An otherwise healthy year-old man presented with a persistent rash on his penis. He said that the lesion may have slightly increased in size over the previous six months. He had no history of atopic dermatitis, psoriasis, lichen planus, or sexually transmitted diseases. The patient noted episodic tenderness. Previous use of low-potency topical corticosteroids did not alter the appearance of the rash.
Best Value! Kalb RE, et al. Pinhead-sized, hypopigmented papules; often extragenital. Navigate this Article. Articles from Advances in Urology are provided here courtesy of Eroded glans Limited. A simple radiological technique for demonstration of incorrect positioning of a foley catheter with balloon inflated in the urethra of a male spinal cord injury patient. Topical Eroded glans. Glanss lesion on the genitals with corresponding patient history. Int J Dermatol.
Blaze strip club atlanta. 1. Introduction
Soni1 Peter L. Discussion Severe ventral erosion of glans penis and shaft of penis caused by indwelling urethral catheter, and incorrect placement of Foley catheter in urethra are Eroded glans complications. The receiver block was removed in Having said that, balanitis Eroded glans occur on the penis even when you're not having sex, if you're not too scrupulous about penile and underwear hygiene - just as you can get athlete's foot from having sweaty and unclean socks. Balanitis can be diagnosed easily and simply - usually Teen girls see through blouses its appearance, and certainly by taking a sample from the surface of the glans and looking at it under a microscope. Implementation of such a nursing education program significantly decreased the incidence of iatrogenic urethral injury and, thereby, improved patient safety. Balanitis xerotica obliterans is a worse form of lichen sclerosis which is found on the Eroded glans. If the symptoms Etoded then pls consult a dermatologist s oral antifungals may be needed. X-ray of pelvis: twenty mL of contrast was injected thorough lumen of Foley catheter. Hope it helps. Medical devices often are overlooked Eroded glans a potential cause of pressure ulcers. Of course, discarding indwelling urethral catheter is the best way to prevent erosion of urethra. In this case series, improper catheter Eoded and use of a certain type of silicone catheter appear to have contributed to the development of erosive urethral injuries. In less than 4 weeks, Mr. Dermatology Community.
Never Events are serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented.
- Medical devices often are overlooked as a potential cause of pressure ulcers.
- Report Abuse.
- Never Events are serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented.
Never Events are serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented. If a Never Event occurs, health professionals should report the incident through hospital risk management system to National Patient Safety Agency's Reporting and Learning System, communicate with the patient, family, and their carer as soon as possible about the incident, undertake a comprehensive root cause analysis of what went wrong, how, and why, and implement the changes that have been identified and agreed following the root cause analysis.
The policy is designed to promote transparency and accountability when serious patient safety incidents occur. The National Patient Safety Agency was established in England with a mandate to identify patient safety issues and find appropriate solutions.
The core list of Never Events the following. Wrong site surgery: a surgical intervention performed on the wrong site e. Wrong route administration of chemotherapy: intravenous or other chemotherapy e. Misplaced nasogastric or orogastric tube not detected prior to use: naso or orogastric tube placed in the respiratory tract rather than the gastrointestinal tract and not detected prior to commencing feeding or other use.
In-hospital maternal death from postpartum haemorrhage after elective caesarean section: in-hospital death of a mother as a result of a haemorrhage following elective caesarean section, excluding cases where imaging has identified placenta accreta.
Escape from within the secure perimeter of medium or high secure mental health services by patients who are transferred prisoners. Severe ventral erosion of glans penis and shaft of penis caused by indwelling urethral catheter. Incorrect placement of a Foley catheter leading to inflation of Foley balloon in urethra. Severe ventral erosion of penis relates only to those cases where the urethral catheter has cut through glans penis and shaft of penis as well.
We present two cases to illustrate these complications, which should not have occurred if good care had been provided to spinal injury patients. A twenty-three-year-old male sustained C-5 incomplete tetraplegia in a road traffic accident in He underwent implantation of sacral anterior root stimulator in The receiver block was removed in Considering this patient's condition, he was advised to have indwelling urethral catheter on 26 February in the community.
