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A man presented with a 1-year history of a progressively worsening penile skin lesion. Over the preceding 2 months, he reported passage of urine from two distinct exit points on the distal penis. There were associated low grade penile pain, dysuria, spraying of urine on micturition, daytime urinary frequency, nocturia of three, the sensation of incomplete bladder emptying and contact bleeding at the distal penis. …