Masturbation using metal washers for the treatment of impotence: painful consequences

Strangulation of the Penis by a Metallic Ring: Prevention Is Better Than Cure

Strangulation of the penis is a rare condition that requires emergency management. Several objects, metallic or not, can be placed on the penis to increase sexual performance or for self-erotic intentions especially in psychotic patients with unusual sexual impulses. The problem of removing the foreign body and repairing the damage is a real challenge for the practitioner and a great stress for the patient. We report a case of a 42-year-old schizophrenic patient who presented to the emergency department for a strangulation of the penis secondary to a metal ring placed at the base of the penis 10 days before the consultation without urinary disorder. A review of the literature allowed us to highlight the different clinical pictures of penis strangulation and the therapeutic methods and to highlight the importance of psychiatric care of sexual behaviour in chronic psychotics.

Penile incarceration with encircling metallic objects: a study of successful removal

OBJECTIVE

This article aimed to study the various treatment options according to the grading scale for penile incarceration.

MATERIALS AND METHODS

A retrospective review, of all the case files of patients presented with penile incarceration with encircling metallic object was performed. The patients were analyzed for age, marital status, motive, object used, who applied it, trauma grade, duration of incarceration, removal technique, removal time, anesthesia used and recovery time.

RESULT

A total of seven patients were identified. The average age was 46.71 years. Self-sexual gratification was the most common motive (five patients). Six patients presented within 24 hours. Grade II of injury was commonest type of injury seen in five patients.The technique of removal chosen was according to grade of penile injury, duration of incarceration and type of object used. Spinal anesthesia was used in most of the cases (five patients).

CONCLUSION

Penile incarceration with encircling metallic objects is a rare presentation and requires urgent intervention according to trauma grade to prevent complications.

Penile incarceration with metallic foreign bodies: management and review of literature

INTRODUCTION

Penile strangulation from constricting metallic objects disorders is an uncommon urological emergency which requires prompt intervention to prevent complications. The treatment modalities are diverse and characterized by lack of consensus.

MATERIAL AND METHODS

Three cases with penile incarceration due to constricting metallic objects who presented to our department were included in this study. All 3 patients required different management options highlighting the diversity of clinical presentation and need for customization of treatment as per the clinical scenario.

RESULTS

The 3 patients required different approach for treatment. First patient could be managed by degloving of penile skin while second patient required mechanical removal of the foreign body and debridement of local necrotic tissues. The third patient had to undergo excision of gangrenous penile skin and skin grafting.

CONCLUSION

The study emphasizes the diversity of clinical presentations and the need for employing different surgical techniques to achieve the desired results.

Wedding ring in the wrong place: an unusual presentation of penile incarceration in a child with a wedding ring

An unusual case of penile incarceration in a 13-year-old boy is presented, with lessons to be learned for Accident and Emergency Department junior doctors in particular and for all in general. The presentation was misleading and the condition would have gone undiagnosed with fatal consequences without a team effort. The object used was a wedding ring in this case. Penile incarceration is not common in routine practice. The need for development of necessary paediatric history taking and examination techniques among Emergency Department doctors and staff is highlighted. Recalling the basics, this case report emphasises the importance of thorough physical examination. With early diagnosis and treatment, lifelong disabilities can be prevented.

Penile incarceration with metal objects--a review of procedure choice based on penile trauma grade

OBJECTIVE

To outline treatment guidelines according to level of penile trauma for penile incarceration by metal devices.

METHOD

A post-1950 (hand-held powered cutting tool era) Medline search was performed. Cases were divided into four groups: string techniques and variants with and without aspiration of blood from the glans; aspiration techniques; cutting devices; and surgical techniques. Trauma grade (according to Bhat et al., 1991), site time (incarceration time), removal technique, removal time, anesthesia and recovery time were assessed.

RESULTS

The string technique and variants were used for grades 1-3. They had short removal (30-120 min), site (3-72 h) and recovery (1-24 h) times. Occasional glans decompressive with blood aspiration was required. Anesthesias included none (wrapping without glans aspiration), i.m. morphine and general (glans aspiration). Pure aspiration techniques used multiple needle punctures for grades 2-3. Aspiration cases had short site times (8-14 h), but required a spinal or general anesthesia. Cutting device cases (grades 1-5) required general anesthesia, had a short removal times (45-90 min), but long site (7 h-30 days) and recovery (2-66 days) times. Surgical degloving was utilized mainly for grade 5 cases, required spinal or general anesthesia, had short site (2-30 days), but long recovery (9-28 days).

CONCLUSIONS

The string, wrapping, aspiration techniques and cutting devices are suited for grades 1-3. Cutting requires a shield to avoid blade trauma and water-cooling to prevent thermal injury. Suspected underlying devitalized tissue (e.g. grade 4) is examined by Wood's lamp. Failure to identify gangrenous tissue will result in post interventional complications and a prolonged recovery time.