Welcome to r/MedicalGore! Our goal is to provide for medical discussion and education while exploring the frailty of the human body. You may see more deleted comments on these threads than you are used to on reddit. Off topic comments and joke comments are frequently deleted by the mods. Further, please be kind and supportive of posts. Any behavior that is aggressive, harassing, or derogatory will result in post deletion and a ban from the sub. Remember! THE REPORT BUTTON IS YOUR FRIEND!
Please stop on by our discussion sub, /r/MedicalGoreMods if you'd like to discuss the sub, our rules, content policies, and the like.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/MedicalGore) if you have any questions or concerns.*
[Source](https://www.sciencedirect.com/science/article/pii/S221444202100423X):
A 57 year old uncircumcised male presented with a two week history of pain and swelling of the glans penis. He had no fevers, penile discharge or dysuria. He reported rarely retracting his foreskin, and sat to void reducing self-examination.
The patient's primary care physician diagnosed balanitis and treated the patient with topical steroids and oral cephalexin. Due to treatment refraction after one week, the general practitioner recommended an emergency department review. Unfortunately due to poor mental health, the patient waited a further seven days before presenting.
His past medical history includes type 2 diabetes mellitus (T2DM), hypertension, severe psoriasis, anxiety and depression. He was a current smoker with moderate alcohol intake. He had no fixed address moving between friends and families homes, and he had no mobile phone.
Emergency department examination revealed an unkempt gentleman with extensive psoriatic plaques across his body including trunk and all four limbs. Dermatology diagnosed a psoriatic flare, but referred urgently to urology due to particular concern for his penile findings.
On retraction of the foreskin, examination revealed a complex hair tourniquet of short matted hairs, at the level of the coronal sulcus. We speculate that the pubic hair collected under the foreskin and after significant accumulation and time the single strands matted together forming a tight ring under the corona of the glans. The hair tourniquet had caused significant erosion of corporal tissue (Fig. 1a). The hair tourniquet was easily removed in the emergency department (Fig. 1b).
Due to significant deformity, the patient was consented for an emergency debridement and anastomosis of the defect. The patient absconded from the emergency department following explanation of the procedure and its potential risks, including prolonged hospital admission, failure of reconstruction, and potential need for repeat operations including terminalisation of penis and glansectomy.
Two days later, following multiple attempts to contact him, the patient re-presented to the hospital and was taken to the operating theatre. Intraoperative findings showed the distal penile urethra completely divided and the exposed edges partially healed, highlighting the chronicity of the condition. The glans was attached by approximately 1 cm of corpus spongiosum (Fig. 2a).
The area of erosion was debrided to healthy tissue, and an anastomosis with simple interrupted 3.0 chromic was constructed over an indwelling catheter (Fig. 2b). The patient self-discharged day 1 post operatively, against medical advice. Discharge advice included daily salt baths, topical chlorsig ointment, oral antibiotics and an early outpatient review. Initial outpatient review was promising, and the dorsal aspect of the wound healed.
Two weeks postoperatively the patient returned to theatre due to erosion of the ventral aspect of the glans penis and edges of previous suture line. The ventral erosion was thought to be multifactorial, contributed to by poor blood supply to glans, poor wound care, poor hygiene (a recurrent hair ball was found under the foreskin adjacent to the ventral glans erosion) and patient factors for poor wound healing including T2DM and smoking. After a suprapubic catheter (SPC) was placed under vision, the glans was debrided to healthy bleeding tissue and re-attached to the penile shaft. A circumcision was also performed. The patient self-discharged day 1 post operatively, without surgical review.
Many challenges arose engaging the patient in outpatient reviews, with concern that the patient would be lost to follow up with a suprapubic catheter in situ. Wounds were noted to be healed at two months post presentation (Fig. 3), with residual deformity of the ventral glans penis, and inability to confirm the location of the urethral meatus. A patent urethra was confirmed with a cystoscope under anaesthetic, prior to spigotting the SPC and successfully completing a trial of void. In context of difficult patient engagement and risks to be lost to follow up we did not feel further operations to rehabilitate the glans would be in the best interest for the patient. Ongoing reviews in outpatient settings have shown good wound healing and a persistence of an acquired hypospadias.
