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Shaw C, Wagg A. Penile compression devices for the treatment of urinary incontinence: current status and future prospects. Expert Rev Med Devices 2024; 21:811-817. [PMID: 39230092 DOI: 10.1080/17434440.2024.2400092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 08/30/2024] [Indexed: 09/05/2024]
Abstract
INTRODUCTION Urinary incontinence (UI), especially stress UI, is common after prostatectomy. Penile compression devices (PCDs) may be a safe, tolerable option for conservative management in men who are not candidates for or not interested in surgical intervention for their UI. AREAS COVERED This article examines the epidemiology of post-prostatectomy urinary incontinence (PPI), and options for management. All available studies on PCDs are explored, including those on biomechanics, safety, tolerability, and user experience. History, availability of PCDs, and areas for future development are discussed. EXPERT OPINION PCDs are an option for conservative management of PPI. They are recommended for those men without impairment in cognition, dexterity, or sensation. They should be worn for short periods of time and are best used during situations when incontinence might be precipitated. Overall, data suggest they are well tolerated and effective when tested, but large randomized comparative trials and studies of long-term use with relevant patient reported outcome measures are lacking. More studies are needed on commercially available PCDs. Biomechanical studies suggest that there are superior designs and materials both for efficacy and tolerability. With an aging population, and more older men going for prostate surgery, a larger market for these devices is likely.
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Affiliation(s)
- Christina Shaw
- Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, Canada
- Division of Geriatric Medicine, Department of Medicine, University of British Columbia in Vancouver, Vancouver, Canada
| | - Adrian Wagg
- Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, Canada
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2
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Nguyen V, Garg N, Cedars BE, Puri D, Ahmadieh K, Buckley JC. Delayed gangrenous penile necrosis following prolonged utilization of penile constriction ring. Urol Case Rep 2024; 55:102762. [PMID: 38911466 PMCID: PMC11190493 DOI: 10.1016/j.eucr.2024.102762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 05/31/2024] [Indexed: 06/25/2024] Open
Abstract
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.
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Affiliation(s)
- Vi Nguyen
- Department of Urology, University of California, San Diego, La Jolla, CA, USA
| | - Nishant Garg
- Department of Urology, University of California, San Diego, La Jolla, CA, USA
| | - Benjamin E. Cedars
- Department of Urology, University of California, San Diego, La Jolla, CA, USA
| | - Dhruv Puri
- Department of Urology, University of California, San Diego, La Jolla, CA, USA
| | - Kian Ahmadieh
- Department of Urology, University of California, San Diego, La Jolla, CA, USA
| | - Jill C. Buckley
- Department of Urology, University of California, San Diego, La Jolla, CA, USA
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3
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Campbell KJ, Kwenda EP, Bozorgmehri S, Terry RS, Yeung LL. Penile Strangulation: Analysis of Postextrication Follow-Up, Sequelae, and a Review of Literature. Am J Mens Health 2024; 18:15579883231223366. [PMID: 38293721 PMCID: PMC10832435 DOI: 10.1177/15579883231223366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 02/01/2024] Open
Abstract
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.
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Affiliation(s)
- Kevin J. Campbell
- Department of Urology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Elizabeth P. Kwenda
- Department of Urology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Shahab Bozorgmehri
- Department of Urology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Russell S. Terry
- Department of Urology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lawrence L. Yeung
- Department of Urology, College of Medicine, University of Florida, Gainesville, FL, USA
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4
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Uthman A, Al‐Mashhadani S, Blower N, Iqbal M. Strangulated penis in a prison inmate: Complete penile degloving and full-thickness skin graft. IJU Case Rep 2024; 7:38-41. [PMID: 38173451 PMCID: PMC10758896 DOI: 10.1002/iju5.12663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/13/2023] [Indexed: 01/05/2024] Open
Abstract
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.
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Affiliation(s)
| | | | - Naomi Blower
- Cwm Taf Morgannwg University Health BoardPontylunUK
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Lo BS, Ng AT, Tsu JH, Lam WP. Penoscrotal Incarceration By Metal Ring: case reports and literature review of management. SURGICAL PRACTICE 2022. [DOI: 10.1111/1744-1633.12575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Bryan Shing‐Hin Lo
- Division of Urology, Department of Surgery Queen Mary Hospital Hong Kong SAR
| | - Ada Tsui‐Lin Ng
- Division of Urology, Department of Surgery Queen Mary Hospital Hong Kong SAR
| | - James Hok‐Leung Tsu
- Division of Urology, Department of Surgery Queen Mary Hospital Hong Kong SAR
| | - Wayne Pei Lam
- Division of Urology, Department of Surgery Queen Mary Hospital Hong Kong SAR
- Department of Surgery, Li Ka Shing Faculty of Medicine University of Hong Kong Hong Kong SAR
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Nguyen TT, Ngo XT, Chau QT, Hoang KC, Dinh LQV, Ly HT, Hoang TD, Dobbs RW, Thai MS. Use of dental drill handpiece to remove steel nut causing penile strangulation: a case report and review of the literature. J Med Case Rep 2022; 16:158. [PMID: 35440026 PMCID: PMC9020065 DOI: 10.1186/s13256-022-03342-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 02/21/2022] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Tuan Thanh Nguyen
- Cho Ray Hospital, Ho Chi Minh City, Vietnam.,University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Xuan Thai Ngo
- Cho Ray Hospital, Ho Chi Minh City, Vietnam.,University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | | | | | | | | | - Ryan W Dobbs
- Cook County Health and Hospitals System, Chicago, IL, USA
| | - Minh Sam Thai
- Cho Ray Hospital, Ho Chi Minh City, Vietnam. .,University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
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Dewitte M, Reisman Y. Clinical use and implications of sexual devices and sexually explicit media. Nat Rev Urol 2021; 18:359-377. [PMID: 33948009 DOI: 10.1038/s41585-021-00456-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 12/14/2022]
Abstract
Given that sexual pleasure is a core component of sexual health, devices that are designed to enhance and diversify sexual pleasure are particularly useful in clinical practice. Despite their growing popularity and widespread use in various biopsychosocial circumstances, many taboos still seem to exist, as indicated by the paucity of scientific literature on the prevalence, application and effectiveness of sexual devices for therapeutic use. However, sex toys and sexual devices are commonly used and have a variety of indications to expand individual and partnered sexuality and to treat sexual difficulties. Different devices are associated with specific advantages and potential risks, opportunities, barriers and ethical challenges when used in a clinical context. Increased knowledge about the aim and functional possibilities of sexual devices might help health-care professionals overcome potential embarrassment, preconceptions and other barriers, learn which patients might benefit from which products, consider their use in treatment programmes, educate about correct use and safety issues, and facilitate open communication about sexual pleasure with their patients.
