Abstract:
We report a case of a 37-year-old male who presented
with a 12-hour history of a strangulating 2cm wide by
0.8 cm thick metallic nut on the penile shaft at the peno-
scrotal junction. Unlike instances where these metallic
objects are placed to enhance sexual stimulation
this nut was rather placed to prevent intercourse. A
Bosch electric circular grinder was successfully used
for removal but a thermal burn to the penile tissues was
sustained in the process as the hardness of the nut required
a high energy to cut and its thickness did not
allow for effective cooling during the process of removal.
This resulted in a circumferential denudation of
penile skin, a urethro-cutaneous fistula at the penoscrotal
junction and a mid-bulbar urethral stricture. The
penile wound was subsequently covered with a split
skin graft with a delayed closure of the urethrocutaneous
fistula and a buccal mucosa patch urethroplasty for
the mid bulbar stricture. Despite the degree of thermal
burns sustained the patient has maintained good erectile
function with grade four rigidity. The tunica albuginea
and the underlying corpora cavernosa have
shown a significant degree of resilience to thermal
burns compared to the corpora spongiosum where the
thermal burns led to a urethrocutaneous fistula.