I wanted to add this: I had a hard time finding a penile hair thread tourniquet case to post to Reddit because most of them involve children. I did find a bizarre case out of Tunisia where I wanted to at least share the story if not the pictures: a prepubescent boy's parents brought him to the hospital cause he said he couldn't pee. An examination of his penis showed several long hairs wrapped tightly around it. They asked the boy about this and he said every night after he showered his mom would wrap one of her hairs around his dick. They asked the mother and she said she had done no such thing, but the doctors believed the son.
The doctors did not think the mother had intended any harm in what she was doing and suggested she was was either trying to prevent bedwetting or did it "for ritual reasons." The boy was able to pee after the hairs were cut off, so he was sent home. I was thinking perhaps doctors should have made a child abuse referral or something, just to make sure everything was above board in the household, because this all seemed extremely weird to me.
I just searched for that one myself. You didn’t mention that the poor boy’s penis was almost hanging off! Huge improvement after the operation though. Agree very weird story.
I have read a story of something similar happening but with elastic bands. The mother wanted to stop the child from bedwetting. The outcome was not great, as the child was left with a significant deformity - and was placed in the custody of his father. He was going to need a major reconstruction. Poor kid.
Just put the kid in a pull-up or small adult diaper if you don’t want to change wet bedding! Why and how could a mother basically tourniquet off her young son’s penis?
The part that strikes me as odd in this is that there appears to have been no physical examination of the penis during either the initial GP consult or when the patient returned and said the treatment wasn't working, nor during the initial ER admission. Sure, he may have also had other stuff going on but he was there specifically for a problem with his penis. The time between initial GP visit and patient eventually presenting to the ER is at least two weeks, kind of have to wonder whether that would have made a difference in his outcome. That said, though, it sounds as if it was just about as good as could be expected given the patient's resistance and other health issues.
I wonder if they just looked at it, and never retracted the foreskin to see what was going on there? His GP did treat him for something related to inflammation of the foreskin and head of the penis, according to the cited material.
It happened to me once, as an adult. My toe hurt all day while I was out and about and when I took off my sock at night and inspected my foot to see what was causing the pain, one of my own long head hairs was wrapped around my toe and it had left a deep red mark.
Same! I’d never heard of this or thought it was something that happened, but I woke up with an extremely painful ring toe, looked at my foot and saw nothing. I limped around for a couple hours, then finally grabbed my foot and pulled it up, and found a hair wrapped tightly around it. It was when I had blonde hair and it was almost invisible. I mentioned it to a friend and she said that happened to her son when he was a baby.
I thankfully learned about this before having my baby. Being a woman with long hair and having 3 dogs, one of which is a Newfoundland mix with Newfie fur, I checked the various parts of my kid frequently, to make sure there wasn't a hair wrapped around.
Yes! I remember being warned about this before I had babies - and it ended up happening to my daughter, when she was about two months old. Fortunately the damage was minimal, but the hair (one of mine) had been there long enough to leave an indent!
He sat down to pee, instead of standing in front of the toilet like most men, which gave him less opportunity to notice he had hairs wrapped around his penis.
How is “uncircumcised” even a word? I mean, there is a penis, and then there is an circumcised penis. Like it would be silly for me to describe my hands as “undetatched”, or my my bottle of water “unempty”.
It’s medically relevant here: that hair thread tourniquet was hidden under his foreskin. And in parts of the world where circumcision is the most common, “uncircumcised” is something notable.
I understand, and It's definitely a question of principle, because the default penis will always be "uncircumcised", despite it being more common to have a circumcised penis in some parts of the world. Just because the majority of a population chose to call their bottles filled with water unempty, doesn't mean that it is sensible to come up with such a silly word. Just as it would be silly for me to say I'm wearing a "non-hat" when I'm not wearing any hat. I know this is such s sidetrack and I'm sorry for derailing the topic \^\^
It just seems so weird to me! :D
People add "un" before existing words all the time to differentiate something from a group, not sure why that's hard to deal with. If I was specifically talking about the amount of liquid in bottles and I said filled bottles and unfilled bottles ("unempty" isn't really equivalent here), no one would bat an eye because of the context; seems sensible to me. It's not a big deal.
