BMJ  2005;330:1015 (30 April), doi:10.1136/bmj.330.7498.1015

Filler

A memorable patient

Self treatment, African style

In my 22 years of medical and surgical work in Africa, this was a unique experience. A truck driver whose job involved long journeys in remote areas of Africa attended an outreach clinic that I was running with my friend and colleague Jack Gardner from the United States.

The patient complained of a three year history of difficulty passing urine, being able to produce only a thin trickle of urine with straining. He had been to many hospitals, where his urethral passage was dilated many times, and he had been told that the passage had been narrowed because of sexually transmitted disease, apparently acquired while away from home because of his work. He mentioned that he had episodes of pus-like discharge from his penis in the past few years.

We offered him another operation, but he declined. Since his last operation, some six months previously, he had resorted to self treatment. He told us that he had made a dilator for himself from a piece of electric copper wire, which he inserted into his penile urethra until it went so far that the urine could pass with ease after a few attempts. Apparently, it worked every time and had never caused trauma or bleeding. He did still have occasional dysuria, for which he went to clinics and got pills once in a while.

Clinical examination revealed a normal external urethra and normal prostate. I sent him for x rays of the bladder and kidney and ultrasound scan, which were normal. Urethrography was not possible because of lack of dye. Urine microscopy showed pus cells and red blood cells consistent with a urinary tract infection, probably gonococcal urethritis, for which he was given antibiotics. We recommended that he undergo urethroplasty, but he considered his copper dilator was good enough and cheaper.

Mission Medical Department, PO Box 61019, Livingstone, Zambia, Africa

---

We welcome articles up to 600 words on topics such as A memorable patient, A paper that changed my practice, My most unfortunate mistake, or any other piece conveying instruction, pathos, or humour. Please submit the article on http://submit.bmj.com Permission is needed from the patient or a relative if an identifiable patient is referred to. We also welcome contributions for "Endpieces," consisting of quotations of up to 80 words (but most are considerably shorter) from any source, ancient or modern, which have appealed to the reader.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?