corpus ca vernosography on the 5th post-operative day revealed no leakage through the tunica albuginea. On the 6th post-operative day, the patient was discharged from the hospital with normal erectile function. 546 Acta Urol. Jpn. Vol. 40, No.6, 1994 Fig. I. This photography shows the cleft glans penis and blue .tattoo covering the entire glans penis with 3cm extension along the shaft. Fig. 2. Urethrography indicates that wire shadow was located outside the urethral space. DISCUSSION This case represented a combination of two rare clinical situations , an intracaver-nous foreign body and cleft glans penis that coexisted in a single patient. Penile foreign bodies such as those in the ure-thra are relatively common and those in the form of several beads inserted into the foreskin via preputiotomy are also spo-radically encountered in the literaturel - S). However, foreign bodies in the corpus cavernosum other than therapeutic penile prosthesis have not been reported to our knowledge. Insertion of a wire into the corpus cavernosum from the glans region as used in caverno-glans shunt (Winter's procedureS»), would be techni-cally difficult in the hands of an amateur when penile anatomy is normal. It is naturally expected to be accompanied by severe pain. It may be that the foreign body could be inserted more easily in our case because of the presence of cleft glans penis, although it is doubtful that insertion is less painful in the presence of this ana-tomical aberration. It is well known that some patients with psychiatric problems oc-casionally exhibit deviated sexual conducts including insertion of intraurethral foreign bodies. Our case was apparently a normal full-fledged member of society without' known mental abnormalities, although the tattoo on the penis is bizarre by any usual standard. The psychology behind it can only be speculated since the patient was reluctant to discuss; perhaps the tattoo was intended to mask the penile malformation. Since cleft glans penis was first report-ed by Rosenwald7) there have been only a Matsuzaka et  al.: Foreign body, Cleft glans penishandful of case reports in the  literatures-1°) In general, it is not associated with func-tional problems except for probable psy-chological impact. In fact our patient ex-perienced no difficulty with sexual inter-course with his wife and he had two child-ren. It is unclear how this anomaly de-velops. It has been suggested to be caused by a delayed disappearance of the ure-thral  plates).  Marshal111) suggested that cleft glans represents the mildest form of epispadia. Although this anomaly is of little clinical significance unless there is a meatal  stenosis7), we consider that re-constructive surgery of the glans region early in life is likely to benefit the patient considering the cosmetic and psychological aspects.   In the present case, cavernosography was not taken for a diagnostic purpose in fear of infectious complications, but it can be an effective approach to establish a pre-operative diagnosis. Ultrasonography, com-puted tomography and magnetic resonance imaging would be the method of choice if the object happens to be radiolucent.          REFERENCES 1) Lim KB,  Seow CS, Tulip T, et al.: Artificial547   penile  nodules: case reports. Genitourin   Med 62: 123-125, 1986 2) Bacci M and Porena M: Masturbation injury    resulting from intraurethral introduction of   spaghetti. Am J Med Pathol 7: 254-255, 1986 3) Gelister  JSK: Case  profile: Penile necklace.   Urology 26: 81, 1985 4) Kenney RD: Adolecent males who insert    genitourinary foreign bodies: is psychiatric    referral required? Urology 32: 127-129, 1988 5) Marzou K: Implantation of beads into the    penile skin and its complications. Scan. J   Urol Nephrol  24: 167-169, 1990 6) Winter  CC: Priapism cured by creation of    fistulas between glans penis and corpora    cavernosa. J Urol 119: 227-228, 1978 7) Rosenwald  L: Complete cleft of glans penis.    Urol & Cutan Rev 18: 649-650, 19148)  Leff RG, Peterson RE and Drago JR: Cleft    glans  penis: a case report. J Urol 120:767,   1987 9) Herr HW, Jeppson PM and Bischoff AJ:    Complete vertical cleft of the glans penis. J    Urol 108: 282-283, 1972 10) Ohi T, Obara N, Matsumoto N, et  al.. A    case report: complete vertical cleft of the    glans penis. Rinsho Hinyoukika 39: 781-783,   1985 11) Marshall F: Cleft glans penis: a case report.     Urol 120: 767, 1987, Editorial comment 'Received on December 3, 1993  Accepted on February 3, 1994和文抄録二分亀頭を伴 った陰茎海綿体異物の1例岩手医科大学泌尿器科学教室(主任:久保 隆教授)松 坂 純 一,青 木 光,萬 谷 喜 明,藤 岡 知 昭,久 保 隆恵仁会三愛病院泌尿器科(副院長:長根 裕)長根 裕われわれは,陰茎異物のなかでも非常に稀である陰茎海綿体異物を報告した.症例は63歳,男性.以前よりマスターベーションのため,陰茎に針金を挿入していたが,自己抜去困難とな り抜去 目的にて受診 した.針金は長さ13cmで,手 術的に摘出した.われわれの調べたかぎり,陰茎海綿体異物は他にも報告はなく,第一例目と思われる.さらに陰茎は二分亀頭を合併し,入れ墨も認めた.(泌尿紀要40:545-547,1994)

二分亀頭を伴った陰茎海綿体異物の1例

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二分亀頭を伴った陰茎海綿体異物の1例

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