Novel Extraction Technique to Remove a Penile Constriction Device

Abstract

Introduction Penile strangulation can be a challenging clinical situation and usually requires prompt treatment. The clinician should be aware of the various techniques to remove such devices. Aim The aim of this article was to describe a new noninvasive technique, the “pseudo-pulley” method, to remove a penile constriction device. Methods During an episode of medication-induced hypersexuality, a 63-year-old man presented to the emergency department with a cast iron locking nut of a vehicle towbar lodged at the base of the patient’s penis. Results The utilization of the “pseudo-pulley” method to remove the constriction device negated the need for more invasive measures. We outline a step-by-step description on this new technique. The patient’s recovery was complete and uneventful. Conclusion The current case report describes a noninvasive technique for removing a penile constriction device that does not rely on specialized equipment and industrial drills that can cause iatrogenic injury.

The Queen Elizabeth Tuck Technique - A Novel Technique For Removal Of A Strangulating Penile Ring.

“…It was decided to attempt to remove the device by using an adaptation of the 'modified string method' [1]. The fragile nature of the patient's skin as well as the severe oedema precluded the use of thin strings or guide wires.…”

“…Strangulation of the penis is an uncommon [1] urological emergency requiring prompt diagnosis and management in order to avoid the complications of ischemic necrosis and auto-amputation. It can present with varying clinical scenarios depending on the degree of vascular obstruction; from insignificant, easily-reversible obstruction to severe gangrene and the accompanying complications [1]. In order to avoid these severe complications, every attempt at prompt removal of the strangulating device needs to be made [2][3][4].…”

Successful Removal of Metal Rings Causing Penile Strangulation

“… Analgesia and anesthesia are essential in management of patients with genital strangulation.  Selection of tools needed for removal of a constriction device depends on [1] the resourcefulness of the clinicians, [2] the equipment available, [3] the size and thickness of the constricting object, and [4] the severity of injury.  Prolonged strangulation of the genitals can lead to penile lymphedema, voiding dysfunction, erectile dysfunction, skin ulceration, necrosis, urethral cutaneous fistula, and colonization of hypertrophic skin.…”

“…Localized edema, superficial ulcers, and skin loss are the most common complications of strangulation, but with prompt attention to the injury, patients can leave in excellent condition (2). Without prompt attention and intervention, the patient is susceptible to vascular occlusion, ischemia, necrosis, erectile dysfunction, urethral-cutaneous fistula, and ultimately penile amputation which is an unusual but devastating consequence (3).…”

Vaseline injection, an inadequate method for penile augmentation

“…Four needle guide wire is placed under the metal bearing. The tourniquet is removed, the penis is lubricated and with the help of the needle guide wire the bearing is pulled off (Katz et al, 2012). In rare cases, the damage is so severe that the penis cannot be saved and must be amputated (Ivanovski et al, 2007.…”