Penile Strangulation: Two Case Reports and Review of the Literature

Delayed gangrenous penile necrosis following prolonged utilization of penile constriction ring

Penile strangulation secondary to utilization of a constrictive ring is a rare urologic emergency that requires urgent decompression to prevent prolonged vascular obstruction resulting in necrosis and gangrene. Current literature is mainly comprised of case presentations that focus on management in the acute setting via removal of the ring. Herein, we describe surgical management of a patient who presents in delayed fashion after self-removal of the constrictive ring. We discuss our penectomy-sparing technique of debridement and split thickness skin graft.

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.

Strangulated penis in a prison inmate: Complete penile degloving and full-thickness skin graft

Introduction

Penile strangulation is a rare urological emergency that necessitates urgent management. The reasoning behind it may include sexual pleasure, erection reinforcement, or a psychiatric disorder.

Case presentation

Despite being an uncommon complication of penile strangulation, we report a 45-year-old prison inmate who presented with penile shaft necrosis secondary to using a non-metallic constriction object. The patient reported a 5-day history of progressive penile pain, edema, and skin injury but no urinary symptoms. The patient underwent complete penile skin degloving, circumcision, and insertion of a suprapubic catheter. Postoperatively, the penile tissue appeared healthy, and the wound was granulating. On the eleventh day following degloving, a full-thickness skin graft was taken from the groin area. The patient remained in the hospital for 20 days, during which he was clinically stable with clean, healing wounds.

Conclusion

Early management of penile strangulation is vital in order to prevent vascular and mechanical complications.

Use of dental drill handpiece to remove steel nut causing penile strangulation: a case report and review of the literature

BACKGROUND

Penile strangulation is an uncommon urological emergency that requires prompt intervention to avoid potentially serious sequelae including loss of the distal penis secondary to ischemia and subsequent gangrene. We present a case report of a patient who presented to the hospital with penile strangulation injury of 10-hour duration secondary to the presence of a thick hexagonal steel nut. This case is presented in accordance with Consensus Surgical Case Report guidelines.

CASE PRESENTATION

A 24-year-old Vietnamese man presented to the emergency room with urinary retention and decreased penile sensation following a 10-hour history of penile strangulation due to the presence of a thick hexagonal steel nut that he had placed around the shaft of the penis for the purpose of sexual enhancement during masturbation. The hexagonal nut was tightly entrapping the penile shaft, resulting in edema, congestion, and swelling of the distal 5 cm of the phallus. Given the thickness of the foreign body as well as the degree of penile swelling, we were unable to remove the hexagonal nut using traditional methods of alleviating penile strangulation injuries. Following consultation with a dental colleague, a dental diamond drill handpiece was utilized to cut the foreign body without injury to the underlying penile skin. Subsequent follow-up in clinic demonstrated no significant urinary or sexual sequalae from this episode.

CONCLUSION

We report a case of penile strangulation requiring novel instrumentation and collaboration for successful treatment.

Using a fretsaw in treating chronic penial incarceration: A case report

BACKGROUND

Penial incarceration (PI) is a rare situation. It is usually caused by a foreign object which strangulates at the base of the penis. PI may derive from pranks, sexual demand, mental disease, or intention to prohibit urinary disease. Generally, these situations are emergent and immediate treatments are needed. Cases of chronic PI are less reported, and their treating methods are yet to be discussed.

CASE SUMMARY

We reported a case on treating a 73-year-old male who had PI with a metallic hoop for three months. After multidisciplinary consultation, the operation was performed successfully with the help of a fretsaw. Despite the chronic strangulation, the prognosis of the patient was satisfying. To the best of our knowledge, this case was rare and precious as it featured the longest strangulating time, which might enlighten the treating process of future PI cases. Also, we have reviewed and summarized major published cases to encapsulate appropriate approaches when facing diverse strangulation situations.