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Affiliation(s)
- Marieke Dewitte
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands.
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Removal of a Steel Ring Causing Penile Strangulation Without the Use of Powered Tools or Sharp Blades. Urology 2020; 148:e15-e16. [PMID: 33186579 DOI: 10.1016/j.urology.2020.10.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/19/2020] [Accepted: 10/26/2020] [Indexed: 11/22/2022]
Abstract
Penile strangulation is an uncommon urologic emergency that requires prompt evaluation and treatment to avoid disastrous consequences. Strangulation has been reported with objects ranging from hair tourniquets, to plastic rings, to iron rings. Strangulation with these devices can result in vascular congestion of the penis, swelling and eventual gangrene of the penis distal to the constricting device. We present a case report of a 43-year-old male who had a 2-day history of penile pain and swelling secondary to a metal ring constricting the proximal phallus. Ring removal was achieved with an orthopedic bolt cutter to cut the ring in two places, using a malleable retractor to act as a "backboard" to prevent iatrogenic injury to the penis.
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9
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Rahmita MM, Parikesit D, Widia F. Penile entrapment by metal ring: Case reports of effective non-surgical management. Urol Case Rep 2020; 33:101387. [PMID: 33102085 PMCID: PMC7574151 DOI: 10.1016/j.eucr.2020.101387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/12/2020] [Accepted: 08/17/2020] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Maulidina Medika Rahmita
- Department of Urology, Cipto Mangunkusumo National Hospital, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Dyandra Parikesit
- Department of Urology, Cipto Mangunkusumo National Hospital, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Fina Widia
- Department of Urology, Cipto Mangunkusumo National Hospital, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
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10
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Kyomukama LA, Ssebuufu R, Wani SA, Waziri MA, Lule H. Penile ring entrapment and strangulation: A case report at Kampala International University Teaching Hospital in Western Uganda. Int J Surg Case Rep 2020; 80:104982. [PMID: 33607367 PMCID: PMC7900217 DOI: 10.1016/j.ijscr.2020.09.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 11/04/2022] Open
Abstract
Penile ring entrapment is when a ring previously inserted onto penis is left for extended period of recommended time. Delayed removal of the ring lead to strangulation that presents challenges to general surgeons and institution to manage it. 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.
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Affiliation(s)
- Lauben Amagara Kyomukama
- Department of Surgery, Kampala International University Teaching Hospital, P.O. Box 71, Bushenyi, Uganda.
| | - Robinson Ssebuufu
- Department of Surgery, Kampala International University Teaching Hospital, P.O. Box 71, Bushenyi, Uganda.
| | - Shaban Abdullah Wani
- Department of Surgery, Kampala International University Teaching Hospital, P.O. Box 71, Bushenyi, Uganda.
| | - Musa Abbas Waziri
- Department of Surgery, Kampala International University Teaching Hospital, P.O. Box 71, Bushenyi, Uganda; Department of Surgery, Muhammad Shuwa Memorial Hospital, Maiduguri, Nigeria.
| | - Herman Lule
- Department of Surgery, Kampala International University Teaching Hospital, P.O. Box 71, Bushenyi, Uganda.
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[Cutaneous and mucosal manifestations of sexual practices]. Ann Dermatol Venereol 2020; 147:629-636. [PMID: 32654793 DOI: 10.1016/j.annder.2020.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 03/23/2020] [Accepted: 04/06/2020] [Indexed: 11/22/2022]
Abstract
Sexual activity may on occasion be associated with local trauma, infections or allergies. During visits, patients may be reluctant to report on the circumstances leading to such lesions. The dermatologist may be unfamiliar with these manifestations, especially where they occur outside the genital area. Our aim is to present the spectrum of genital and extra-genital signs associated with sexuality. The dermatologist must feel sufficiently confident to broach the patient's sexual history in order to avoid any diagnostic errors and unnecessary explorations.
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