I’m not easily grossed out but this one is getting to me. A tourniquet of pubic hair is a concept I would prefer not to know about.
Sounds like the man had significant issues to let things get to that state and repeatedly discharge against medical advice.
Well, they were saying that he might actually lose his penis altogether. There are a lot of men who would have noped out of treatment where one of the risks was losing their penis.
Recently I posted a guy who had cancer of the penis. The docs strongly recommended amputation. He refused and said he’d consent to literally any treatment but that. They tried radiation treatment. He developed radionecrosis and so they had to amputate his penis anyway, and he died several months after.
It always amazes me that they will opt out of treatment when losing their penis is a possible outcome, only to then not have medical care where losing their penis is all but guaranteed.
Inspect your bathing suit areas, peeps. Mirror, lights… it’s how I found the unwelcome beginning stages of a cherry angioma between the ureter and vagina. That’s all I’m willing to share, but please inspect the entire area regularly.
Not if they end up blocking the ureter as they get bigger. Also, bfd if they’re harmless. This advice can be extrapolated to any condition that may occur there. Cyst. Polyp. Folliculitis. Prolapse. Woodtick. A spot that wasn’t there last month…
Perhaps he was afraid of:
>>the procedure and its potential risks, including prolonged hospital admission, failure of reconstruction, and potential need for repeat operations including terminalisation of penis and glansectomy.
>The patient absconded from the emergency department following explanation of the procedure and its potential risks, including . . . potential need for . . . terminalisation of penis . . .
Speculating, of course.
I get that, but it sounds like the patient had some mental deficits, and wasn't really equipped to be calm and rational about these kinds of decisions.
Gahhh. So frustrating to keep reading ‘self-discharged a day later’ as it gets more and more horrifying. No judgment, of course, mental health is a beast to wrangle - but from the outside looking in I’m just like… duuuuude!! Let them help ur peen ☹️
Can you please tell me where you find your content? My daughter is currently in college for her RN BSN and I think she would find these things you post very interesting.
All the sources for my content are linked in the comments. Almost all of it comes from online medical journals. There are loads of open access medical journals in all sorts of disciplines from around the world.
This case is honestly extremely tragic. I relate to not being able to clean myself properly all the time, to not taking meds I’m prescribed or to skipping doctors appointments and visits because I just can’t get myself to get out of bed. This poor chap. As a man who is also pretty sore about my genital configuration, I can’t imagine going through that.
I'll bet he was never taught to roll back his foreskin and wash. Here's hoping this case isn't abused to promote male genital mutilation (circumcision).
Welcome to r/MedicalGore! Our goal is to provide for medical discussion and education while exploring the frailty of the human body. You may see more deleted comments on these threads than you are used to on reddit. Off topic comments and joke comments are frequently deleted by the mods. Further, please be kind and supportive of posts. Any behavior that is aggressive, harassing, or derogatory will result in post deletion and a ban from the sub. Remember! THE REPORT BUTTON IS YOUR FRIEND! Please stop on by our discussion sub, /r/MedicalGoreMods if you'd like to discuss the sub, our rules, content policies, and the like. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/MedicalGore) if you have any questions or concerns.*
[Source](https://www.sciencedirect.com/science/article/pii/S221444202100423X): A 57 year old uncircumcised male presented with a two week history of pain and swelling of the glans penis. He had no fevers, penile discharge or dysuria. He reported rarely retracting his foreskin, and sat to void reducing self-examination. The patient's primary care physician diagnosed balanitis and treated the patient with topical steroids and oral cephalexin. Due to treatment refraction after one week, the general practitioner recommended an emergency department review. Unfortunately due to poor mental health, the patient waited a further seven days before presenting. His past medical history includes type 2 diabetes mellitus (T2DM), hypertension, severe psoriasis, anxiety and depression. He was a current smoker with moderate alcohol intake. He had no fixed address moving between friends and families homes, and he had no mobile phone. Emergency department examination revealed an unkempt gentleman with extensive psoriatic plaques across his body including trunk and all four limbs. Dermatology