CONCLUSION

The selection of surgical tools depends on the material of the strangulating objects, the availability of equipment, and the severity of the penial damage. The urination function may not be affected after three months of incarceration as in our case, whilst prudent preoperative measures and multidisciplinary evaluations are always essential. Although using a fretsaw is comparatively slow, it is safe and feasible to treat metallic penial incarceration.

Impacted Ring in the Penis: A Crisis Rescued by Plier

A trapped penile ring is a urological emergency rarely seen. An impacted ring in penis is a real emergency uncommonly faced by a urologist. Emergent removal of the penile ring is indicated to prevent gangrene and damage to the penis. The insertion of these rings for autoerotic purposes is not uncommon. However, this can lead to impacted, stuck articles, rings in the penis. These patients present with symptoms ranging from mild penile pain, swelling to gangrenous changes in the penis. The removal of ring constricting penis is a penile-saving procedure. We describe a patient with a stuck ring in the penis and the technique of removal of the impacted penile ring by a household device plier. In case of emergency, the pliers are a useful tool for removing a strangulating penile ring

Penile strangulation with a plastic bottle neck: Intervened by an atypical instrument: A case report

INTRODUCTION AND IMPORTANCE

Strangulation of penis, a surgical emergency, is often encountered in patients with psychiatric disorders and patients attempting to increase sexual arousal. Materials ranging from metallic to non-metallic like plastic bottles are used by the patients. The important factors to be considered for the successful treatment include the availability of instruments and the surgical skills of the doctor.

CASE PRESENTATION

A 45 year-old man with a comorbidity of severe depression presented to Emergency with a two months long history of penile strangulation with a plastic bottle neck. The gross appearance of the penis showed edema and proliferative growths. He was intervened with a cable wire cutter as standard instrument failed to do so. The patient was discharged on the same day of intervention. However, he was lost to subsequent follow up.

DISCUSSION

Penile strangulation which is common in people with mental disorders should be considered as a surgical emergency as it can present with devastating complications. No specific methods and tools have been recommended for the removal of those objects. The shame felt by patient is the root cause for late surgical consultation and are prone to develop complications. Simple instruments can be used for the intervention provided good surgical skills are demonstrated.

CONCLUSION

Common in psychiatric patients who deny medical attention due to shame, penile strangulation should be intervened quickly and simple instruments not routinely used in surgical practice can be effectively used to remove the offending objects.

Penile strangulation injury by metallic ring: A study of 4 cases

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Penila strangulation required emergency management to preserve the organ function.

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Each case managed individually according to its clinical finding and operative settings.

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Management depends on the type and size of constricting object, time after incarceration, degree of injury, available instrument, and experience of the physicians.

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Different methods and tools may arise due to circumstance and individual cases differences.

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Surprisingly, there is no erection problem after removing the strangulation.

Penile strangulation by metallic ring is an emergency situation which requires urgent management. Strangulation of the penis usually performed in order to increase sexual performance or because underlying mental disorder or paraphilia. It is an uncommon urological emergency, if not treated as soon as possible it can lead to complications such as gangrene and amputation of the penis. There is no standard of care that has been found to be superior, with each case managed individually according to its clinical findings and operative settings. In this study, we present four cases of penile strangulation in last two years in a tertiary care hospital.

Penile Rings: No Innovation without Evaluation

Penile strangulation is a rare clinical entity which if left untreated can cause serious urogenital problems. We present the case of 45-year-old male patient who presented with penile strangulation after applying a metallic ring. Strangulation of the external male genitalia is a serious problem that requires urgent intervention in order to avoid serious complications. If left untreated, it can result in gangrene and penile amputation. Management of penile strangulation is a real challenge for the treating surgeon and should be treated as an emergency in order to avoid vascular compromise.

LEARNING POINTS

Penile strangulation by metallic rings is not routinely encountered in daily emergency practice and can be a challenge for the treating surgeon.Problem awareness is a crucial part of the management of such a rare entity.Every attempt should be made as early as possible to preserve penile arterial supply.

