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P-03-070 Extraordinary cause of female urethral dilatation and urinary incontinence: Urethral coitus
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P-03 Cases that Matter Posters
on 6/12/16. The patient had a wound infection to a small part of the donor site of the skin graft. The wound was swabbed and grew Pseudomonas aeruginosa, which, responded well to oral antibiotics. This patient was followed up regularly over the next 4 months and was instructed to carry out penile stretching exercises. The graft healed well and he was discharged with normal erectile function in March 2014. Conclusion: This was an example of how an immunocompromised patient presented with penile cellulitis and subsequent Fournier’s gangrene after oral intercourse. Policy of full disclosure: A low threshold of suspicion for Fournier’s gangrene should be kept in imunocompromised patients with infection of the genitalia. Prompt surgical resection followed by delayed skin grafting can produce good cosmetic and functional results.
P-03-070 EXTRAORDINARY CAUSE OF FEMALE URETHRAL DILATATION AND URINARY INCONTINENCE: URETHRAL COITUS Sarikaya, S.1 1 Keçiören Research and Training, Urology, Ankara, Turkey
Figure 1. Preoperative outcome.
Figure 2. Preoperative outcome. J Sex Med 2016;13:S172eS212
Objective: Urethral coitus is a very rare condition that causes urinary incontinence and urethral dilatation. This condition is usually seen in women with vaginal or hymenal anomalies. Also this may be seen with intact vagina. There is a close anatomical relationship with urethra and and external genital organs. This close relationship may lead urethral traumas during coitus. Urethral coitus with the presence of intact and normal vagina may be as a result of mulitple vaginal births and a severely dilated vagina. There are several causes and different types of urinary incontinence in women. Urethral coitus is a very rare cause of urinary incontinence. In this case we aimed to present a 72 year-old, sexually active, multiparous female patient with intact vagina and severe urinary incontinance due to regular urethral coitus. Methods: 72 year-old female patient admitted to our clinic with a 5-year history of severe urinary incontinence. The complaint of urinary incontinence was increasing after sexual activity and the patient had also a history of total abdominal hysterectomy operation and three normal vaginal births. When the sexual relationship was queried, the patient and her husband had sex for one or two times a week regularly and the couple clearly expalined that they had sex through urethral way. According to the physical examination, urethra was seen as severely dilated.(Figure 1) Also there was a urine leakage without intervention. Results: The urine test and biochemical parameters were normal. Transobturatory tape and urethral repair operation was planned for the patient. During the operation, urethral catheter was inserted and firstly transobturatory tape was performed. After that, an inverted U incision extending from 5 o’clock to 7 o’clock was made on anterior urethral wall. The anterior part of the
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P-03 Cases that Matter Posters
urethral wall between 5 and 7 o’clock was excised and three 2/ 0 vicryl plicating sutures were inserted around the urethral catheter. The urethral catheter was removed on postoperative third day and the patient was discharged. On postoperative first month, the patient had no complaints about urinary incontinence, uroflowmetry result was normal and there was no postvoiding residual volume. Conclusion: Oral, vaginal and anal ways are frequently used ways but urethral way is a strange and rare way to have sex. Urethral coitus usually causes severe urethral dilatation and urinary incontinence but in some cases urinary incontinence may not be seen. If severely dilated urethra is seen during the physical examination, physician must think about urethral sex and ask additional questions about sexual intercourse. Medical and surgical treatment modalities would be used for the treatment of stress urinary incontinence. Transobturatory tape is a frequently used technique for the surgical treatment of stress urinary incontinence. For these type of patients, especially who had a history of urethral coitus, urethral repair would be successful like the patient we have reported. Policy of full disclosure: None.
Methods: In September 2014, a 21 year old male patient was admitted to emergency clinic of Keçiören Research and Training Hospital with a urethral foreign body that was extendig into the bladder. Nearly the half of that urethral foreign body was outside of the urethra and was an electrical wire cable. The patient was routinely inserting the cable into the urethra for masturbation but at that time the cable was inserted more deeply and the patient had a severe urehtral pain. On the X-ray, the electrical wire cable was clearly seen and was extending into the bladder (Figure 1). Results: Firstly, we tried to remove the cable from the extraurethral part but the patient had a severe urethral pain and after that, under spinal ansetesia we cystoscopically removed the wire cable. A gross electrical wire cable was seen after removal. During cystoscopy, minimal urethral injury was seen and a urethral catether was inserted. Also there was a urinary tract infection and intravenous antibiotherapy was given to the patient. On postoperative third day, the urethral catether was taken out and the patient was discharged with oral antibiotherapy. During the routine follow-ups, the uroflowmetry of the patient was normal. Conclusion: There are a few male cases in the literature that were reported with intravesical or intraurethral masturbation instruments. Interestingly most of the cases with these extraordinary instruments in the literature, have regular sexual activity and have not any other diseases. Urethral foreign bodies may cause some severe infections and injuries. Also there are endoscopic and open surgical techniques for removing the foreign bodies. But for the most cases, endoscopic procedures are sufficient. Policy of full disclosure: None.
Figure 1. P-03-071 AN EXTRAORDINARY MASTURBATION INSTRUMENT: INTRAVESICAL ELECTRICAL WIRE CABLE Sarikaya, S.1 1 Keçiören Research and Training, Urology, Ankara, Turkey Objective: In this case report, we aimed to present a 21 year-old male patient that was admitted to emergency clinic of Keçiören Research and Training Hospital in September 2014 wih a urethral foreign body that was extending into the bladder and was used for masturbation.
