NDT Advance Access originally published online on April 19, 2005
Nephrology Dialysis Transplantation 2005 20(7):1485-1486; doi:10.1093/ndt/gfh848
© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Case Report
Renal failure in a patient with an amputated penis by a dog bite
Ja Hyeon Ku and
Hyeon Hoe Kim
Department of Urology, Seoul National University Hospital, 28, Yongon Dong, Jongno Ku, Seoul, 110-744, Korea
Correspondence and offprint requests to: Hyeon Hoe Kim, Department of Urology, Seoul National University Hospital, 28, Yongon Dong, Jongno Ku, Seoul, 110-744, Korea. Email: hhkim{at}snu.ac.kr
Keywords: dog bites; injuries; penis; renal failure; stings; wounds
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Introduction
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Dog bites have been characterized as ‘a major public health
problem’ and ‘a tremendous injury problem’
[
1,
2]. Although reports include dog bites of the penis and scrotum,
urethral stricture by a dog bite has not been previously reported.
We describe a patient with an amputated penis by a dog bite,
in whom a long evolution urethral stricture caused renal failure.
To our knowledge, this is the first case of renal failure following
the amputation of penis by a dog bite over a time span of 60
years.
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Case
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A 60-year-old man presented at our hospital with lower leg oedema.
His general appearance was eunuchoid. The patient had been told
by his parents that his penile shaft and bilateral testis had
been amputated by a dog when he was a year old. The patient
stated that he had not received specific management for the
injury. A physical examination revealed absent axillary hair,
a large non-tender palpable mass in the lower abdomen, suggesting
a distended bladder, scanty pubic hair and no bilateral testes.
The distal and shaft parts of the penis were absent, leaving
a stump of 1 cm, the distal surface of which was covered scar
tissue. The urethral meatus was not identified. He underwent
ultrasound and computed tomography of the abdomen and pelvis,
which demonstrated severe bilateral hydronephrosis with thin
cortical thickness and a huge distended urinary bladder (
Figure 1).
The patient was initially treated by haemodialysis to resolve
his symptoms and azotemia, and then a suprapubic cystostomy
was inserted. Voiding cystourethrography through a suprapubic
cystostomy showed a narrow penile urethra, but no vesicoureteral
reflux or bladder trabeculation. Despite bladder drainage, his
renal function did not improve, and he remains dialysis dependent.
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Fig. 1. Contrast-enhanced computed tomographic scan of the abdomen showing thin renal parenchyme in bilateral kidneys.
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Dogs are well known for being attracted to the perineal area
not only of other dogs but of other species as well. They are
also known to be attracted to and to ingest the excrement of
other animals (coprophagia). It is therefore not uncharacteristic
for a dog to be drawn to the perineal area and the genitalia
of scantily clad and defenceless or immobilized subjects. Such
attacks have the potential to cause significant morbidity, especially
with respect to soft tissue injury and infection. Dog bites
may result in serious bacterial infections with the Gram-negative
rods
Capnocytophaga canimorsus. Common clinical and laboratory
findings include a rash, leukocytosis, features of disseminated
intravascular coagulation and acute renal failure [
3]. Haemolytic
uremic syndrome and thrombotic thrombocytopenic purpura have
also been described [
4–7]. The case we present here is
an example of how an unusual but readily preventable condition
can be overlooked. This case report highlights the fact that
animal bites can result in severe complications.
Conflict of interest statement. None declared.
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References
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- Wishon PM, Huang A. Pet-associated injuries: the trouble with children's best friends. Child Today 1989; 18: 24–27[Medline]
- Weiss HB, Friedman DI, Coben JH. Incidence of dog bite injuries treated in emergency departments. JAMA 1998; 279: 51–53[Abstract/Free Full Text]
- Pers C, Gahrn-Hansen B, Frederiksen W. Capnocytophaga canimorsus septicemia in Denmark, 1982–1995: review of 39 cases. Clin Infect Dis 1996; 23: 71–75[ISI][Medline]
- Mars DR, Knochel JP, Cotton JR, Fuller TJ. Thrombotic thrombocytopenic purpura after a dogbite. South Med J 1980; 73: 676–678[Medline]
- Finn M, Dale B, Isles C. Beware of the dog! A syndrome resembling thrombotic thrombocytopenic purpura associated with Capnocytophaga canimorsus septicaemia. Nephrol Dial Transplant 1996; 11: 1839–1840[Free Full Text]
- Tobe TJ, Franssen CF, Zijlstra JG, de Jong PE, Stegeman CA. Hemolytic uremic syndrome due to Capnocytophaga canimorsus bacteremia after a dog bite. Am J Kidney Dis 1999; 33: e5[Medline]
- Mulder AH, Gerlag PG, Verhoef LH, van den Wall Bake AW. Hemolytic uremic syndrome after capnocytophaga canimorsus (DF-2) septicemia. Clin Nephrol 2001; 55: 167–170[Medline]
Received for publication: 20. 3.05
Accepted in revised form: 31. 3.05
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