Stepwise approach in the management of penile strangulation and penile preservation: 15-year experience in a tertiary care hospital

Objective: To present our stepwise approach to the management of penile strangulation and penile preservation with 15 years’ experience in a tertiary care hospital, as penile strangulation is a rare urological emergency that requires immediate attention.

Patients and methods: A prospective observational study was performed from March 2003 to December 2018 of patients presenting with penile strangulation to our hospital.

Results: Nine patients with penile strangulation presented to us between March 2003 and December 2018. The most common motive for the application of a foreign body was sexual gratification (four patients). Three of the nine patients had a mental disorder. Objects used for strangulation included: metallic nut (three), metallic ring (two), plastic bottle (two), wooden hole (one), hammer head (one), and horse hair to control bleeding during circumcision (one). Most of the foreign bodies were located in the proximal penile region. The mean operative time was 38 min and three of the nine patients had complications.

Conclusions: Penile strangulation is one of the rare urological emergencies experienced by a urologist. Removal of the foreign body can be difficult and there is no universal method of removal, as each case differs. So, following our stepwise approach can aid in removal of foreign body quickly and preserve the penis from fatal outcomes. Urologist should be aware of all the available armamentarium used for the removal of such foreign bodies.

Abbreviation: SPC: suprapubic cystostomy

Penile strangulation intentionally using a rubber band to prevent the development of penile cancer

Penile strangulation is a disease which causes circulatory failure in the distal part of the penis by the penis strangulated by foreign substances, and it is a rare emergency disease in urology. Most of the motives are for pranks, sexual intercourses and treatments of incontinence. We herein report the clinical course of penile strangulation complicated by penile cancer. Although the treatment was completed in accordance with its clinical stage of the penile cancer without any perioperative complications, it was considered that more case studies and further examinations would be needed to determine the treatment plans.

Penile strangulation by different objects and its removal by the modified string method: Management of four cases with review of literature

Penile strangulation is a challenging clinical situation and usually requires prompt treatment. Penile strangulation by a nonmetallic or thin metallic ring is easily overcome by severing/cutting the object; however, a heavy and long metal ring causing penile strangulation is not only difficult to sever but also it may worsen the scenario if removal is tried with inappropriate method. Here, we report four cases of penile strangulation by different objects which were successfully removed by aspiration and string method. We found that instead of using heavy cutting instruments and other surgical methods, string and aspiration technique is much better.

The Fire Service for the Removal of a Metallic Penile Constricting Device: A Ready Help When All Else Fail

The placement of a constricting device around the penis is a urologic emergency. Though injuries from constricting penile devices are generally rare, they may be associated with serious complications. There is no standard modality for the removal of penile constricting devices and the management of the patient can therefore prove to be a formidable challenge to the urologist. Timely intervention is always important in preventing complications especially penile gangrene. Depending on the type of device used along with the duration and severity of penile constriction caused, significant resourcefulness may be required in the treatment of the patient. Achieving a timely and successful outcome may require a multidisciplinary approach involving equipment only available with the fire service or other agencies. We report the case of a 30-year-old man with a background psychiatric illness who had his penile constricting device removed under conscious sedation in the emergency room with the aid of a power driven arc saw from the fire service with a successful outcome.

A case of penile strangulation after placement of metallic rings

Penile strangulation following placement of metallic rings is a rare clinical entity that needs urgent attention to avoid potentially severe clinical consequences. Careful handling and occasionally a multidisciplinary approach are the keys to a successful outcome.

Successful removal of a penoscrotal constricting ring in a 49-year-old male

Placement of constricting devices around the penis and scrotum for autoerotic purposes or increasing sexual performance represents a well-known challenge for urologists and can result in serious complications. The removal of the constricting devices can be challenging and often requires resourcefulness and multidisciplinary approach. We report one case of successful removal of a penoscrotal constricting metal ring in a 49-year-old male using a hand-held orthopaedic saw under ketamine and midazolam sedation in the emergency department.

