Penile strangulation: report of a fatal case

Penile Strangulation: Analysis of Postextrication Follow-Up, Sequelae, and a Review of Literature

Numerous case reports exist on penile strangulation injuries and extrication methods; however, the care and long-term consequences of penile strangulation injuries have been under-reported. Our aim is to investigate the long-term outcomes and sequalae following penile strangulation injuries. The PubMed Medline database was searched using the keyword string "penile strangulation," "penis strangulation," and "constriction" for all studies reporting outcomes of published penile strangulation injuries. Articles were evaluated for follow-up after strangulation injury, strangulating agent, extricating agent, and sequelae of injury. Fifty-six studies resulted with reports of 100 cases of penile strangulation and extrication from January 2000 to December 2019. The mean patient age was 41 (range: 3-86) years. Twenty-four (24/100) cases reported sequalae following extrication. Follow-up ranged from 2 weeks to 7 years with median follow-up time in the 7- to 12-month grouping. Metal rings comprised 36% (36/100) of strangulation agents and 50% of reported incidents were attributed to sexual activity. To our knowledge, this is the only study focusing on long-term outcomes after penile strangulation. This review provides a summary of 56 studies that document penile strangulation injuries over the last 20 years. Although a wide array of penile strangulation injuries have been documented in the literature, reports lack secondary management and long-term outcomes after removal of the strangulation device. We recommend that providers report long-term penile strangulation outcomes for future urologic evaluations after extrication.

Robot-Assisted Repair of Bladder Rupture following Penile Ring Entrapment

Penile rings have been used to help sustain erection and enhance sexual pleasure for centuries. Constriction of the penis reduces the outflow of blood from the cavernosal tissue. However, if left for an extended time period, a condition called penile ring entrapment can occur. This may result in severe edema, gangrene, necrosis, and even penile amputation. Penile ring entrapment is a very rare condition; complete urinary obstruction with concomitant bladder rupture as a result renders this case even more extraordinary. We discuss our experience in the management of a 64-year-old man, who presented with altered mental status and inability to urinate, found to have penile ring entrapment and intraperitoneal bladder rupture. Removal of the constricting ring was performed in the ED, and bladder injury and penile necrosis were subsequently repaired with robot-assisted laparoscopic cystorrhaphy, penectomy, and perineal urethrostomy.

Characterization of genital injuries secondary to foreign bodies from 2011 to 2020

PURPOSE

To identify demographic trends of foreign object genital injuries presenting to emergency departments from 2011 to 2020.

MATERIALS AND METHODS

The National Electronic Injury Surveillance System database reports consumer product-related injuries in United States ED visits. The database was queried to identify 375 cases of genital injuries from 2011 to 2020. Inclusion criteria consisted of cases reporting injuries involving the urethra, penis, or scrotum. Data was reported and analyzed using linear regression.

RESULTS

Based on 375 cases, an estimated 13,170 (95% confidence interval, 10,817-15,522) patients in the US suffered genital injuries due to foreign bodies between 2011 and 2020. These injuries involved the penis (65.9%), urethra (30.7%) and scrotum (3.5%). Of all patients, 11.8% required hospital admission after treatment of which injuries to the urethra were most common (44.0%). Most of these patients were ages 19 to 64 (66.1%). Consumer products most implicated included rings (50.7%), zippers (17.1%), and pens and pencils (10.3%). Injuries due to zippers and swimming apparel occurred significantly more frequently in patients ages 0-18 (p<0.05). Injuries due to kitchen gadgets occurred significantly more in patients ages ≥65 (p<0.05). Pens, pencils, and massage devices were items that routinely resulted in urethral injuries, often requiring hospitalization. Linear regression showed genital injuries related to foreign objects significantly increased from 2011 to 2020 (p<0.001).

CONCLUSIONS

Due to the nature of injury caused to genitalia by intentional and unintentional exposure to foreign bodies, educating individuals on this topic in sexual education classes is necessary for preventing future injuries.

Patient With Penile and Scrotal Strangulation Due to Prolonged Use of a Metal Ring Device

Penile and scrotal incarceration by a metal ring is a rare urological emergency that requires immediate removal of the strangulating object to avoid severe clinical consequences. Metal rings are used to enhance sexual activity. Here we present a case of penile and scrotal entrapment in a young patient who presented three hours after removal with fever and pain. Before removal, the ring had remained in place for over 48 hours. This case highlights the importance of prompt treatment of these patients as complications such as gangrene can occur if not treated expediently.

Penile entrapment by metal ring: Case reports of effective non-surgical management

Penile strangulation by metal ring is a rare urological emergency situation which requires urgent intervention and treatment. We believe that an entrapped ring should be removed by the most efficient and if possible, a non-surgical method for better recovery. We present a case of penile strangulation caused by metal ring insertion. The metal ring was successfully removed using metal clamp. Penile strangulation by metal ring can be properly treated using available mechanical or electrical tools in a timely manner in the emergency setting.