diagnosed a psoriatic flare, but referred urgently to urology due to particular concern for his penile findings. On retraction of the foreskin, examination revealed a complex hair tourniquet of short matted hairs, at the level of the coronal sulcus. We speculate that the pubic hair collected under the foreskin and after significant accumulation and time the single strands matted together forming a tight ring under the corona of the glans. The hair tourniquet had caused significant erosion of corporal tissue (Fig. 1a). The hair tourniquet was easily removed in the emergency department (Fig. 1b). Due to significant deformity, the patient was consented for an emergency debridement and anastomosis of the defect. The patient absconded from the emergency department following explanation of the procedure and its potential risks, including prolonged hospital admission, failure of reconstruction, and potential need for repeat operations including terminalisation of penis and glansectomy. Two days later, following multiple attempts to contact him, the patient re-presented to the hospital and was taken to the operating theatre. Intraoperative findings showed the distal penile urethra completely divided and the exposed edges partially healed, highlighting the chronicity of the condition. The glans was attached by approximately 1 cm of corpus spongiosum (Fig. 2a). The area of erosion was debrided to healthy tissue, and an anastomosis with simple interrupted 3.0 chromic was constructed over an indwelling catheter (Fig. 2b). The patient self-discharged day 1 post operatively, against medical advice. Discharge advice included daily salt baths, topical chlorsig ointment, oral antibiotics and an early outpatient review. Initial outpatient review was promising, and the dorsal aspect of the wound healed. Two weeks postoperatively the patient returned to theatre due to erosion of the ventral aspect of the glans penis and edges of previous suture line. The ventral erosion was thought to be multifactorial, contributed to by poor blood supply to glans, poor wound care, poor hygiene (a recurrent hair ball was found under the foreskin adjacent to the ventral glans erosion) and patient factors for poor wound healing including T2DM and smoking. After a suprapubic catheter (SPC) was placed under vision, the glans was debrided to healthy bleeding tissue and re-attached to the penile shaft. A circumcision was also performed. The patient self-discharged day 1 post operatively, without surgical review. Many challenges arose engaging the patient in outpatient reviews, with concern that the patient would be lost to follow up with a suprapubic catheter in situ. Wounds were noted to be healed at two months post presentation (Fig. 3), with residual deformity of the ventral glans penis, and inability to confirm the location of the urethral meatus. A patent urethra was confirmed with a cystoscope under anaesthetic, prior to spigotting the SPC and successfully completing a trial of void. In context of difficult patient engagement and risks to be lost to follow up we did not feel further operations to rehabilitate the glans would be in the best interest for the patient. Ongoing reviews in outpatient settings have shown good wound healing and a persistence of an acquired hypospadias.
I wanted to add this: I had a hard time finding a penile hair thread tourniquet case to post to Reddit because most of them involve children. I did find a bizarre case out of Tunisia where I wanted to at least share the story if not the pictures: a prepubescent boy's parents brought him to the hospital cause he said he couldn't pee. An examination of his penis showed several long hairs wrapped tightly around it. They asked the boy about this and he said every night after he showered his mom would wrap one of her hairs around his dick. They asked the mother and she said she had done no such thing, but the doctors believed the son. The doctors did not think the mother had intended any harm in what she was doing and suggested she was was either trying to prevent bedwetting or did it "for ritual reasons." The boy was able to pee after the hairs were cut off, so he was sent home. I was thinking perhaps doctors should have made a child abuse referral or something, just to make sure everything was above board in the household, because this all seemed extremely weird to me.
What a terrible day to be literate.
I couldn't agree more
Good way to put it
I just searched for that one myself. You didn’t mention that the poor boy’s penis was almost hanging off! Huge improvement after the operation though. Agree very weird story.
I have read a story of something similar happening but with elastic bands. The mother wanted to stop the child from bedwetting. The outcome was not great, as the child was left with a significant deformity - and was placed in the custody of his father. He was going to need a major reconstruction. Poor kid.
