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

      case-report

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          Abstract

          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.

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          Penile strangulation: two case reports and review of the literature.

          Ognen Ivanovski, Oliver Stankov, Marjan Kuzmanoski … (2007)
          Entrapment or strangulation of the penis is a rare emergency situation that can lead to a wide range of vascular and mechanical injuries. The aim of this article is to present our experience dealing with penile strangulation. A review of the literature is also summarized in this report. Current treatment options and outcomes are also evaluated. We performed a computerized MEDLINE search followed by a manual bibliographic review of cross-references. These reports were analyzed and the important findings summarized. Penile strangulation has been first time reported in 1755. Since that time, sporadic reports have appeared in the literature describing a variety of foreign bodies on the penis that have in common only the property of circularity. We noted motives, types of objects, types of strangulation, symptomatology, trauma grades, diagnoses, including psychological involvement, as well as possible treatment options. Furthermore, two cases of penile strangulation from our clinical practice are presented involving different degrees of vascular insult leading to different pathogenesis, clinical presentation, and surgical approach. Penile strangulation is an unusual clinical condition and the consequences can be severe. Penile strangulation could lead to different degrees of vascular obstruction. Consequently, several clinical syndromes can occur: from mild nonsignificant vascular obstruction that resolves after decompression to severe gangrene of the penis accompanied with impaired renal function. The most common motive associated with foreign bodies on the penis is sexual or erotic in nature. The choice of method for removal depends upon type, size, incarceration time, trauma grade, and availability of the equipment. Prompt diagnosis and early treatment are essential to avoid the potential complications of ischemic necrosis and autoamputation.
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            Penile strangulation treated with the modified string method.

            T Kang, Tag Heo, Jihae J Noh … (2004)
            Penile strangulation by a nonmetallic or thin metallic ring is easily overcome by severing the object, but a heavy metal ring causing penile strangulation is very difficult to sever. Here we report 2 cases of penile strangulation by metal rings, involving a 38-year-old man and a 44-year-old man, both of whom were treated with the modified string method and glandular puncture.
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              Penile incarceration with metal objects--a review of procedure choice based on penile trauma grade.

              M Detweiler (2001)
              To outline treatment guidelines according to level of penile trauma for penile incarceration by metal devices. 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. 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). 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.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Urol Ann
                Journal ID (iso-abbrev): Urol Ann
                Journal ID (publisher-id): UA
                Title: Urology Annals
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0974-7796
                ISSN (Electronic): 0974-7834
                Publication date (Print): Jan-Mar 2017
                Volume: 9
                Issue: 1
                Pages: 74-76
                Affiliations
                [1]Department of Urology and Renal Transplant Surgery, Shija Hospitals and Research Institute, Langol, Imphal, Manipur, India
                [1 ]Department of Dentistry, Shija Hospitals and Research Institute, Langol, Imphal, Manipur, India
                [2 ]Department of General Surgery, Shija Hospitals and Research Institute, Langol, Imphal, Manipur, India
                Author notes
                Address for correspondence: Dr. Somorendro Paonam, Department of Urology and Renal Transplant Surgery, Shija Hospitals and Research Institute, Langol, Imphal - 795 004, Manipur, India. E-mail: drsomo07@ 123456gmail.com
                Article
                Publisher ID: UA-9-74
                DOI: 10.4103/0974-7796.198873
                PMC ID: 5308044
                PubMed ID: 28216935
                SO-VID: 0a48a9ae-a9b9-4d48-8766-83c030410b9d
                Copyright © Copyright: © 2017 Urology Annals
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Date received : 22 August 2016
                Date accepted : 07 October 2016
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Urology
                Keywords: decompression,entrapment,strangulation
                Data availability:
                ScienceOpen disciplines: Urology
                Keywords: decompression, entrapment, strangulation

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