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

A Case Series on Penile Garroting: Causes, Considerations, and Consequences

Penile injuries from self-inflicted strangulation or garroting are uncommon. Children are more likely than young adults or elderly patients to sustain such injuries. Numerous foreign things, including hair, thread, rubber bands, metallic rings, nuts, and vacuum erection devices, have been reported to be used for garroting in the literature search. Determining the precise cause of such anomalous behavior can be difficult. If there is an underlying mental disorder, the situation becomes even more complex. While such mishaps in the elderly population may be for the relief of lower urinary tract symptoms such as frequency or incontinence, in young persons, they may be for sexual stimulation and erection augmentation. These devices tightly constrict the penis root, obstructing the venous return and causing corpora congestion that leads to ischemia, gangrene, or necrosis. We describe our observations of three incidents of penile garroting and its aftereffects. Here, we also talk about the several gadgets that our patients use and the methods that we employ to remove the constriction.

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.

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.

Two cases of penile strangulation: varied presentations and vastly different outcomes

Background

Penile strangulation by various metallic and non-metallic objects is a true urological emergency that requires prompt emergency management. The cases in this report will help in highlighting the varied presentations one can face in the emergency department. Management of such cases at times needs out-of-the-box thinking and improvised skills as resources to remove the foreign body are often scarce within the hospital.

Case presentation

We present two such cases of penile strangulation in adult patients. Both patients presented to us in the emergency department, one with a large metallic cone and another with a rubber band constricting their penises. Both the patients had hugely different grades of injuries and were managed accordingly. Both the patients required different methods to remove the constriction objects as per the need of the situation. One of the patients required total penectomy with permanent perineal urethrostomy; however, in the other case, we were able to save the penis.

Conclusion

Penile strangulation needs urgent medical attention and timely removal of the offending object. Grade of injuries and complications are directly proportional to the type of object and the duration of the strangulation. The non-metallic objects are easy to cut and remove. However, one should be aware of the challenges and the complications in managing metallic foreign bodies which at times may need out-of-the-box thinking, like use of motorized cutting tools.

Angle grinder as surgical tool for incarcerated penoscrotal steel ring

Penile strangulation with concomitant scrotal entrapment by a steel ring is an extremely rare urological emergency that requires immediate intervention. Any delay may lead to irreversible complications. Metal rings increase penile engorgement and are usually associated with an attempt to improve sexual pleasure or to maintain a prolonged erection. The removal of steel rings can be challenging and may require a multidisciplinary approach. We present a unique case report of an 18-year-old male with a penoscrotal steel ring retained for 24 hours that was safely removed using an angle grinder as a surgical tool.

Penile ring entrapment and strangulation: A case report at Kampala International University Teaching Hospital in Western Uganda

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Penile ring entrapment is when a ring previously inserted onto penis is left for extended period of recommended time.

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Delayed removal of the ring lead to strangulation that presents challenges to general surgeons and institution to manage it.

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Pilot bearing ball ring was removed by cutting with electrically powered angled grinder

Introduction

Penile ring entrapment during self-sexual satisfaction is one of the rare cases in general and urologic surgery. When the penile shaft is entrapped in a metal ring, one risks possible complete loss of distal penis to strangulation and gangrene. We present management of a case of entrapped penile ring with penile strangulation in resource limited set up amidst absence of management guidelines. The case has been reported in line with SCARE criteria (1).

Presentation of case

A 43-year-old male presented after 72 h of pilot ball bearing ring penile insertion for sustainability of an erection, with 24 -h history of painful penile swelling and acute urine retention. The patient had history of using recreational drugs and erectile dysfunction with evidence of high-grade penile injuries at presentation. The ring was cut using electrically powered angled grinder, with full penile recovery on conservative management in eight months of follow up.

Discussion

Entrapped penile ring is clinically diagnosed but establishing incentive of insertion is difficult just like identifying a correct technique to remove it. Entrapped ring obstructs blood and lymphatic flow leading to oedema and ischaemia with associated penile tissue injuries. High grade penile injuries or penile amputation are sequels of delayed ring removal and good outcomes are tangible through timely multidisciplinary approach.

Conclusion

Eroticism and erectile dysfunctions are known incentive to using penile rings to sustain erection. Delayed ring removal results in its entrapment and penile strangulation and related complications. Timely removal of ring requires multidisciplinary approach and local management protocols.

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.

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 incerceration-A tight affair

A patient presents with penile ring incarceration after using it for penile enlargement and prolonging tumescence. We present a case study of removal of the penile ring under local anaesthesia in a setting where cutting tools were inadequate.