Penile strangulation by iron metal ring: A novel and effective method of management

Penile strangulation by metal ring is a rare urological emergency situation which requires urgent decompression of the penis to avoid adverse effect. It is usually associated with an attempt to improve sexual act and/or to prolong erection. But sometimes, cutting of the ring to decompress the penis safely is a very difficult task particularly when the strangulating object is a hard metal object as in our case. Here, we present a case which was managed by cutting in a novel way with the help of dental micromotor with wheel shape bur.

Bone Cutting Forceps: A Safe Approach for Saving Strangulated Penis

Penile strangulation is considered a rare andrological emergency that may lead to a wide range of complications. Penile strangulation may be related to mental retardation in children or hypersexuality, abnormal sexual preferences in adults. This case report shows a 23-year-old male who presented to the emergency room with agonizing pain related to a metallic ring placed at the base of the penis for more than 8 hours during an attempt of masturbation. Removing this metallic ring and saving the patient's penis from gangrene without causing injury were very challenging. Patient was successfully managed and had an uneventful recovery.

Lower genitourinary tract trauma

Lower genitourinary tract trauma comprises a substantial portion of the trauma burden in the USA. Some key trends and findings are described. Mortality is relatively high in patients with bladder trauma due to associated injuries. Urethral injuries should be suspected in patients presenting with the triad of blood at the urethral meatus, suprapubic fullness indicative of a full bladder, and urinary retention. Urethral injury is common in penetrating penile trauma, and stab wounds to the penis are more likely to involve the urethra than gunshot wounds. Penile fracture is largely a clinical diagnosis and suspicion of fracture requires urgent surgical exploration. Zipper injuries are the most common cause of presentation to the emergency department for penile trauma in adults. Toilet seat injuries are the leading cause of penile pediatric trauma presenting to the emergency department. In the setting of testicular trauma, rates of testicular salvage are excellent when exploration is prompt. Trauma in the form of animal or human bites requires treatment with broad-spectrum antibiotics in addition to repair of the injury. Military trauma has seen an increase in explosive injuries to the lower urinary tracts due to evolution of warfare tactics. Increasing awareness of presentation and context of lower genitourinary tract trauma can reduce delay of diagnosis and morbidity associated with such injuries.

Post coital penile ring entrapment: A report of a non-surgical extrication method

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Removal of an entrapped penile ring where possible should be done in a simple non-invasive way.

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Milking the oedematous penis through the thick metallic ring in a slippery field complemented by levering with a blunt end paediatric bone lever, was the technique used to remove the ring.

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The ring was extricated without any morbidity and the patient went home on the same day.

This case report shows how a simple but painstaking method of milking and levering in a slippery field was used to remove a thick metallic ring entrapped at the root of the penis after sexual intercourse. A ring can be removed easily from an organ if the inter-phase is made slippery. However this must be weighed against the handling difficulties posed by a wet slippery surface. With perseverance and the use of unconventional instrument, the ring was successfully extricated as a day case and without a surgical incision.

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.

Strangulation of the penis: two case reports

Till now numerous reports have depicted the different constricting devices (CDs) previously threaded on the penis for obtaining of sexual pleasure or/and prolonged erection. The causes of CD bearing on the penis are sexual or autoerotic actions.

Here we present two cases of successful removal of a metal device from a penis that was associated with trauma grade II according to Bhat et al. The techniques used are also described. In both cases the essential features of successful device removal were its motionless fixation by nippers or vice combined with placing a metal plate under the constricting ring. The CDs were successfully removed without complications.

Successful removal of metal objects causing penile strangulation by a silk winding method

Penile strangulation is a challenge to urologists. The decompression of the penis is required to prevent long-term complications. Metal objects are difficult to remove. Cutting is the most common method described. Appropriate cutting tools may be difficult to obtain, and the process may be time-consuming with the possibility of iatrogenic penile injury. In this paper, we will present a simple method to remove such objects by use a silk winding method and subcutaneous puncture.

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.

