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-
1
-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
4
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
E181
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