Iatrogenic hypospadias: a rare complication due to chronic placement of urethral catheters

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In the near future longer life expectancies will continue to greatly influence society. Patients requiring the adaptation of balloon catheters for long times will increase annually. Although secondary or iatrogenic hypospadias does not appear to be unusual, few cases have been reported in the literature. We report a case of an iatrogenic hypospadias in an extremely old patient harboring spinal cord injury and several complications and discuss the strategies facing patients with iatrogenic hypospadias. A 94 year-old man with permanent vesicorectal dysfunction caused by spinal cord injury during the wartime, was admitted to our University Hospital due to huge blood clot formation in the bladder. His significant vesical dysfunction, which has been worsening since 1985, allowed indwelling and exchanging the urethral catheter regularly by physicians. CT scanning with contrast material demonstrated a vesical stone of 1.5 cm in diameter, which was responsible for macrohematuria, and bilateral common iliac aneurysms with maximum diameter of 7.1 cm. Physical examination showed a longitudinal cleavage of penile urethra caused by chronic placement of urethral catheter. Although cystostomy diversion could resolve the potential problem with his voiding dysfunction, extremely high age and large aneurysms harboring the risk of rupture during the procedure rendered it impossible to apply suprapubic cystostomy. This situation reinforced him to exchange the balloon catheter regularly, but reluctantly. Much
emphasis should be placed by the urologists, focusing on the prevention or avoidance of the iatrogenic hypospadias as a complication caused by chronic placement of urethral catheter.