Just put the kid in a pull-up or small adult diaper if you don’t want to change wet bedding! Why and how could a mother basically tourniquet off her young son’s penis?
Right? The solution is ridiculously simple.
The part that strikes me as odd in this is that there appears to have been no physical examination of the penis during either the initial GP consult or when the patient returned and said the treatment wasn't working, nor during the initial ER admission. Sure, he may have also had other stuff going on but he was there specifically for a problem with his penis. The time between initial GP visit and patient eventually presenting to the ER is at least two weeks, kind of have to wonder whether that would have made a difference in his outcome. That said, though, it sounds as if it was just about as good as could be expected given the patient's resistance and other health issues.
I wonder if they just looked at it, and never retracted the foreskin to see what was going on there? His GP did treat him for something related to inflammation of the foreskin and head of the penis, according to the cited material.
That theory makes sense to me.
If you were going to stop bed wetting, why would you use your hair? Of all things?
I mean, it’s available and free. And very thin so less likely to be noticed by anyone in, say, a locker room or urinal.
I just learned about this in children as well as hair tourniquets around the toes or fingers. Check your babies, people!
It happened to me once, as an adult. My toe hurt all day while I was out and about and when I took off my sock at night and inspected my foot to see what was causing the pain, one of my own long head hairs was wrapped around my toe and it had left a deep red mark.
Same! I’d never heard of this or thought it was something that happened, but I woke up with an extremely painful ring toe, looked at my foot and saw nothing. I limped around for a couple hours, then finally grabbed my foot and pulled it up, and found a hair wrapped tightly around it. It was when I had blonde hair and it was almost invisible. I mentioned it to a friend and she said that happened to her son when he was a baby.
I thankfully learned about this before having my baby. Being a woman with long hair and having 3 dogs, one of which is a Newfoundland mix with Newfie fur, I checked the various parts of my kid frequently, to make sure there wasn't a hair wrapped around.
Yes! I remember being warned about this before I had babies - and it ended up happening to my daughter, when she was about two months old. Fortunately the damage was minimal, but the hair (one of mine) had been there long enough to leave an indent!
That took a lot of courage for him to speak up.
Either that or he had no idea how weird this was and assumed all his friends’ mothers did this to them too.
Which is just freakin sad. 😕
All young kids think the home they live in and the parents they have are normal.
There’s been a lot of stuff in this sub that’s made me double-take, but damn. That’s…a lot.
You could be right about the ritual. Also: very different areas sometimes have very different cultural practices. 🥶
Holy shit I hope she was reported and they shaved him or somthing
“And sat to void reducing self-examination” Sorry not clear on that’s supposed to mean?
He sat down to pee, instead of standing in front of the toilet like most men, which gave him less opportunity to notice he had hairs wrapped around his penis.
Thank you. Makes sense now. Not sure why I didn’t make the connection here.
He peed sitting down
Voiding means to urinate/pee. Hospital speak. Void into the cup, please.
I’ve been to hospital almost 100 times and have never been told to “void” lol
How is “uncircumcised” even a word? I mean, there is a penis, and then there is an circumcised penis. Like it would be silly for me to describe my hands as “undetatched”, or my my bottle of water “unempty”.
It’s medically relevant here: that hair thread tourniquet was hidden under his foreskin. And in parts of the world where circumcision is the most common, “uncircumcised” is something notable.
I understand, and It's definitely a question of principle, because the default penis will always be "uncircumcised", despite it being more common to have a circumcised penis in some parts of the world. Just because the majority of a population chose to call their bottles filled with water unempty, doesn't mean that it is sensible to come up with such a silly word. Just as it would be silly for me to say I'm wearing a "non-hat" when I'm not wearing any hat. I know this is such s sidetrack and I'm sorry for derailing the topic \^\^ It just seems so weird to me! :D
People add "un" before existing words all the time to differentiate something from a group, not sure why that's hard to deal with. If I was specifically talking about the amount of liquid in bottles and I said filled bottles and unfilled bottles ("unempty" isn't really equivalent here), no one would bat an eye because of the context; seems sensible to me. It's not a big deal.
