A Bosch electric circular grinder was successfully used for removal but a thermal burn to the penile tissues was sustained in the process as the hardness of the nut required a high energy to cut and its thickness did not allow for effective cooling during the process of removal. This resulted in a circumferential denudation of penile skin, a urethro-cutaneous fistula at the peno-scrotal junction and a mid-bulbar urethral stricture.
The penile wound was subsequently covered with a split skin graft with a delayed closure of the urethrocutaneous fistula and a buccal mucosa patch urethroplasty for the mid bulbar stricture. Despite the degree of thermal burns sustained the patient has maintained good erectile function with grade four rigidity. The tunica albuginea and the underlying corpora cavernosa have shown a significant degree of resilience to thermal burns compared to the corpora spongiosum where the thermal burns led to a urethrocutaneous fistula
Below: Strangulating nut fixed at the peno-scrotal junction
Below: Electric circular grinder being used to cut the nut (insert is the cut nut)
Below: Thermal burns sustained after removal of the strangulating nut
Below: The penis after surgical management
Read more at: http://ht.ly/S9R9B
By: MY Kyei,1 E K Asante,1 J E Mensah,1 G O Klufio,1 A Paintsil,2 S Gepi-Atee,1 B Morton,3 K Ampadu,2 and B Toboh3
1Urology Unit, Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P.O. Box 4236 , Accra, Ghana
2Plastic Surgery Unit, Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P.O. Box 4236, Accra, Ghana
3 Korle Bu Teaching Hospital, P.O. Box 77 Korle Bu, Accra, Ghana
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