A Knot in the Urethra

A 42‐year‐old unmarried man had made a habit for years of masturbating by inserting along plastic cord down his urethra into the bladder. Earlier he had used a straw but one day it escaped from his fingers and migrated to the bladder. A cystotomy was necessary toremove it. Since this accident he took a long cord which could not escape from his hands. One morning he entered the hospital because he could not extract the cord from his urethra. He had severe pain in the penis and presented with acute retention and serious urethral bleeding. A big haematoma had developed in the scrotum and penis. X‐ray showed that the cord had knotted in the bladder and was pulled down into the penile urethra (Fig. I). The knot was easily removed (Fig. 2) by a longitudinal, ventral incision in the penis butthe urethra and corpus spongiosum were disrupted completely in their penile part, only the most distal end being intact. Bleeding was profuse. A perineal incision was necessary to repair the proximal part of the urethra which was traumatised but which could be conserved. A new, scrota1 hypospadiac meatus was made and the defect in the penile urethra was replaced by penile skin. A contraincision was performed on the dorsal side of the penis. An indwelling catheter was left in the bladder and a compressive bandage was applied a round the penis. A reconstructive urethroplasty planned.