555
CASE REPORTS
Congenital ureteric valve associated with renal dysgenesis. Br. J . U T O ~61, . , 362-363. Sant, G . R., Barbalias, G. A. and Klauber, G. T. (1985). Congenital ureteral valves-an abnormality of ureteral ernbryogenesis? J. Urol., 133,427-431. Requests for reprints to: 3. Govaerts, Department of Urology, St Joseph’s Hospital, Leopoldstraat 2, B-2800 Mechelen, Belgium.
Iatrogenic Penile Foreign Body S. D.MARK and J. M.GRAY, Department of Urology, Waikato Hospital, Hamilton. New Zealand
Case Report A 67-year-old man presented with a history of a needle
Fig. 2 The ureter has been longitudinally opened and shows several valves (arrows).
phrosis, we believe that the condition of the kidney is the result of the obstructing valves. The earlier in fetal life obstruction occurs, the more likely is dysplasia rather than hydronephrosis to result. The high incidence of other genitourinary anomalies cannot be explained by the theory of persisting fetal folds. Therefore, abnormal ureteric embryogenesis would seem to offer a better explanation for the formation of ureteric valves in the ureter, together with duplication or ectopy. Acknowledgements We thank Dr H. Crispin for help in translating the manuscript and Mrs Ann Jeuris for secretarial assistance.
References Gordon, H. L. and Kessler, R. (1972). Ectopic ureter entering the seminal vesicle associated with renal dysplasia. J . Urol., 108, 389-391. Pourmand, G., K ~ ~ a l i a nN. , and Sohrabvand, F. (1988).
embedded in his penis. He was self-administering intracorporeal papaverine for erectile dysfunction. Immediately prior to injecting he had dropped the syringe and bent the needle. He subsequently straightened the needle, penetrated the skin and injected. The papaverine leaked around the needle and upon withdrawal the needle was missing. On palpation the needle tip could be felt in the penis. X-ray revealed the needle tip embedded in his penis (Fig.). The needle was removed under local anaesthesia.
556
BRITISH JOURNAL OF UROLOGY
Comment Injection at home of vasoactive pharmacotherapy for the treatment of impotence is becoming more common. Short-term complications include priapism, penile nodules, bruising, urethral injections, erc (Sidi, 1988; Levine et al., 1989). This is the first reported case of a retained needle in the penis following self-injection of papaverine. The cost of each disposable needle (Termuo disposable 27G) to the patient is 8 c. Prevention of this complication is attained by advising patients to discard contaminated or bent needles prior to injection. Acknowledgment We thank Miss Fiona Middleton for secretarial assistance.
References kvine, S. B., Althof, S. E., Turner, L. A. etal. (1989). Side effects of self-administration of intracavernous papaverine and phentolamine for the treatment of impotence. J. Urol., 141,
Fig. The prostate shows multiple large suppurative foci with destructionof glands. (H and E x 110).
54-51.
Sidi, A. A. (1988). Vasoactive intracavemouspharmacotherapy. Urol. Clin. North Am., 15,95-101.
Requests for reprints to: S. D. Mark, Department of Urology, Christchurch Hospital, Private Bag, Christchurch, New Zealand.
glandular pattern (Fig.). Gram stained sections of the abscesses revealed abundant Gram-negative rods admixed with the pus cells.
Comment
Acute Disseminated Melioidosis Presenting as Acute Retention of Urine T. L. QUE, Y. F. CHAN and S. Y. LAM, Clinical Pathology Unit, Princess Margaret Hospital, Hong Kong
Case Report A 53-year-old Chinese man was admitted with acute retention of urine after taking anti-tussive mixture for 1 week. He hadno historyofdiabetesmellitusorprostatism. He was febrile on admission. Both physical examination and chest X-ray showed severe bilateral chest infection. A Foley catheter was inserted and more than 1000 ml of urine drained. He was also found to have hyperglycaemia and ketonuria. The patient died 6 h after admission despite antibiotics and insulin treatment. Blood culture taken on admission showed growth of Pseudomonas pseudomallei. Urine culture was negative. On necropsy multiple abscesses were found in the prostate, kidneys, liver, spleen and lungs. Section of the prostate showed numerous suppurative foci with destruction of the normal
Pseudomonas pseudomallei infection or melioidosis is endemic in South-east Asia and the bacterium is mainly found in the soil and water. The routes of infection are inhalation, ingestion and minor trauma. Relatively few cases of melioidosis have been reported in Hong Kong, yet there is evidence that the actual incidence is likely to be much higher (So et al., 1987). The infection usually presents as pulmonary infection or septicaemia, but other organs may also be involved, including liver, spleen and kidneys, either as solitary focus or as disseminated abscesses. On necropsy, the findings are usually non-specific, with abscess formation in multiple viscera. On microscopy abundant Gramnegative bacilli can often be found within the abscesses. Our case is of interest in that the patient presented with acute urinary retention, obviously due to the acutely inflamed and enlarged prostate causing urinary obstruction. Review of the literature showed that melioidosis not uncommonly involved the upper urinary tract, but prostatic involvement causing urinary obstruction is very rare.
