Genitalia strangulation--fireman to the rescue!

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.

Penile Entrapment With Thick Penile Ring: A Case Report and Literature Review

The penis is one of the end-artery organs in the human body. The blood supply of the penis depends on the internal pudendal artery, which arises from the anterior division of the internal iliac artery. Subsequently, the penis is one of the organs that are highly affected by peripheral vascular disease. Furthermore, erectile dysfunction is a clinical sign that might precede coronary heart disease. Artificial entrapment of the blood into the cavernous bodies is one of the treatment options for erectile dysfunction. In addition, the same concept might be utilized in some sex aids to increase self-pleasure; hence, penile rings are widely used in some cultures. We present here a case of metal penile ring entrapment, which was managed successfully with the help of the hospital maintenance team. Therefore, it is of tremendous importance in unusual cases to seek advice from all possible resources. Such complications should be highlighted to increase the awareness of the users and the medical professionals as well.

Evaluation of the use of a specially designed saw to remove penis rings at the emergency department

Objective:

Penile strangulation is a rising problem in emergency departments (ED) and can cause serious medical issues. The removal of a penile ring requires immediate action, but is a difficult task. In this study an in-house specialised designed saw to safely remove penis rings is evaluated.

Materials and Methods:

To evaluate the use of the penis ring saw we used information from our maintenance management software to evaluate the amount of malfunctions. The evaluation of the experiences in the ED were based on semi-structured interviews with ED employees and with the mechanical engineers that developed and maintain the saw.

Results:

Since 2013 seven jobs were found regarding to a defect of the saw. All defects were broken saw blades. Four emergency care department employees and two instrumentmakers were interviewed. All four are pleased with the saw, because it improves patient safety during removal of the penis ring. The two instrument makers agree with the ED nurses that the saw is an improvement compared to the previous used solutions. Possible improvements were also suggested.

Conclusion:

A specialized saw was designed and developed for the removal of penis rings. This saw offers a safe and standardized way to remove the penis rings.

Penis Ring Injuries Treated at Emergency Departments

The purpose of this study was to determine the pattern of penis ring-related injuries in the US. During 2000-2019, 162 penis ring-related injuries (for a national estimate of 6,344 such injuries) were treated at US emergency departments (EDs). Of the estimated injuries, 32.3% occurred during 2000-2011 and 67.7% during 2012-2015. The patients were 49.8% age 30-49 years. The most common types of injuries were ring stuck on the penis or scrotum (75.3%), edema (29.9%), pain (18.7%), and contusion or abrasion (7.6%). In 81.9% of the estimated injuries, the patient was treated or examined at the ED and then released.

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 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.

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.

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.

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 Strangulation by self-Placement of Metallic Nut

We report a case of a 37-year-old male who presented with a 12-hour history of a strangulating 2cm wide by 0.8 cm thick metallic nut on the penile shaft at the peno-scrotal junction. Unlike instances where these metallic objects are placed to enhance sexual stimulation this nut was rather placed to prevent intercourse. A Bosch electric circular grinder was successfully used for removal but a thermal burn to the penile tissues was sustained in the process as the hardness of the nut required a high energy to cut and its thickness did not allow for effective cooling during the process of removal. This resulted in a circumferential denudation of penile skin, a urethro-cutaneous fistula at the peno-scrotal junction and a mid-bulbar urethral stricture. The penile wound was subsequently covered with a split skin graft with a delayed closure of the urethrocutaneous fistula and a buccal mucosa patch urethroplasty for the mid bulbar stricture. Despite the degree of thermal burns sustained the patient has maintained good erectile function with grade four rigidity. The tunica albuginea and the underlying corpora cavernosa have shown a significant degree of resilience to thermal burns compared to the corpora spongiosum where the thermal burns led to a urethrocutaneous fistula.

Removal of a penile constriction device with a large orthopedic pin cutter

Penile strangulation is an infrequent clinical condition that has widely been reported. It usually results following placement of a constriction device to enhance sexual stimulation. Early treatment is essential to avoid potential complications, including ischemic necrosis and autoamputation. We describe the use of a Large Orthopedic Pin Cutter to remove a metal penile constriction device in the Emergency Department (ED). This case report describes the relatively safe technique of using an instrument available in many hospitals that can be added to the physician's arsenal in the removal of metal constriction devices.

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.

Successful remove of a metal axletree causing penile strangulation in a 19-year-old male by degloving operation

Penile strangulation caused by foreign bodies mostly occurs in adolescents and adult males. When it happens, foreign bodies are often not easy to be removed. Penile strangulation is a rarely described urological emergency, especially in the adolescent population. This paper demonstrates the successful removal of a metal axletree causing penile strangulation in a 19-year-old male with the help of degloving operation.

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.