In December , this patient was admitted to spinal unit for management of pressure sore. Clinical examination revealed severe degree of erosion of urethra. Clinical photograph of penis shows erosion of ventral surface of penis. Erosion of urethra by an indwelling catheter is preventable. This patient was advised to manage his bladder by intermittent catheterisation.
But intermittent catheterisations were not possible in the community. Therefore, this patient was left with long-term indwelling catheter, which resulted in erosion of urethra. Ventral erosion of penis by indwelling catheter can lead to bleeding from raw edges of split urethra, and increased chances of urine infection because of shorter urethra.
Patients with urethral damage and erosion related to prolonged catheter present a formidable challenge in surgical reconstruction. Casey and associates [ 3 ] studied eleven patients with neurogenic bladder dysfunction, who underwent urethral reconstruction.
Men undergoing reconstruction for urethral erosion had inferior outcomes compared to those with other urethral pathology. Patients with spinal cord injury in whom urethral reconstruction is considered should be advised that urethral surgery carries a high risk of reoperation and eventual need for urinary diversion.
Clearly, many patients with neurological disease and severe urethral pathology are best treated with urinary diversion [ 4 ]. The need for urinary diversion can be averted if spinal cord injury patients are not allowed to develop ventral erosion of penis by indwelling catheter. Anchoring the drainage tube of leg bag to thigh with a strap will allow free movement of catheter and avoid any pull on the catheter and penis. When the urethral catheter is fixed taut and the patient develops erection of penis, the indwelling catheter acts as a bowstring and cuts through the penis.
Leaving the catheter slack prevents catheter-induced erosion of urethra especially when patient develops erection of penis. Of course, discarding indwelling urethral catheter is the best way to prevent erosion of urethra. Intermittent catheterisation is preferable to indwelling urinary catheter drainage. Suprapubic cystostomy would have prevented catheter-induced erosion of urethra.
A year-old male with tetraplegia C-5 incomplete attended spinal unit in May with history of sweating. He started sweating after indwelling urethral catheter was changed by a community health professional.
On examination, a long segment of Foley catheter was lying outside penis. The balloon of Foley catheter was palpable in the perineum. Clinical impression was that Foley catheter had been placed incorrectly with the balloon inflated in urethra.
Five mL of water was aspirated from the balloon channel of Foley catheter. Then two mL of contrast Optiray was injected into the balloon channel of Foley catheter and X-rays were taken as per the radiological technique described for demonstration of incorrect positioning of Foley catheter [ 5 ]. X-ray of pelvis showed that balloon of Foley catheter was located in urethra and not inside urinary bladder Figure 2. The contrast visualised the proximal penile urethra, thus confirming that the tip of Foley catheter was lying within urethra Figure 3.
The Foley balloon was deflated completely and then, Foley catheter was removed. Follow-up ultrasound scan confirmed correct positioning of Foley balloon inside the urinary bladder Figure 4.
X-ray of pelvis was taken after injecting two mL of contrast through balloon channel of Foley catheter. The Foley balloon was located in scrotum arrow and not inside urinary bladder. X-ray of pelvis: twenty mL of contrast was injected thorough lumen of Foley catheter. Proximal urethra was visualised by the injected contrast arrow thus confirming that the tip of Foley catheter was lying in urethra and not in the bladder.
There was large amount of urine retained in the bladder. The balloon of Foley catheter was located within urinary bladder arrow , thus confirming correct placement of Foley catheter. Insertion of urinary catheter in a tetraplegic patient requires expert knowledge, skills and judgement.
Spasm of urethral sphincter may hinder insertion of urethral catheter in a spinal cord injury patient. False passages in urethra if present, pose additional difficulties in urethral catheterisation. Even when a catheter is inserted into the bladder, sudden bladder spasm may push the catheter out before Foley balloon is inflated.