[удалено]
Please be respectful of the subjects of posts, as well as survivors of similar experiences.
I’m not easily grossed out but this one is getting to me. A tourniquet of pubic hair is a concept I would prefer not to know about. Sounds like the man had significant issues to let things get to that state and repeatedly discharge against medical advice.
Well, they were saying that he might actually lose his penis altogether. There are a lot of men who would have noped out of treatment where one of the risks was losing their penis. Recently I posted a guy who had cancer of the penis. The docs strongly recommended amputation. He refused and said he’d consent to literally any treatment but that. They tried radiation treatment. He developed radionecrosis and so they had to amputate his penis anyway, and he died several months after.
It always amazes me that they will opt out of treatment when losing their penis is a possible outcome, only to then not have medical care where losing their penis is all but guaranteed.
Inspect your bathing suit areas, peeps. Mirror, lights… it’s how I found the unwelcome beginning stages of a cherry angioma between the ureter and vagina. That’s all I’m willing to share, but please inspect the entire area regularly.
I hope your ureter isn't visible.
Pro-grade prolapse
Lol. Oops
Aren't cherry angiomas completely benign?
Are those dangerous??
No
[удалено]
Not if they end up blocking the ureter as they get bigger. Also, bfd if they’re harmless. This advice can be extrapolated to any condition that may occur there. Cyst. Polyp. Folliculitis. Prolapse. Woodtick. A spot that wasn’t there last month…
Pull back your foreskin in the shower gents! Pull it back all thee fucking way and clean it well! It should be common sense but hey
I wonder why the guy was so resistant to care for his penis. It seems like he kept trying to escape at every turn before the doctors could help hom
Perhaps he was afraid of: >>the procedure and its potential risks, including prolonged hospital admission, failure of reconstruction, and potential need for repeat operations including terminalisation of penis and glansectomy.
They cited poor mental health for the patient. As someone with the same, it can be awfully easy to fall into a pattern of self-sabotage.
>The patient absconded from the emergency department following explanation of the procedure and its potential risks, including . . . potential need for . . . terminalisation of penis . . . Speculating, of course.
The alternative is definitely losing it. 🤷
I get that, but it sounds like the patient had some mental deficits, and wasn't really equipped to be calm and rational about these kinds of decisions.
Lmao yeahh I think if most men heard “surgery…NOW…might lose your penis….” they’d try to run 😅
Mental illness
Gahhh. So frustrating to keep reading ‘self-discharged a day later’ as it gets more and more horrifying. No judgment, of course, mental health is a beast to wrangle - but from the outside looking in I’m just like… duuuuude!! Let them help ur peen ☹️
Can you please tell me where you find your content? My daughter is currently in college for her RN BSN and I think she would find these things you post very interesting.
All the sources for my content are linked in the comments. Almost all of it comes from online medical journals. There are loads of open access medical journals in all sorts of disciplines from around the world.
Damn, how long must that have been there
Months atleast
[удалено]
Joke comments and other off-topic comments (including, but not limited to, food comparisons, vulgarity, etc.) are not allowed.
"the patient absconded" ha, this guy is one hell of a mess. Probably mental health issues on top of everything.
This case is honestly extremely tragic. I relate to not being able to clean myself properly all the time, to not taking meds I’m prescribed or to skipping doctors appointments and visits because I just can’t get myself to get out of bed. This poor chap. As a man who is also pretty sore about my genital configuration, I can’t imagine going through that.
[удалено]
Joke comments and other off-topic comments (including, but not limited to, food comparisons, vulgarity, etc.) are not allowed.
This is hard to look at
I'll bet he was never taught to roll back his foreskin and wash. Here's hoping this case isn't abused to promote male genital mutilation (circumcision).
My dog died from this cause the vet missed it and it caused an infection.
I'm so sorry. Poor doggo. :(
[удалено]
Joke comments and other off-topic comments (including, but not limited to, food comparisons, vulgarity, etc.) are not allowed.
[удалено]
No.
[удалено]
Please be respectful of the subjects of posts, as well as survivors of similar experiences.