Iatrogenic Hypospadias – Is this preventable?

Abstract

Background

Iatrogenic hypospadias is an avertible deformation to the ventral part of male urethra caused by downward pressure of an indwelling urethral catheter. Whereas it is not a life-threatening complication, most patients with such condition find the penile appearance appalling.

Case Report

An 86-year-old man who is being managed for bladder outlet obstruction secondary to benign prostate enlargement and he has been using urethral catheter for about a year. Clinical examination revealed stable vital signs except for elevated blood pressure (173/94mmHG) and catheterized penis with a cleft on the ventral part extending from the external urethral meatus to the subcoronal region. The blood work up was essentially normal except for mild thrombocytopenia. Pus culture yielded multidrug resistant staphylococcus aureus and urine culture grew mixed bacterial growth. He was treated with urinary antiseptics which resulted in improved clinical state and was discharged second day of admission for further care as outpatient.

Conclusion

Iatrogenic hypospadias is a relatively uncommon complication of prolonged urethral catheterization that is preventable by appropriate choice of catheter size, securing urethral catheter the right way and suprapubic cystostomy when prolonged catheterization is inevitable.

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References

Garg G, Baghele V, Chawla N, Gogia A, Kakar A. Unusual complication of prolonged indwelling urinary catheter – iatrogenic hypospadias. J Family Med Prim Care. 2016; 5(2):493–494. Doi: 10.4103/2249-4863.192335.

Garg G, Chawla N, Gogia A, Kakar A. Urinary catheterization from benefits to hapless situations and a call for preventive measures. J Family Med Prim Care. 2016; 5(3):593–542. Doi: 10.4103/2249-4863.197261.

Murphy C, Cowan A, Moore K, Fader M. Managing long term indwelling urinary catheters. BMJ. 2018; 363: k3711.

Andrew HO, Nauth-Misir R, Shah PJ. Iatrogenic hypospadias – A preventable injury? Spinal Cord. 1998; 36: 177- 180.

Becker B, Witte M, Gross AJ, Netsch C. Iatrogenic hypospadias classification: a new way to classify hypospadias caused by long-term catheterization. Int J Urol. 2018; 25(11): 980-981.