Penile and urethral injury due to urethral sheath: case repo
A thirty year old male patient, who had myelitis at age 18, at that time he suffered from quadraplasia associated with stool and urinary incontinence, the patient retained full power of his limps after multiple sessions of physiotherapy within one year, he also retained stool control after 3 years, unfortunately he can’t get back urine control yet. The advice was to manage his continuous urine incontinence by wearing penile sheath. With time the patient fall in severe depression, that in addition to financial causes pushes the patient to neglect care of the sheath.

The patient presented after getting married complaining of very ugly penis with long urethral defect (about 6cm). The defect has hard texture and can be divided to three zones (proximal, intermediate, and distal). The proximal zone which is about 3cm in length has almost complete loss of corpus spongiosum. The intermediate zone about 1 cm length contains a stony hard fibrous tissue encircling the urethra. About (50%) of corpus spongiosum at distal zone was lost it is about 2cm in length.

Surgical repair started after insertion of 16F silicon Foley catheter. Dissection between the hard texture skin of the defect and underlying tissue has been done. All fibrous tissue at intermediate and distal zones removed leaving a thin membranous layer covering the Foley catheter, the tissue sent to pathology to be identified and to rule out malignant changes.

The tissue surrounding the proximal urethral defect was dissected and inverted to cover the Foley catheter making the urethra continues again, all other ugly tissue are dissected and removed and sent to pathology.

Tow parallel incision done at the ventral proximal healthy penile skin and extended to the scrotum for 11cm length. Dissection done between dartos and buck fascia in the penile zone, and between the dartos and external spermatic fascia in the scrotal zone, creating a flap that freely reach the distal normal ventral penile skin to cover the penile defect ventrally, the flap fixed by Interrupted 2-0 polydioxanone suture.

Dressing removed 3 days after; Foley catheter removed 14 days after.

Source: Urology case reports

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Dr. R●●●●●●●●●a k
Dr. R●●●●●●●●●a k Internal Medicine
What is the reason for dissection of scrotum? I mean there is no pathology in scrotum so all you need is reconstruct pennies with muscles like Platysma or any muscle flap my suggestions thank you
Apr 11, 2019Like