Figure 1. J Sex Med 2016;13:S172eS212
P-03 Cases that Matter Posters
on 6/12/16. The patient had a wound infection to a small part of the donor site of the skin graft. The wound was swabbed and grew Pseudomonas aeruginosa, which, responded well to oral antibiotics. This patient was followed up regularly over the next 4 months and was instructed to carry out penile stretching exercises. The graft healed well and he was discharged with normal erectile function in March 2014. Conclusion: This was an example of how an immunocompromised patient presented with penile cellulitis and subsequent Fournier’s gangrene after oral intercourse. Policy of full disclosure: A low threshold of suspicion for Fournier’s gangrene should be kept in imunocompromised patients with infection of the genitalia. Prompt surgical resection followed by delayed skin grafting can produce good cosmetic and functional results.
P-03-070 EXTRAORDINARY CAUSE OF FEMALE URETHRAL DILATATION AND URINARY INCONTINENCE: URETHRAL COITUS Sarikaya, S.1 1 Keçiören Research and Training, Urology, Ankara, Turkey
Figure 1. Preoperative outcome.
Figure 2. Preoperative outcome. J Sex Med 2016;13:S172eS212
Objective: Urethral coitus is a very rare condition that causes urinary incontinence and urethral dilatation. This condition is usually seen in women with vaginal or hymenal anomalies. Also this may be seen with intact vagina. There is a close anatomical relationship with urethra and and external genital organs. This close relationship may lead urethral traumas during coitus. Urethral coitus with the presence of intact and normal vagina may be as a result of mulitple vaginal births and a severely dilated vagina. There are several causes and different types of urinary incontinence in women. Urethral coitus is a very rare cause of urinary incontinence. In this case we aimed to present a 72 year-old, sexually active, multiparous female patient with intact vagina and severe urinary incontinance due to regular urethral coitus. Methods: 72 year-old female patient admitted to our clinic with a 5-year history of severe urinary incontinence. The complaint of urinary incontinence was increasing after sexual activity and the patient had also a history of total abdominal hysterectomy operation and three normal vaginal births. When the sexual relationship was queried, the patient and her husband had sex for one or two times a week regularly and the couple clearly expalined that they had sex through urethral way. According to the physical examination, urethra was seen as severely dilated.(Figure 1) Also there was a urine leakage without intervention. Results: The urine test and biochemical parameters were normal. Transobturatory tape and urethral repair operation was planned for the patient. During the operation, urethral catheter was inserted and firstly transobturatory tape was performed. After that, an inverted U incision extending from 5 o’clock to 7 o’clock was made on anterior urethral wall. The anterior part of the
S208
P-03 Cases that Matter Posters
urethral wall between 5 and 7 o’clock was excised and three 2/ 0 vicryl plicating sutures were inserted around the urethral catheter. The urethral catheter was removed on postoperative third day and the patient was discharged. On postoperative first month, the patient had no complaints about urinary incontinence, uroflowmetry result was normal and there was no postvoiding residual volume. Conclusion: Oral, vaginal and anal ways are frequently used ways but urethral way is a strange and rare way to have sex. Urethral coitus usually causes severe urethral dilatation and urinary incontinence but in some cases urinary incontinence may not be seen. If severely dilated urethra is seen during the physical examination, physician must think about urethral sex and ask additional questions about sexual intercourse. Medical and surgical treatment modalities would be used for the treatment of stress urinary incontinence. Transobturatory tape is a frequently used technique for the surgical treatment of stress urinary incontinence. For these type of patients, especially who had a history of urethral coitus, urethral repair would be successful like the patient we have reported. Policy of full disclosure: None.
Methods: In September 2014, a 21 year old male patient was admitted to emergency clinic of Keçiören Research and Training Hospital with a urethral foreign body that was extendig into the bladder. Nearly the half of that urethral foreign body was outside of the urethra and was an electrical wire cable. The patient was routinely inserting the cable into the urethra for masturbation but at that time the cable was inserted more deeply and the patient had a severe urehtral pain. On the X-ray, the electrical wire cable was clearly seen and was extending into the bladder (Figure 1). Results: Firstly, we tried to remove the cable from the extraurethral part but the patient had a severe urethral pain and after that, under spinal ansetesia we cystoscopically removed the wire cable. A gross electrical wire cable was seen after removal. During cystoscopy, minimal urethral injury was seen and a urethral catether was inserted. Also there was a urinary tract infection and intravenous antibiotherapy was given to the patient. On postoperative third day, the urethral catether was taken out and the patient was discharged with oral antibiotherapy. During the routine follow-ups, the uroflowmetry of the patient was normal. Conclusion: There are a few male cases in the literature that were reported with intravesical or intraurethral masturbation instruments. Interestingly most of the cases with these extraordinary instruments in the literature, have regular sexual activity and have not any other diseases. Urethral foreign bodies may cause some severe infections and injuries. Also there are endoscopic and open surgical techniques for removing the foreign bodies. But for the most cases, endoscopic procedures are sufficient. Policy of full disclosure: None.
Figure 1. P-03-071 AN EXTRAORDINARY MASTURBATION INSTRUMENT: INTRAVESICAL ELECTRICAL WIRE CABLE Sarikaya, S.1 1 Keçiören Research and Training, Urology, Ankara, Turkey Objective: In this case report, we aimed to present a 21 year-old male patient that was admitted to emergency clinic of Keçiören Research and Training Hospital in September 2014 wih a urethral foreign body that was extending into the bladder and was used for masturbation.
Figure 1. J Sex Med 2016;13:S172eS212