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[TNP photo illustration: A patient bottled up the fact that his penis was stuck in the neck of a 1.5-litre bottle for more than a week.]
By Amanda Yong
FOR more than a week, his penis was stuck in the neck of a 1.5-litre soft drink bottle.
But the 77-year-old man chose to suffer in silence.
Even when he finally sought help at Tan Tock Seng Hospital (TTSH), he did not tell doctors about it straight away.
Instead, he complained that there was blood in his urine and that he had difficulties urinating.
He finally told the truth after much probing.
Doctors managed to cut away the constricting plastic. But the man developed a 'rare complication' and died two days later.
The case was mentioned in a recent medical journal article on penile strangulation.
This is when blood supply to the penis is cut off due to a foreign body being placed on it.
The doctors said that he was not forthcoming with information at first, but he finally revealed that he had pushed the bottle over his penis.
It was not stated how the plastic bottle ended up being stuck. But the article noted that 'in most cases, the act is performed to heighten erotic stimulation'.
'The constricting effect of the foreign body increases the engorgement of the penis,' the doctors wrote.
They added that while cases of penile strangulation are uncommon, it is treated as an emergency because the object must be removed quickly to prevent long-term complications.
In this case, three days after the bottle got stuck, the man had managed to cut away most of it.
But its neck remained at the base of his penis, in spite of the 'copious use of soap' to try to remove it.
By the time he went to TTSH's emergency department, his penis was badly swollen and the skin was worn, torn and brittle.
The doctors sedated him and cut the neck of the plastic bottle with surgical scissors. They then drained 1 litre of urine using a catheter.
The man 'was well immediately after the removal of the constricting bottle'.
Well at first, then...
But he developed post obstructive diuresis - a condition in which one has a high urine output that often occurs after a urinary obstruction has been relieved.
Over a 42-hour period, the man passed 5.8 litres of urine.
This, in turn, caused him to have an abnormally low concentration of potassium in the blood. He was 'adequately hydrated orally' and given 'intravenous potassium replacement'.
The man had existing heart conditions. He suffered from rapid and irregular heartbeat and also had heart disease.
Three days after he was admitted to hospital, he had heart failure and efforts to resuscitate him were unsuccessful.
His cause of death was stated as coronary heart disease.
During his stay in hospital, the man also underwent a psychiatric review, and was diagnosed with psychotic depression, abnormal grief, dementia and sexual disinhibition. An Internet source defines sexual disinhibition as the 'inability to manage sexual impulses manifested by touching others inappropriately'.
The article on the subject was written by Dr Ooi Chee Kheong, Dr Goh Hsin Kai and Dr Lim Ghee Hian from TTSH's Department of Emergency Medicine, and Dr Chong Kian Tai from TTSH's Department of Urology. It was published in the Singapore Medical Journal last month.
Another patient who was treated at TTSH for penile strangulation recovered.
The man, 60, went to the emergency department and told doctors that he had inserted a metallic ring over his penis. He found that he could not remove it later due to swelling.
He was sedated and doctors tried to cut the ring using a ring cutter, but were 'unsuccessful as the ring cutter could not cut through the ring'.
They then called the Singapore Civil Defence Force (SCDF) for help and asked to borrow a suitable tool that would be able to remove the ring.
But the SCDF also did not have the appropriate equipment.
End man's agony
The emergency department doctors then consulted the urologist who was on call and sent the man to the operating theatre.
There, they removed 50ml of blood from his penis using a butterfly needle. Despite this, the metallic ring still could not be dislodged.
The doctors then consulted an orthopaedic surgeon and decided to use an orthopaedic cutter.
The metallic ring was finally 'cut on two sides' and removed, bringing an end to the man's agony.
The doctors wrote that there were many other cases of penile strangulation in medical literature that also required the use of special equipment.
These include tools such as an iron saw, pliers, a high-speed diamond-tipped dental drill and orthopaedic equipment.
Complications can arise
In a few cases, fluid had to be removed from the penis using a suction device to reduce the swelling. This made it easier to remove the foreign body.
'As the constricting devices involved are very variable, the clinician needs to be creative in his attempts to extricate the foreign bodies, and industrial-strength devices should be deployed if necessary,' said the doctors.
'The engagement of non-medical staff in the management of this condition, such as the local fire department and hospital carpenter, should be explored.'
They also said that penile strangulation can result in various complications.
Apart from postobstructive diuresis, patients can develop complications as serious as kidney impairment and gangrene on the penis, which may require amputation as a life-saving measure.
Other complications include an abnormal connection between the urethra and the skin of the penis, and the excessive accumulation of blood in the veins.
Another possible complication is necrosis (death of living cells or tissue) of the skin on the penis from prolonged pressure. This may require the patient to undergo skin grafting.
When contacted, a TTSH spokesman said the hospital could not comment further on the cases because of patient confidentiality.
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This story was first published in The New Paper.
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