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 , t Fepilnted from the Jof^'NAL of Co^NEOusrlsD Oenito-Ukinaky Disea 
 
 ^^■""""''^ ^ * ^r April, 1893. . 
 
 66 
 
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 REMARKABLE CASE OF CIRCULAR CONSTRICTION OF THE 
 PENIS IN A BOY, PRODUCING A CONDITION^OF ELEPHAN- 
 TIASIS. 
 
 BT 
 
 <^ 
 
 FRANCIS J. SHEPHERD, M.D., CM. < 
 
 Surgeon to the Montreal General Hospital, etc. 
 
 THE following case is of sufficient rarity and Jnterest to be 
 placed on record. 
 Gustave R., set 15, was admitted into tha^ wards of the 
 Montreal General Hospital on September 2d, J<fe92, suffering 
 from an enormous enlargement of penis and a urethral fistula. 
 His history taken from the case-book is as foUows : " At the 
 age of three years had a fall which caused feceration of the 
 under surface of the penis. The urethra wg^s rnptured and the 
 wound took some time to heal. Ever since' . .^ accident the 
 boy has passed his water through the torn p5rtipn of the 
 urethra which is about one inch from the root of the penis. 
 His parents say that for some years the dorsum of the organ 
 remained quite normal in appearance but later on the scar 
 tissue about the old wound on the under surface l)egan to 
 grow and gradually encircled the penis causing at the same 
 time an enlargement in its anterior part. During the past 
 year this enlargement has increased much more rapidly and a 
 deep furrow is now produced by the constricting band which 
 gives the penis the appearance of hanging by a thin pedlMe." 
 
 When I saw him tirst his penis presented a remarkable con- 
 dition. The root was normal in size for about an incli, then 
 came a deep furrow with cicatricial tissue at the bottom, this 
 caused a great diminution of the circumference at this point and 
 formed a pedicle by which hung an enormously enlarged and 
 altered penis. There was, in fact, a condition of elephantiasis, 
 the prepuce being especially enlarged. It looked as if a string 
 had been tied around the organ and had produced this effect. 
 (See cut.) 
 
2 
 
 1 4 \ 
 Original Communioatjon. 
 
 } 
 
 On passing a sound'^t was found that the urethra, anterior to 
 the constric^diK was normal, the sound passed out in front of the 
 cicatrix ana could be made to enter the other end of the torn 
 urethra with ease, about half an inch of the urethra being en- 
 tirely wanting. Micturition was performed without difficulty 
 and no trouble reijrulted. The boy says he had occasional erec- 
 tions, the large end, which hangs down from the narrow pedicle 
 enlarges, but is ^uite independent of the root of the penis 
 which tends to assume the erect position. 
 
 It is evideht that in this case the enlargement of the penis 
 is caused by;, the gradual growth of scar tissue at the site 
 
 of the old wound constricting the parts so as to interfere with 
 the proper return of blood. No doubt, at the time of the acci- 
 dent, the cavernous bodies were broken or torn across as well as 
 the spongy portion and urethra. As the anterior portion of 
 penis could never be of any use and was decidedly not orna- 
 mental, amputation at the point of constriction was recom- 
 mended and hopes were held out that the remaining inch of the 
 penis which was normal might develop. This treatment was 
 refused and the boy now occasionally attends as an out patient. 
 It was suggested that the urethra be repaired by a plastic opera 
 tion, but this course has little to recommend it considering the 
 uselessness of the interior portion of the organ and the charac- 
 ter of the tissues to be operated upon. 
 
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 nterior to 
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 being en- 
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 the penis 
 
 the penis 
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