Erosion of urethra by malleable penile prosthesis in a spinal cord injury patient with diabetes mellitus and repeated misplacement of Foley balloon in the urethra: lessons we learn: a case report.

INTRODUCTION: Spinal cord injury patients with indwelling urethral catheters are at high risk for erosion of urethra by penile prosthesis. Repeated misplacement of a Foley catheter with the balloon inflated in the urethra produces additional compression, thus predisposing to erosion of urethra by the prosthesis.

CASE PRESENTATION: A 22-year male sustained tetraplegia in 1980. He underwent implantation of bladder stimulator, urethral sphincterotomy twice, transurethral resection of bladder neck and then, prostate. In 1991, malleable penile prostheses were implanted to facilitate maintenance of a penile sheath. He required urethral catheter drainage since 1996. The balloon of Foley catheter was misplaced in membranous/bulbar urethra during catheterisations since 2018. In 2020, he developed recurrent penile cellulitis and periurethral abscess resulting in perineal urethro-cutaneous fistula. Cystoscopy showed erosion of urethra at the verumontanum by both prostheses. The prostheses were removed; suprapubic cystostomy was performed.

CONCLUSION: Inflation of Foley balloon in the urethra for prolonged periods, aggravated by recurrent cellulitis of penis and diabetes mellitus resulted in urethral erosion by the prostheses. Urethral catheterisations in spinal injury patients, who have undergone sphincterotomy, resection of bladder neck/prostate, should be performed by experienced clinicians to prevent complications of catheterisation. Suprapubic cystostomy, performed earlier, could have averted these adverse events.