Penile strangulation and necrosis due to condom catheter

Abstract

Condom catheters are often used in the management of male urinary incontinence, and are considered to be safe. As condom catheters are placed on the male genitalia, sometimes adequate care is not taken after placement owing to poor medical care of debilitated patients and feelings of embarrassment and shame. Similarly, sometimes the correct size of penile sheath is not used. Strangulation of penis due to condom catheter is a rare condition; only few such cases have been reported in the literature. Proper application and routine care of condom catheters are important in preventing this devastating complication especially in a neurologically debilitated population. We present a case of penile necrosis due to condom catheter. We will also discuss proper catheter care and treatment of possible complications.

Introduction

Condom catheters are often used in the management of male urinary incontinence, and are considered to be safe. As condom catheters are placed on the male genitalia, sometimes adequate care is not taken after placement owing to poor medical care of debilitated patients and feelings of embarrassment and shame. Similarly, sometimes the correct size of penile sheath is not used 1. Strangulation of penis due to condom catheter is a rare condition; only few such cases have been reported in the literature. Proper application and routine care of condom catheters are important in preventing this devastating complication especially in a neurologically debilitated population.

Case report

An 86‐year‐old patient admitted to our clinic with oedema and black discolouration of glans penis. He was suffering from severe dementia for 5 years and had been using condom urinary catheters for the last few months. Eight days ago, he developed discolouration and subsequent gangrenous changes of penis and was referred to our clinic (Figure 1). The history of application and care of the catheter were not clear because the caregiver was a local citizen and had been fired by the relatives of the patient after the occurrence of complication. At the initial examination, glans penis was totally necrotic; rest of the penile tissues were viable but significant oedema existed. White blood cell count was within normal limits and there were no other signs of infection in the genitoperineal area. Debridement under spinal anaesthesia was performed and local wound care was applied for 2 weeks (Figure 2). Broad‐spectrum antibiotics were administered parenterally and then reconstruction of the defect was utilised with a split thickness skin graft (STSG). He was discharged uneventfully after the graft healing.

Figure 1.

Glans penis necrosis due to condom catheter strangulation.

Figure 2.

After debridement of necrotic tissue. All of the glans penis was found to be necrotic.

Discussion

Condom catheters are made of silicone or latex and cover the penis. They are designed to be worn 24/7 and changed every 24 or 48 hours. They have several sizes to accommodate anatomical variation and are not appropriate for men who have retracted anatomy or are uncircumcised 2. Although these catheters are more comfortable and less painful than indwelling catheters, they are not completely without risk. Users may experience a range of potential complications. These complications can increase in severity and frequency with long‐term use. Up to 40% of condom catheter users will develop a urinary tract infection with long‐term use. Additionally, 15% of long‐term users will develop skin injuries including inflammation, ulceration, necrosis, gangrene and constriction of the penis 3. These complications are more commonly seen in household bedridden patient care and in developing countries with poor general knowledge. Our patient developed gangrene of the penis during household care. Especially in severe dementia patients, early symptoms of possible complications due to condom catheters can be overlooked. Proper application and routine care of condom catheters are important in preventing complications. The appropriate size of condom suitable for the penis should be selected. Before applying the condom catheter, the penis should be cleaned with soap and water and then dried. It is also important to note that the adhesive tape of the condom at the base of penis is not applied too tightly. The skin of the penis should be inspected routinely after applying the condom catheter to ensure that the catheter is not placed too tightly. The applied condom catheter should be changed every 48 hours 4. Immediate medical attention has to be sought if the penis becomes very red or swollen or with any signs of inflammation. If the patient presents early in the course of strangulation, the penis can be salvaged by removing the catheter. Debridement, penectomy and suitable reconstruction with skin grafts or local flaps should be performed if necrosis occurs.