CASE REPORTS
Congenital ureteric valve associated with renal dysgenesis. Br. J . U T O ~61, . , 362-363. Sant, G . R., Barbalias, G. A. and Klauber, G. T. (1985). Congenital ureteral valves-an abnormality of ureteral ernbryogenesis? J. Urol., 133,427-431. Requests for reprints to: 3. Govaerts, Department of Urology, St Joseph’s Hospital, Leopoldstraat 2, B-2800 Mechelen, Belgium.
Iatrogenic Penile Foreign Body S. D.MARK and J. M.GRAY, Department of Urology, Waikato Hospital, Hamilton. New Zealand
Case Report A 67-year-old man presented with a history of a needle
Fig. 2 The ureter has been longitudinally opened and shows several valves (arrows).
phrosis, we believe that the condition of the kidney is the result of the obstructing valves. The earlier in fetal life obstruction occurs, the more likely is dysplasia rather than hydronephrosis to result. The high incidence of other genitourinary anomalies cannot be explained by the theory of persisting fetal folds. Therefore, abnormal ureteric embryogenesis would seem to offer a better explanation for the formation of ureteric valves in the ureter, together with duplication or ectopy. Acknowledgements We thank Dr H. Crispin for help in translating the manuscript and Mrs Ann Jeuris for secretarial assistance.
References Gordon, H. L. and Kessler, R. (1972). Ectopic ureter entering the seminal vesicle associated with renal dysplasia. J . Urol., 108, 389-391. Pourmand, G., K ~ ~ a l i a nN. , and Sohrabvand, F. (1988).
embedded in his penis. He was self-administering intracorporeal papaverine for erectile dysfunction. Immediately prior to injecting he had dropped the syringe and bent the needle. He subsequently straightened the needle, penetrated the skin and injected. The papaverine leaked around the needle and upon withdrawal the needle was missing. On palpation the needle tip could be felt in the penis. X-ray revealed the needle tip embedded in his penis (Fig.). The needle was removed under local anaesthesia.
556
BRITISH JOURNAL OF UROLOGY
Comment Injection at home of vasoactive pharmacotherapy for the treatment of impotence is becoming more common. Short-term complications include priapism, penile nodules, bruising, urethral injections, erc (Sidi, 1988; Levine et al., 1989). This is the first reported case of a retained needle in the penis following self-injection of papaverine. The cost of each disposable needle (Termuo disposable 27G) to the patient is 8 c. Prevention of this complication is attained by advising patients to discard contaminated or bent needles prior to injection. Acknowledgment We thank Miss Fiona Middleton for secretarial assistance.
References kvine, S. B., Althof, S. E., Turner, L. A. etal. (1989). Side effects of self-administration of intracavernous papaverine and phentolamine for the treatment of impotence. J. Urol., 141,
Fig. The prostate shows multiple large suppurative foci with destructionof glands. (H and E x 110).
54-51.
Sidi, A. A. (1988). Vasoactive intracavemouspharmacotherapy. Urol. Clin. North Am., 15,95-101.
Requests for reprints to: S. D. Mark, Department of Urology, Christchurch Hospital, Private Bag, Christchurch, New Zealand.
glandular pattern (Fig.). Gram stained sections of the abscesses revealed abundant Gram-negative rods admixed with the pus cells.
Comment
Acute Disseminated Melioidosis Presenting as Acute Retention of Urine T. L. QUE, Y. F. CHAN and S. Y. LAM, Clinical Pathology Unit, Princess Margaret Hospital, Hong Kong
Case Report A 53-year-old Chinese man was admitted with acute retention of urine after taking anti-tussive mixture for 1 week. He hadno historyofdiabetesmellitusorprostatism. He was febrile on admission. Both physical examination and chest X-ray showed severe bilateral chest infection. A Foley catheter was inserted and more than 1000 ml of urine drained. He was also found to have hyperglycaemia and ketonuria. The patient died 6 h after admission despite antibiotics and insulin treatment. Blood culture taken on admission showed growth of Pseudomonas pseudomallei. Urine culture was negative. On necropsy multiple abscesses were found in the prostate, kidneys, liver, spleen and lungs. Section of the prostate showed numerous suppurative foci with destruction of the normal
Pseudomonas pseudomallei infection or melioidosis is endemic in South-east Asia and the bacterium is mainly found in the soil and water. The routes of infection are inhalation, ingestion and minor trauma. Relatively few cases of melioidosis have been reported in Hong Kong, yet there is evidence that the actual incidence is likely to be much higher (So et al., 1987). The infection usually presents as pulmonary infection or septicaemia, but other organs may also be involved, including liver, spleen and kidneys, either as solitary focus or as disseminated abscesses. On necropsy, the findings are usually non-specific, with abscess formation in multiple viscera. On microscopy abundant Gramnegative bacilli can often be found within the abscesses. Our case is of interest in that the patient presented with acute urinary retention, obviously due to the acutely inflamed and enlarged prostate causing urinary obstruction. Review of the literature showed that melioidosis not uncommonly involved the upper urinary tract, but prostatic involvement causing urinary obstruction is very rare.