In such a situation, an inexperienced health professional may not realise what has happened and unknowingly might inject water in to the balloon channel. This will lead to inflation of the balloon of Foley catheter in urethra, as indeed happened in this patient. An astute health professional will spot this clinical sign but it may be elusive to a novice. This case illustrates that only senior health professionals should perform urethral catheterisation of a tetraplegic patient in order to minimise risks of catheter-related complications.
Trainee nurses and intern doctors may not have gained sufficient expertise to carry out catheterisations in spinal cord injury patients. Kashefi and associates from Division of Urology, University of California-San Diego School of Medicine, San Diego, California [ 7 ] recognised that iatrogenic urethral injuries were a substantial source of preventable morbidity in hospitalized male patients.
These researchers designed and implemented a nursing education program that included basic urological anatomy, urethral catheter insertion techniques and catheter safety.
Implementation of such a nursing education program significantly decreased the incidence of iatrogenic urethral injury and, thereby, improved patient safety. Severe ventral erosion of glans penis and shaft of penis caused by indwelling urethral catheter, and incorrect placement of Foley catheter in urethra are preventable complications. In a good spinal injuries centre these adverse events should never occur. Severe ventral erosion of glans penis and penile shaft caused by indwelling urethral catheter.
We believe that spinal cord injury physicians should observe following protocol if a Never Event occurs. Undertake a comprehensive root cause analysis of went wrong, how and why [ 8 ]. National Patient Safety Agency's Incident Decision Tree may be used to decide what initial action to take with the staff involved in the incident [ 9 ].
This ensures a consistent and fair approach. Implement the changes that have been identified and agreed following the root cause analysis or significant event audit. By applying this policy to spinal cord injury patients, it is likely that the quality of care will be is improved. Steps have already been taken by National Patient Safety Agency to decrease the risks of suprapubic catheter insertion [ 11 ], reduce harm from omitted and delayed medicines in hospital [ 12 ] and preventing complications due to inadvertent use of female urinary catheters in adult male patients [ 13 ].
A Never Event list addressing peculiar clinical problems encountered in spinal cord medicine is likely to improve patient care by increasing awareness amongst health professionals, who will be encouraged to identify and implement appropriate measures promptly in order to stop these complications from happening in spinal unit and in the community.
The authors are grateful to Ms. National Center for Biotechnology Information , U. Journal List Adv Urol v. Adv Urol. Published online Jun Soni , 1 Peter L. Hughes , 2 Gurpreet Singh , 3 and Tun Oo 1. Bakul M. Peter L. Author information Article notes Copyright and License information Disclaimer.
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC.
Abstract Never Events are serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented. Introduction Never Events are serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented.
Inpatient suicide using noncollapsible rails. Intravenous administration of wrongly selected concentrated potassium chloride. Case Presentation 2. Open in a separate window. Figure 1. Comments — Erosion of urethra by an indwelling catheter is preventable. Case 2—Inflation of Foley Balloon in Urethra A year-old male with tetraplegia C-5 incomplete attended spinal unit in May with history of sweating.
It certainly looks a bit strange. Neurourology and Urodynamics. Clearly, many patients with neurological disease and severe urethral pathology are best treated with urinary diversion [ 4 ]. On examination, a long segment of Foley catheter was lying outside penis. The policy is designed to promote transparency and accountability when serious patient safety incidents occur. Incidence and prevention of iatrogenic urethral injuries.
Eroded glans. Main navigation
Medical devices often are overlooked as a potential cause of pressure ulcers. Indwelling urinary catheters have been described as a cause of urethral erosion. In men, the resultant partial-thickness or full-thickness wound can involve a small area of the glans penis or cleave the glans or penile shaft, requiring reconstructive surgery or urinary diversion. During a 3-month period, four elderly men, all residing in one unit of a long-term care facility, were referred to the wound specialist for erosive urethral injuries.
