July 1988, Volume 38, Issue 7

Case Reports

PENILE NECROSIS CAUSED BY CONDOM CATHETER

Mohibur Rehman  ( Department of Medicine, Jinnah Postgraduate Medical Centre, Karachi 35. )
S.M. Rab  ( Department of Medicine, Jinnah Postgraduate Medical Centre, Karachi 35. )

In recent years awareness of the unde­sirable side effects of indwelling catheter has resulted in the popularity of condom catheters in unconscious, incontinent and paraplegic patients; hitherto these have been found to be safe.
A case of penile necrosis following pro-longed use of condom catheter is reported. Only one other report is available in the world litera­ture1.

CASE REPORT

A 40 year old male was undergoing treat­ment for acute miliary tuberculosis complicated by tuberculous meningitis at a hospital. Because of his comatose state, a condom catheter was applied, two days latter the patient was transferred under our care. Three days later he developed high grade fever accompanied by chills and rigor. On exami­nation the diagnosis of miliary tuberculosis along- with choroid tubercies and tuberculous meningitis was confirmed. However, he showed remarkable changes in the penis distal to the ring of condom. This was swollen, the margins were red and hot and the skin over the glans was swollen and black (Figure).

The condom was removed, aseptic dressing followed by debridement alongwith treatment for his tuberculous disease caused a recovery without the loss of penis except for the sloughing of the skin which healed slowly by granulation oyer a period of 2 months.

DISCUSSION

Strangulation and incarceration of the penis by devices other than condom catheter have been reported2,3. Various objects and rings have been placed on the penis in an effort to con­trol enuresis in children or to cause masturbation4. Some of these have been responsible for incar ceration and strangulation.5 Penile necrosis has only rarely been described because of risk anasto­motic network of vessels supplying the penis.6 Therefore only tight torniquet effect can explain the catastrophe.
The vascular strangulation does not neces­sarily result in pain as was noted by Steinhardt.1 It can be appreciated that in an unconscious patient like ours there can be more than one reason for the absence of pain. The patient might have developed this complication because of a poorly designed and poorly applied or neglected condom. In order to avoid such a complication in future close monitoring and frequent change of condom is suggested.

REFERENCES

1. Steinhardt, G. and McRoberts, J. Total distal penile necrosis caused by condom catheter. JAMA., 1980; 244: 1238.
2. Hoffman, HA. and Colby, H.F. Incarceration of the penis. J. Urol., 1945; 54:391.
3. Thomas, A.J., Timmson, J.W. and Perlmutter, A.A. Progressive penile amputation. Urology, 1977 ;9 :42.
4. Stuppler, S.A., Walker, J.G., Kandzara, Si. et al. Incarceration of penis by foreign body. Urology, 1973; 2 : 308.
5. Markiand, C. and Merrill, D. Accidental penile gangrene. J. Urol., 1972; 108:494.
6. Myers, R.P. and Kelalis, P.P. Penile gangrene successfully treated by debridement and sciotal skin bridge; case report. J. Urol., 1973; 109: 733.

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