An effective treatment for penile strangulation

The aim of this study was to present our experience of patients with penile strangulation. The clinical data of 6 patients (mean age, 36 years; range, 18-72 years) with penile strangulation caused by a metal hoop are provided, where the duration of strangulation was between 3 h and 1 month. Among these patients, the case of a 22-year-old patient with a steel hoop entrapment on his penis for 5 days is described; due to serious injury of the skin at the root of penis, an intermediate split‑thickness thigh skin graft was used to repair the skin loss. A review of the literature is also provided in this study, and current treatment options and outcomes are evaluated. In all the cases described, the metal hoops were successfully removed, without gangrene of the penis. These patients were discharged 2-27 days later with a satisfactory outcome. Penile strangulation is an unusual clinical condition and the consequences may be severe. The choice of method for removal depends on the type and size of metal hoop, incarceration time, trauma grade and availability of equipment. Early treatment is essential to avoid potential complications, including ischemic necrosis and autoamputation.

Self-inflicted strangulation of prepuce in a child

Penile trauma is an uncommon but potentially serious injury presenting to pediatric emergency room. Strangulation injuries of the penis can be self-inflicted or occur accidentally. However, self-inflicted strangulation of the foreskin in children is rare. This is a case of 7-year-old uncircumcised boy who himself tied foreskin of prepuce with a cotton thread. The thread was cut and circumcision performed to remove the damaged foreskin.

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.

Penile strangulation: report of a fatal case

Penile strangulation or entrapment is an unusual entity that requires urgent treatment due to its potential complications. Several cases have been reported in the medical literature, some of them describing serious injuries such as necrosis, gangrene, and amputation of the penis. However, as far as we know, no fatal cases have been described before. We present the death of an adult male secondary to the complications due to penile strangulation with a plastic bottle neck. The time of incarceration was unknown, but according to a witness it could be about 10 to 14 days. The findings of autopsy were penile strangulation, necrosis of the penis, acute pyelonephritis, and bronchopneumonia. The subject's refusal to ask for medical help was the cause of this atypical evolution.

Strangulation of penis by a ball bearing device

INTRODUCTION

Penile strangulation is rare and usually results following placement of constricting objects to enhance sexual stimulation. It requires urgent treatment as delay may lead to irreversible penile ischemia and gangrene. Various objects causing penile strangulation have been reported. Nonmetallic and thin metallic objects can be removed easily as compared to heavy metallic objects. Cutting is the commonest method described, although procuring special cutting tools may be difficult and the process of cutting may be tedious with the possibility of iatrogenic penile injury.

AIM

To present a simple, safe, minimally invasive, effective, and feasible technique for removing heavy metallic objects constricting the penis.

METHODS

The published English literature (PubMed™) was searched for cases of "penile strangulation" using the keywords penile strangulation, penile injury, penile trauma, penile constriction, penile entrapment, and penile incarceration. The described treatment modalities were carefully reviewed and studied.

MAIN OUTCOME MEASURES

Reviewed published English literature on the various causes of penile incarceration and the various techniques used for their extrication.

RESULTS

Search results yielded several cases of penile strangulation caused by a variety of metallic and nonmetallic objects. Various modalities have been described in the English literature for their safe removal, each with its own merits and demerits.

CONCLUSIONS

Penile strangulation should be viewed and managed as an emergency in order to prevent penile necrosis and urethral injury and to preserve erectile function. The modified method described herein for managing penile strangulation due to heavy metallic rings is minimally invasive, safe, effective, does not require any special cutting instrument(s) or skill, and is free of causing iatrogenic collateral thermal or mechanical damage to the penile organ. A stepwise algorithm depicting a rational and comprehensive approach to the diagnosis and management of penile incarceration is also suggested for the clinicians.

Removal of a long PVC pipe strangulated in the penis by hot-melt method

INTRODUCTION

Penile incarceration for erotic or autoerotic purposes has been reported in a wide range of age groups, and often presents a significant challenge to urologic surgeons. No ready method has been reported for removing a polyvinylchloride (PVC) pipe entrapped on the penis.