All were observed to have a history of improper securement of a rigid style silicone catheter. As part of creating a latex-free environment, the facility had recently replaced the softer latex-containing catheters with new silicone catheters. In addition to providing meticulous catheter care and comfort measures for the patients, all securement procedures were reviewed and different silicone catheters were evaluated for their potential to cause pressure ulcers. This case series highlights the importance of careful evaluation of catheter materials and securement devices before selecting them for widespread patient use and emphasizes the need for research focused on catheter composition and pressure injury risk.
Incontinence rates are high among older patients and incontinence remains the primary reason for admission to long-term care LTC facilities. In an effort to reduce comorbid conditions, an indwelling urinary catheter may be placed. Although medical devices are commonly used in both acute care and LTC, pressure ulcer statistics often do not differentiate source of pressure.
An uncommon complication of urinary catheterization is severe urethral erosion, noted in the literature as a known but rare consequence of indwelling catheter use in spinal cord injured patients of both genders. Urethral erosion in men ranges from a partial-thickness wound involving a small area of the glans penis to a full-thickness pressure ulcer, or erosion, cleaving the glans or penile shaft see Figure 1.
In extreme cases, gangrene of the penis can result. Erosion secondary to catheter placement can cause bleeding from the edges of the urethra and increases the risk of urinary tract infection. Individuals with multiple medical comorbidities ultimately may require urinary diversion.
Penile erosion may be physically and psychologically painful due to disfigurement. Logically, the optimal way to prevent urethral erosion is to avoid using an indwelling urinary catheter if feasible. Other options for managing urinary incontinence include implementing a toileting program; using disposable briefs, pads, or condom catheters; placing a suprapubic catheter; or intermittent catheterization. Suprapubic catheterization reduces the risk of urethral erosion but the catheter can cause pressure at the abdominal insertion site.
Their use increases the risk of developing skin problems such as dermatitis, maceration, fungal and bacterial infections, and skin breakdown.
If a urinary catheter is used, proper securement is a priority. Improper urinary catheter securement is associated with urethral erosion ; however, the optimal way to secure indwelling catheters remains controversial and there is no evidence to guide practice. Several best-practice models 9,10 recommend securing the catheter to the upper thigh on a woman and on the abdomen for a man. Some facilities follow an older practice of taping the catheter to the thigh but expert opinion suggests that tape may not stay on well, can cause skin problems, and may damage the core of latex-coated catheters.
Devices designed to secure catheters include elastic leg straps and adhesive products to hold the catheter in place. Conversely, improper positioning of a leg strap can allow the strap to migrate down the leg and place tension on the catheter. Sivaraman et al 11 described a method of securing an indwelling catheter that involved first wrapping the catheter with a soft cloth product, then using silk tape to secure the catheter to the skin.
Based on observations in their clinical practice, this technique has reportedly been successful in preventing pressure ulcers in spinal cord patients with indwelling catheters. Caring for patients with urethral pressure ulcers is challenging.
Unlike other pressure ulcers, urethral erosion is permanent and standard wound care may not be of benefit. Surgical correction is the only option to repair the defect. Nursing caregivers need to continue monitoring device securement because no method is infallible and adhesive products also can cause skin damage.
If the patient experiences pain during catheter care, pain medication should be administered approximately 30 to 60 minutes before the procedure as per general practice guidelines. Many elderly patients have medical comorbidities such as a cardiac history or pulmonary disease that may preclude surgical repair of the urethral erosion due to elevated surgical risk. For younger patients, urethral reconstruction is an option, although Secrest et al 13 have found a lower success rate for patients with spinal cord injury than for those with intact spinal cord.
Of those, 11 with spinal cord injury required reoperation and all eventually required urinary diversion. The authors noted that many of the patients undergoing urethral construction had surgery early after incurring the urethral erosion and the patients did not return to using an indwelling catheter.
For elderly persons with erosive injury and no complications such as pain or frequent urinary tract infections, conservative comfort care is usually the best option. The goal of care should include preventing further erosion and protecting exposed mucosa. Based on expert opinion, regular catheter care using soap and water is important for hygiene and may help prevent urinary tract and skin infections.
