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.  
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.  
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  
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-  
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  
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