AIM

To present our experience in using hot-melt method to remove a constricted PVC pipe on the penis.

METHODS

A long melting split was made on the PVC pipe entrapped on the penis by using the long narrow branch of forceps heated on a gas stove.

RESULTS

The heated forceps was able to make a melt split on the PVC pipe. Consequently, the PVC pipe was removed by pulling the edges of the pipe apart without much difficulty. The total operation time was 20 minutes.

CONCLUSION

Penile incarceration is a urologic emergency, for which resourcefulness is required in some unexpected cases. Hot-melting has proved to be an easy and effective method for removing penile strangulation by a PVC pipe. To our knowledge, it is the first report about the removal of PVC pipe entrapped on a penis.

Successful removal of a 3.6-cm long metal band used as a penile constriction ring

INTRODUCTION

Penile constriction rings are either used for autoerotic stimulus or to increase sexual performance. Potentially, they can become irremovable and cause urologic emergencies.

AIM

We describe the successful removal of a 3.6-cm long piece of heavy metal tubing used as a penile constriction ring.

METHODS

An angel grinder was used to open the metal tubing on both lateral sides. During the cutting procedure, the soft tissue parts were protected by two metal spatulas. Wet towels and cool running water prevented thermal injury.

RESULTS

After removal of the band, no iatrogenic injury was visible and the further recovery of the patient remained uneventful. Postoperatively, one of the surgeons suffered from conjunctivitis of the left eye possibly due to metal sparks.

CONCLUSION

Depending on the constricting object, heavy-duty technical equipment might become necessary for their removal. In such cases, special care should be taken to avoid injury to the patient and the medical crew.

Penile incarceration secondary to an S-shaped lead pipe: removal with Dremel Moto-Tool

BACKGROUND

Penile incarceration or strangulation is a urologic emergency.

OBJECTIVES

Several techniques to remove metallic objects strangulating the penis are described in the literature. The method utilized depends on the severity of the incarceration and the tools that are readily accessible. Prompt action and resourcefulness, with expeditious removal, prevents organ ischemia and vascular or mechanical sequelae.

CASE REPORT

We describe a case in which a Dremel Moto-Tool was used to remove a lead pipe strangulating a penile shaft, after failure of the string technique.

CONCLUSION

A hospital-based Emergency Medical Services and Rescue program is a valuable resource to provide the tools needed for management of penile strangulation. Features of safe removal, including protecting the tissues from heat damage and mechanical injury from the cutting blade, are described.

Genitalia strangulation--fireman to the rescue!

The incidence of metallic rings causing genitalia strangulation has been widely reported. The removal of the constricting rings can be challenging and might need resources not usually available in the hospital. We report one such case where the assistance of a fire crew was required to remove the ring.

Novel use of the Gigli saw for management of penile entrapment

INTRODUCTION

Penile entrapment is a rare clinical entity requiring urgent and efficient management. If left untreated, it may result in vascular compromise to penile soft tissue structures. Management poses unique challenges to the treating physician through variable presentation as well as the lack of specifically designed treatment options.

AIM

This article describes the use of the Gigli saw for management of penile entrapment.

MAIN OUTCOME MEASURES AND METHODS

We employed the Gigli saw to remove an entrapped metallic peno-scrotal constriction ring.

RESULTS

We successfully removed the entrapped ring with no noted immediate complications.

CONCLUSIONS

The Gigli saw can be safely used, and represents an easily available and potentially effective option in the management of penile entrapment.

Penile and scrotal strangulation caused by a steel ring: a case report

Application of constricting devices on the external male genitalia for increasing sexual performance is an unusual practice that can potentially lead to penile strangulation with severe consequences. In this case report we describe a case of a 48 year old male who presented in our hospital with a steel ring on his external genitalia which led to penile strangulation and a short review of the literature. The foreign body was successfully removed by an angle grinder which was not immediately available in the operating theatre. The patient had an uneventful recovery.