Penile elephantiasis: a rare consequence of inappropriate use of condom as external urinary collection receptacle.

To cite: Paul S, Dalela D, Prakash J, et al. BMJ Case Reports Published online: [please include Day Month Year] doi:10.1136/bcr-2012008446 DESCRIPTION A 21-year-old man had overflow incontinence due to cauda equina syndrome. He applied condom as a urine receptacle without any medical consultation to prevent wetness. The condom was fastened to the penile shaft with two rubber bands (figure 1) and was periodically emptied. He used this system for about 18 months and presented to us with changes in the part of penis that was within the condom sheath resembling ‘elephantiasis’. The glans was normal (figure 2B). Skin changes included widespread hypopigmentation and a single ulcer (figure 2A). Suprapubic catheterisation was performed and the patient was advised to apply compressive dressing with glycerine, antibiotic and anti-inflammatory agents. He did not report for follow-up. Complications due to improper condom catheter usage range from ulceration and necrosis to more severe urethrocutaneous fistulae and urethral diverticulum. Generalised penile oedema is a wellrecognised complication but penile elephantiasis following use of condom as a urinary receptacle has not been described in the literature. The possible mechanisms may be: (1) lymphovenous stasis secondary to compression by tight rubber band, (2) chronic irritation of skin by urinary accumulation, alkaline pH, infection and moisture or (3) prolonged duration due to impaired sensations. The glans penis was uninvolved probably on account of an alternate lymphovenous drainage through corpus spongiosum. Patients must be warned about this complication, if found using condom as a urinary collection device and be advised safer clean intermittent catheterisation.