Penile ring entrapment - A true urologic emergency: Grading, approach, and management

Penile rings are used to sustain erection in order to enhance sexual pleasure. They work by reducing the outflow of blood from the cavernosal tissue. However, if left for extended periods of time severe edema, urethral fistula, gangrene, and even complete loss of the distal penis can ensue, this is known as penile ring entrapment (PRE). Management poses particular challenges due to its rarity. Herein, we report our experience with three patients from our institution that presented with PRE and include a review of the approaches others have taken. We also propose a simpler and more effective grading scale to allow for easier communication between providers, as the current grading scales do not do so.

Penile and Scrotal Strangulation due to Metal Rings: Case Reports and a Review of the Literature

Penile and scrotal entrapment from a metal ring placed at the base of the penis is a rare, but important clinical dilemma encountered in urology. Emergent presentation to the urologist, after ring placement far longer than safely practiced, risks ischemic and permanent injury to penile, scrotal, and intrascrotal structures. Treating urologists should be aware of the prevalence of metal ring use, their potential complications, and the surgical approach to their safe removal. We present two patients who were identified at our institution with strangulating injuries of retained penile rings. The first patient was a healthy, 43-year-old male with a metal ring retained for 24 hours that was safely removed with industrial bolt cutters. The second patient, a 74-year-old male, died as a result of sepsis from injuries secondary to penoscrotal ischemia after >48 hour ring retention despite prompt removal at emergent presentation. Although rare, sexual practices may include the use of penoscrotal rings. When retained, ischemic injury and edema may lead to strangulation. Emergent removal may require industrial equipment that is not within the confines of normal operating room tools. Tissue injury may be severe and sepsis life-threatening, even after ring removal.

Penoscrotal Strangulation Caused by a Steel Ring: A Case Report

Introduction

Strangulation of the penis and scrotum by a constricting object has been rarely reported.

Aim

To describe a man with penoscrotal strangulation caused by a steel ring and its successful removal.

Methods

A 28-year-old man presented to the emergency department with a 7-hour history of a steel ring lodged at the base of his penis and scrotum. Removal was accomplished with the assistance of fire brigade personnel who used their hydraulic cable cutter to shear the ring. During the removal, there were no complications.

Results

The hydraulic cable cutter avoided thermal injury and shortened removal time compared with procedures described in the literature. The patient's recovery was uneventful, with erectile function restored after 1 week.

Conclusion

Genital incarceration is an urgent clinical situation requiring prompt treatment. However, suitable tools for removing the foreign object are not readily available in emergency and urology departments. Cooperation with other disciplines, even non-medical disciplines, can result in creative and timely measures for removal of the object.

Zhang J, Wang X, Zhang J, et al. Penoscrotal Strangulation Caused by a Steel Ring: A Case Report. Sex Med 2017;5:e131–e133.

Penoscrotal entrapment: a safe, innovative technique for removing metal constricting devices

Penoscrotal entrapment is a rare urological emergency that requires urgent treatment to avoid penile ischaemia and subsequent erectile dysfunction. Non-metallic and thin metallic objects are easily removed via cutting, while thick metallic constricting devices require specialist saws or motorised cutters, all of which may be difficult to locate in the emergency setting. We report a case of a 45-year-old patient who presented with a 48-h history of gross penoscrotal oedema secondary to entrapment by a thick metal ring (internal diameter 55 mm, external diameter 74 mm and thickness 19 mm). The positioning, thickness of the ring, delayed presentation and extensive oedema meant its removal was especially challenging. We improvised a simple, three-step technique (aspiration, strapping and sling) which enabled the metal ring to be removed without the need for specialist equipment. We would encourage others to employ this safe technique in an emergency setting.

Extrication of penile entrapment in a polyethylene terephthalate (PET) bottle: a technique of suture traction and Dundee and literature review

OBJECTIVE

To describe the use of a technique of suture traction and Dundee in penile entrapment in the polyethylene terephthalate (PET) bottle case. MEASURES AND METHODS: The technique of suture traction in conjunction with Dundee was performed for the management of penile entrapment in PET bottle neck. First, the technique of Dundee (manual compression after multiple prepuce punctures) was used to alleviate and resolve the preputial edema; second, the persistent suture traction power was applied to achieve the removal with lubrication. A review of the literature is also summarized in this report. Current treatment options and outcomes are also evaluated.

RESULT

The PET bottle neck was removed intact successfully in 50 min. Follow-up revealed he got full recovery without any complications. Literature review shows that penile incarceration in PET bottle is frequently described as an isolated case report or small series, the approach for dealing with these problems are often described using cutting instruments, the PET bottle could produce a fatal harm in extreme situation.

CONCLUSIONS

The technique combined suture traction with Dundee could be easy to perform without any special tools required in the management of penile entrapment involving PET bottles. It could be applied safely for the low-grade penile injury.