0007-1 331/90/00654420/$10.00
British Journolcf Llrologv (1990), 65,42&425
ci;.1990 British Journal of Urology
body remained in place for more than 7 years, forming the stone illustrated.
Case Reports
Requests for reprints to: M. M. Abdulla, Department of Urology, Dammam Central Hospital, P.O. Box 4996, Dammam 31412, Saudi Arabia.
Foreign Body in the Bladder Traumatic Neuroma of the Penis M. M. ABDULLA, Department of Urology. Dammam Central HosDital. Dammam, Saudi Arabia
B. S. I. MONTGOMERY,C. D. M. FLETCHER, E. L. H. PALFREY and R. W. LLOYD-DAVIES, Departments of Urology and Histopathology,St Thomas’ Hospital, London
Case Report A 32-year-old, male Egyptian presented to the Casualty Department with acute retention of urine. A KUB showed a radio-opaque shadow in the area of the bladder. The retention was relieved by catheterisation. The patient was admitted for further investigation and the shadow proved to be a stone in the bladder. It was noted that there was an oblong filling defect in the heart of the stone. There was no past history of surgery to explain the presence of a foreign body inside the bladder. Cystolitholapaxy was carried out and examination of the stone revealed a large plastic bean, of the kind used for praying, within the stone (Fig.).
Comment
It is the practice in some areas of upper Egypt, from whence the patient came, to introduce threaded beans knotted at the end of plastic through the urethra up to the verumontanum for sexual pleasure, achieved by pulling the thread to mobilise the plastic bean inside the urethra. This patient was unlucky; the thread was cut and the foreign
Case Report A 58-year-old man with long-standing, diet-controlled diabetes, inadvertently walked through a plate-glass door in January 1985. He sustained lacerations to the face, hands, groin and to the shaft of the penis which were primarily sutured. The wounds healed well but several weeks later he developed a tender lump on the dorsolateral aspect of the penis, deep to the skin and slightly distant from the original wound. Xeroradiography was normal; clinically this was an area of Peyronie’s disease, though the patient felt it was related to the accident. He also had 2 episodes of haematuria. IVU, urethrography and cystoscopy revealed no obvious source. The lump became increasingly troublesome and in 1987 surgical exploration revealed a localised fibrous lump, 1.O x 1.5 cm, arising close to the fascia of the right corpus, dorso-laterally, 2 cm below the glans. Careful dissection of the lump in theatre revealed no glass particles. Histologically this was a classical traumatic neuroma (Fig.) consisting of innumerable small nerve fibres irregularly distributed in a fibroblastic stroma. The lesion had apparently developed from an adjacent nerve in the tunica albuginea, just superficial to the corpus cavernosum. He has made a full recovery.
Comment
We are unaware of any previous reports of a traumatic neuroma arising from the penis, although neurofibromas, neurilemmomas and malignant schwannomas have all been previously reported (Dehner and Smith, 1970). Neuromas may complicate surgical procedures such as amputation or cholecystectomy (Tancino er al., 1985), but they are more common after accidental trauma of more exposed sites, e.g. the digits (Cieslak and Stoute, 1946). We report this case because although attention may be drawn to penile pathology following trauma (cJ testis), misdiagnosis of traumatic lesions as Peyronie’s disease (vide supra) may result in inappropriate management. 420
British Journolcf Llrologv (1990), 65,42&425
ci;.1990 British Journal of Urology
body remained in place for more than 7 years, forming the stone illustrated.
Case Reports
Requests for reprints to: M. M. Abdulla, Department of Urology, Dammam Central Hospital, P.O. Box 4996, Dammam 31412, Saudi Arabia.
Foreign Body in the Bladder Traumatic Neuroma of the Penis M. M. ABDULLA, Department of Urology. Dammam Central HosDital. Dammam, Saudi Arabia
B. S. I. MONTGOMERY,C. D. M. FLETCHER, E. L. H. PALFREY and R. W. LLOYD-DAVIES, Departments of Urology and Histopathology,St Thomas’ Hospital, London
Case Report A 32-year-old, male Egyptian presented to the Casualty Department with acute retention of urine. A KUB showed a radio-opaque shadow in the area of the bladder. The retention was relieved by catheterisation. The patient was admitted for further investigation and the shadow proved to be a stone in the bladder. It was noted that there was an oblong filling defect in the heart of the stone. There was no past history of surgery to explain the presence of a foreign body inside the bladder. Cystolitholapaxy was carried out and examination of the stone revealed a large plastic bean, of the kind used for praying, within the stone (Fig.).
Comment
It is the practice in some areas of upper Egypt, from whence the patient came, to introduce threaded beans knotted at the end of plastic through the urethra up to the verumontanum for sexual pleasure, achieved by pulling the thread to mobilise the plastic bean inside the urethra. This patient was unlucky; the thread was cut and the foreign
Case Report A 58-year-old man with long-standing, diet-controlled diabetes, inadvertently walked through a plate-glass door in January 1985. He sustained lacerations to the face, hands, groin and to the shaft of the penis which were primarily sutured. The wounds healed well but several weeks later he developed a tender lump on the dorsolateral aspect of the penis, deep to the skin and slightly distant from the original wound. Xeroradiography was normal; clinically this was an area of Peyronie’s disease, though the patient felt it was related to the accident. He also had 2 episodes of haematuria. IVU, urethrography and cystoscopy revealed no obvious source. The lump became increasingly troublesome and in 1987 surgical exploration revealed a localised fibrous lump, 1.O x 1.5 cm, arising close to the fascia of the right corpus, dorso-laterally, 2 cm below the glans. Careful dissection of the lump in theatre revealed no glass particles. Histologically this was a classical traumatic neuroma (Fig.) consisting of innumerable small nerve fibres irregularly distributed in a fibroblastic stroma. The lesion had apparently developed from an adjacent nerve in the tunica albuginea, just superficial to the corpus cavernosum. He has made a full recovery.
Comment
We are unaware of any previous reports of a traumatic neuroma arising from the penis, although neurofibromas, neurilemmomas and malignant schwannomas have all been previously reported (Dehner and Smith, 1970). Neuromas may complicate surgical procedures such as amputation or cholecystectomy (Tancino er al., 1985), but they are more common after accidental trauma of more exposed sites, e.g. the digits (Cieslak and Stoute, 1946). We report this case because although attention may be drawn to penile pathology following trauma (cJ testis), misdiagnosis of traumatic lesions as Peyronie’s disease (vide supra) may result in inappropriate management. 420
