By Tedler D. Depaynos, MD
The patient is an expert in cards and has been working in a casino abroad for years. He has been used to night life and from time to time together with his close friends they bring home bedmates especially when their favorite clients are on a winning streak.
He was in a shower one morning when he noticed inflammation at the tip of his uncircumcised organ. There was redness but no pain. Thinking that it was just over worked he did nothing. Several days later, an “ulceration” seemed to appear forcing him to consult their casino MD. He was diagnosed to have the dreaded “syphilis” and he was prescribed medications and given injections. Despite the treatment he noticed no improvement and when his friends and his favorite clients learned of his condition, they started avoiding him.
He was filled with heavy worry because he felt that he has earned enough to marry his girlfriend at home and start a new life. Without further ado, he decided to suddenly come home incognito and sought consultations in a well known medical center in Metro Manila. At least he was much more comfortable because he had severe difficulty understanding the language of the doctors where he came from.
A work -up was done and eventually a biopsy revealed a malignant lesion called Squamous Carcinoma. Our old textbooks say that it is the most common penile Ca and mostly occurring on the 5th and 6th decades. It is rare in circumcised penis and occurs mostly at the glans penis or foreskin. It may look like an ordinary wart and could metastasize in the inguinal lymph nodes. In advanced cases the inguinal areas may be dissected, total penile amputation done and a bladder tube may be placed for urination.
The patient was still lucky since it was still in the early stage but a penile amputation must be done. It was a very difficult decision but he had no choice. Eventually he called his girlfriend and with lots of free flowing tears he prepared to accept whatever faith was before him.
The surgeons did a very conservative amputation that resulted in a penile “stump” that could still be used. He was over elated when he was brought back to his room because his girlfriend was waiting for him.
He underwent medications and external radiation and eventually married his girlfriend.
It was 8 months after when we learned his tragic story. He came inquiring where he could have a follow-up work-up locally. Of course he had to be referred to a Urologist. With his smiles, it seemed that he had no problem satisfying his bedmate especially when he showed us his fingers. **
