Penile Constriction Devices: Case Report, Review of the Literature, and Recommendations for Extrication

Abstract

Introduction Penile constriction devices often present significant challenges to urologic surgeons. Failure to remove such devices can lead to significant ischemia and loss of tissue. Patients often present after several days of ischemia and swelling have developed. Aim This article reviews previously published data on penile constriction devices and strategies for their removal. Additionally, we present new methodologies for extrication. Methods A comprehensive review of the English language literature was performed using MEDLINE. “Penile incarceration” and “penile strangulation” were used as search terms, and a manual bibliographic review of cross-referenced items was performed. Publications prior to 1970 were excluded from our search. Main Outcome Measures Review of published literature on penile constriction devices and their removal. Results Penile incarceration is frequently described in the literature as an isolated case report or small series describing the approach of a single physician or group of physicians for dealing with these problems. Penile incarceration has been reported in a wide spectrum of age groups, with the incarcerating object most frequently placed for erotic or autoerotic purposes. While the most commonly reported devices causing incarceration are metal rings, higher-grade penile injuries are more frequently sustained by nonmetallic objects. Patients who present with incarceration after 72 hours are more likely to sustain higher-grade injuries than those who seek more timely treatment. Strategies for extrication depend on the type of device used, the length of time of incarceration, the patient's ability to remain calm, and the tools available to the presenting physicians. Conclusion Penile incarceration is a urologic emergency with potentially severe clinical consequences. With rapid intervention and removal of the foreign body, most patients do extremely well and need no further intervention. Removal of such devices can be challenging and often requires resourcefulness and a multidisciplinary approach.

Penile Gangrene due to Strangulation by a Metallic Nut: A Case Report

“…nuts, bolts, washers, hammer heads etc are most commonly encountered. 13 Plastic and other less solid materials are said to cause more severe injuries than the metallic objects. 4,7,13 At presentation, the patients are unable to remove the constricting agents after attaining an erection, and tumescence is not possible because of occlusion of the vessels, starting with the veins.…”

“…13 Plastic and other less solid materials are said to cause more severe injuries than the metallic objects. 4,7,13 At presentation, the patients are unable to remove the constricting agents after attaining an erection, and tumescence is not possible because of occlusion of the vessels, starting with the veins. If the patient presents at this stage, (when only the penile veins are occluded), that is within 48 hours or less there will be gross penile oedema but intact distal penile sensation.…”

“…13 Acute urinary retention occurs early in the progression because the urethra is superficial, (covered by a thin layer of corpus spongiosum) on the ventral aspect of the penis. The reason for late presentation in a patient with no psychiatric problems is the intense feeling of shame and embarrassment, whereas the psychiatric patient may simply neglect the injury until it is too late.…”

Successful removal of a penile constriction wedding ring in a rural area

“…[1] Multiple puncture aspi rations were applied with a 20 mL syringe and a pink needle. The oedema subsided and the ring was successfully removed (Figs 2 and 3).…”

“…In adults, it is done mainly for erotic reasons. [1][2][3] We report a case of a strangulating penile ring and the challenges faced during attempts at removing it. [1][2][3] …”