For example, a foam dressing may protect the mucosa from additional pressure and decrease discomfort if present. Case presentation may afford a valuable learning experience for caregivers and providers. As such, four cases of elderly men with urethral erosion treated in a LTC setting are presented. This LTC facility has 90 beds and is attached to a small medical center.
Patients are admitted for subacute care, short-term rehabilitation, and residential care including hospice and dementia. The incidence of urethral erosion at this LTC facility before the cases presented was unremarkable. The development of urethral erosion in four consecutive patients residing on the same unit over a 3-month time frame prompted an inquiry into causation.
Urethral erosion is always a risk with indwelling catheter use, especially in men with long-term catheters. Case 1. M is 75 years old with a history of left leg amputation, cardiac disease, and mild cognitive impairment.
M had a recurrent pressure ulcer mid-back over a kyphotic thoracic spine. He was not ambulatory due to lack of prosthesis and general debility but could transfer from wheelchair to bed by himself. M got out of bed without staff assistance, would not use a leg bag, and often was reported to not move his bag with him when he got out of bed.
An indwelling catheter was inserted and after approximately 5 weeks he sustained full-thickness ventral erosion extending to the base of the penis after catheter insertion. He denied pain with his injury. Treatment was conservative and included catheter care and application of antibiotic ointment twice daily. A focal point of treatment was consistent catheter securement because during weekly wound rounds it was noted that the catheter was not properly secured and torsion at site was evident.
Case 2. Y is a year-old patient with diabetes receiving palliative care following an auto accident that caused severe cognitive impairment. He had sustained no fractures or internal trauma. Y was thin, frail, and unable to feed himself. He was receiving occupational therapy but was not expected to be able to walk again.
Historically, he was on a ventilator. He initially had been admitted to LTC with an ischial pressure ulcer acquired at a rehabilitation facility 3 months earlier. A catheter was placed to allow healing of the ulcer, which resolved in approximately 5 weeks.
In less than 4 weeks, Mr. Y had sustained full-thickness ventral erosion extending to the base of the penis due to an indwelling catheter. The catheter was removed at that time and not replaced. The tear remained but no treatment was indicated except perineal hygiene. Y was on a toileting program and wore diaper briefs overnight. Case 3. S is 74 years old with moderate cognitive impairment.
He could transfer himself to the wheelchair but was not ambulatory. S was diagnosed with urinary retention and was given several trials of intermittent catheterization, which he reportedly failed. His provider decided to reinsert and leave the catheter in place. S frequently pulled on his catheter and moved out of bed without concern for the catheter bag.
Within 2 weeks of catheter insertion, he sustained full-thickness ventral erosion extending to the base of the penis. He denied having pain. Because the provider decided to leave the catheter in place, securement was the focal point of treatment.
Twice-daily catheter care was ordered, including washing and application of an antibiotic ointment. An adhesive catheter holder was the source of a skin tear, so Mr. S was provided an elastic strap.
There was no urine leakage at the meatus. Unfortunately, Mr. S had recurrent urinary tract infections due to an indwelling catheter. His urologist did not think he was a good surgical candidate.
Case 4. A is 75 years old, frail, and had partial urethral erosion on the lateral glans penis. The erosion measured less than 1 cm in length. There was exposed mucosa without bleeding or exudate from the site; Mr. A did not report pain.
A was on palliative care for colon cancer for approximately 2 months; he was eating and drinking very little. Twice-daily catheter care was ordered, the catheter was secured, and it remained until his death 2 to 3 weeks after the erosion occurred. Several commonalities were noted among the men in this study.
Another common denominator was a lack of consistent, proper catheter anchoring procedures. This issue was repetitively identified during weekly wound rounds. It also was noted that all urethral pressure ulcers occurred after the facility stopped using latex and began using silicone catheters, suggesting catheter type may have contributed to the increase in urethral injuries observed.
The facility made the catheter change in an effort to eliminate the use of latex-containing medical devices but the silicone catheters were stiff and not as pliable as the latex catheters formerly used.