residents’ room

An unusual case of polyembolokoilamania: Urethral avulsion from

foreign object use during sexual gratiﬁcation

Garson Chan, MD; Adiel Mamut, MD; Stephanie Tatzel, MD; Blayne Welk, MD, MSc

Department of Surgery, Western University, London, ON, Canada

Cite as: Can Urol Assoc J 2016;10(5-6):E181-3. http://dx.doi.org/10.5489/cuaj.3778

Published online May 12, 2016.

forcefully removed the tubing, which when removed was

found to have an approximately 1 cm knot at the end. On

presentation to the hospital, it appeared that he avulsed a

portion of his urethra. His scrotum and penis were swollen

and ecchymotic. A 5 cm portion of intussuscepted penile

urethra was attached to the glans and bleeding (Fig. 1). The

patient was consented for surgical exploration, possible

urethral repair in a single or multistage manner, or poten-

tially a perineal urethrostomy. A suprapubic catheter was

placed prior to operative management.

Abstract

Polyembolokoilamania is the insertion of foreign objects into

body oriﬁces for sexual gratiﬁcation. While the retrieval of

these objects from the urethra and bladder is a well-known

task among urologists, we present a rare case of an usual and

serious injury from this practice: complete avulsion of the

urethra at the penoscrotal junction. A single-stage urethro-

plasty was used to reconstruct the urethra with good result.

The patient motivation, as well as concomitant medical or

psychological conditions, should be explored in order to

prevent further occurences.

Intraoperatively, we conﬁrmed the diagnosis by exam-

ining the protruding portion of urethral tissue. The edge

was grasped with a Babcock and the urethral intussception

reduced (Fig. 2A). A penoscrotal incision was made; dissec-

tion was carried down to the end of the Babcock and the

distal end of the bulbar urethra identiﬁed. Care was taken

to minimize trauma to surrounding skin and fascia layers.

The urethral viability was conﬁrmed with active bleeding

and blanching and ﬁlling of the spongiosum with pressure.

Cystoscopy was carried out, which showed false passages

and mucosa damage at the level of the prostatic urethra and

a normal bladder without any retained foreign bodies. The

penile urethra appeared to have separated from the corpo-

ral bodies and bucks fascia with minimal trauma and the

peno-glandular urethral junction was intact. Consideration

was given to a staged repair, however, the urethral tissue

appeared to be healthy and a single-stage procedure was

felt to minimize morbidity and provide maximal salvage of

the urethral plate tissue. The proximal portion of the penile

urethral plate was split in half from the injury (Fig. 2B). This

was repaired in two layers using 5-0 moncryl. The edges

of the penile and bulbar urethral were then freshened and

a two-layer closure undertaken using 5-0 monocryl (Fig.

2C). A 16 French urethral catheter and a drain were left.

The patient was discharged home on postoperative Day 1

with the suprapubic and urethra catheter draining. At six

weeks postoperative, a retrograde urethrogram (RUG) did

not show any evidence of extravasation and his urethral

catheter was removed. His suprapubic tube was removed a

Introduction

The insertion of foreign objects into the genitourinary tract

is commonly reported in the literature and our colleagues in

general surgery, gynecology, and otolaryngology also man-

-3

age these problems (depending on the oriﬁce). There are

many motivations and etiologies, however most are related

to sexual satisfaction (polyembolokoilamania). Speciﬁcally,

for urethral manipulation, this likely leads to prostatic stimu-

lation and activation of hypogastric nerve afferents, leading

to sexual pleasure. This case is unusual due to the result-

ing injury, which to our knowledge, has not been reported

before.

Case report

A 65-year-old man was transferred from an outside emergen-

cy department due to the sudden onset of penile pain, bleed-

ing, urethral “mass or clot” at the meatus, and an inability

to void after a urethral trauma. Earlier that evening, he had

been self-instrumenting his urethra using plastic tubing for

sexual gratiﬁcation. He had passed the tubing down the

urethra, but subsequently had difﬁculty removing it. He then

CUAJ • May-June 2016 • Volume 10, Issues 5-6

2016 Canadian Urological Association

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