This story has a delightful combination of youthful misadventure and surgical ingenuity. OK, so ‘delightful’ might be a bit of a stretch, but I suspect you’ve never read anything quite like it. The case was first published in a French medical journal, the Journal des Connaissances Médico-chirurgicales, in 1847.
The headline translates as ‘Memoir and observations on a new and very simple procedure for the extraction of certain sharp foreign bodies caught in the urethra, such as pins, needles, wires, etc.’ The author was a surgeon called Boinet, apparently based in Paris, though since there were several practitioners by this name I can’t identify him with any confidence.
In June 1839 I was called to visit a young man who had inserted a long gold pin into his urethral canal, as a means of excitement. This pin was about six centimetres in length, and had a head the size of a hemp seed.
At this point Dr Boinet’s case report takes on an unexpected, almost awestruck tone.
Endowed with a strong and vigorous constitution, the patient is twenty-three years old; his genitals are remarkable for their development even when not erect. The penis is long and thick; the urethral canal is 22 to 23 centimetres in length.
This may sound abnormally long, but is in fact pretty much average for an adult male.
After a lunch with friends at which he drank no water, and further inflamed by the heat of the day, he returned home and decided to enjoy some of the baser pleasures of life. Lying on his bed, he indulged in a shameful practice, which he had learned in a place of wickedness, and inserted a pin head-first into the urethra canal.
I couldn’t help wondering what sort of ‘place of wickedness’ he had been frequenting where would learn such a skill. A boys’ boarding school?
He did this so effectively that the instrument of his unnatural practices escaped him in one of his movements; he pushed it in in such a way and so quickly that he could not get hold of it again.
The medical literature is full of examples of young men who, having done something stupid, then compound the error by failing to seek help. This chap was no exception.
Shame having prevented him from reporting his accident sooner, he first tried to be his surgeon himself for several hours, which he employed in making attempts to remove the pin. Despite all his desire and all his efforts, he could not achieve it; the pin, instead of coming out, was entering more and more, and had already reached the membranous portion of the canal, when I reached the patient.
Dr Boinet examined the young man and immediately located the foreign body.
I very easily felt the head of the pin in the perineal region, below the scrotum; I applied my left thumb, to prevent it from advancing towards the bladder, and tried to push it out of the canal, pressing in a direction opposite to the one it had followed; I pulled at the same time on the penis so that the point did not engage in the mucous membranes of the urethra, which took place, despite all the precautions taken to avoid it.
This is starting to sound most uncomfortable for the patient – though no doubt he feared that much worse might occur. Sure enough, there were indications that things were not going well.
These manoeuvres, far from favouring the exit of the foreign body, seemed to me to move it towards the bladder, especially when I was trying to free its point from the walls of the canal, where it easily penetrated.
Simple manipulation was not going to remove the pin, the doctor decided. He started to think about performing an operation instead, but there were problems:
I had at my disposal only an ordinary set of surgical instruments. Besides, the pin had entered too deeply and its point was too far from the opening of the canal to be able to grasp it with forceps. Another difficulty still seemed to me to exist, it was the possibility of being able to grasp the fine of this pin with such instruments and in such a narrow channel.
He tried using a fine probe to free the point of the pin from the inside of the urethra, where it had lodged, but without success.
Fearing that the pin might fall into the bladder, from where its extraction would have become more difficult and above all more dangerous, I judged that the only thing I could do was perforate the urethral canal.
I at first assumed that the doctor intended to make a small incision in the side of the penis to extract the pin. But he had a rather different idea in mind.
With the thumb of my left hand, I firmly fixed the head of the pin in place; then, folding the penis in half, at the place corresponding to the point of the pin, I caused it to pierce the walls of the urethra, and then drew it out, except for the head, which was too big to fit through the pinprick.
Ouch. The pin was now protruding painfully through the side of the penis. What do you think he did next? Pull it out? No, the doctor put it back in again – but there was method in his madness.
By using a rocking motion I lowered the point of the pin towards the base of the penis, and then made it enter the urethral canal.
This is clever: without making a big incision the doctor had succeeded in turning the pin the other way around, so that the sharp end now pointed inwards – making it much easier to remove the safer, blunt end.
By pushing from below upwards I was able to make the head of the pin come towards the urinary meatus.
The meatus is the opening at the end of the penis.
From there it was easy for me to complete the extraction of this foreign body, now only a few millimetres from the urethral opening, by grasping it with a dissecting forceps.
It’s an ingenious method which probably counts as ‘minimally invasive’. No doctor today would consider using such an approach, not least because of the dangers of infection – but in this case there was no better option. And the patient made an excellent recovery:
The consequences of this operation were very simple: the patient merely experienced a little burning while urinating. Three days later, all that remained was the memory of his shameful recklessness.