Penile strangulation injury in children — Reconstructive procedure and outcome

Qamar, Javaria; Kazmi, Zehra; Dilawar, Bakhtawar; Nazir, Zafar

doi:10.1016/j.jpedsurg.2019.12.011

Cited by 7 publications

(6 citation statements)

References 13 publications

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“…24 There were 2 cases in India and 1 in Pakistan reporting patients who deliberately tied thread around their penises to stop nocturnal enuresis. [25][26][27] Of those reported, 77% (30/39) of tourniquets involved hair; in 21% (8/39) of these cases, the hair belonged to a female relative (mother was more common than sister or grandmother). In 23% (9/39) of cases, the tourniquet was caused by cotton threads or rubber band.…”

Section: Female Genitalia Httsmentioning

confidence: 99%

Systematic Literature Review of Pediatric Male and Female Genital Hair Thread Tourniquet Syndrome

et al. 2022

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The aim of this study was to describe genital hair thread tourniquet syndrome (HTTS) and its treatment by pediatric and adolescent health care providers through a systematic literature review. Methods:We performed a systematic literature review on pediatric male and female genital HTTS. Studies were included if they involved genital HTTS in males or females 21 years and younger and were published in English. The main outcomes were body parts involved, symptoms, treatment, anesthetic type, providers involved in diagnosis and management, and implications of delayed or missed diagnosis.Results: There were 38 female cases from 33 publications and 147 male cases from 47 publications . The average age among females and males was 9.1 and 5.1 years, respectively. Among cases involving female patients, 93% of them were premenarchal; patients were circumcised in 90% of reviewed cases of male HTTS. The most commonly involved body parts were clitoris and labia minora in females, and penis and urethra in males. Males most commonly presented with edema and urinary symptoms, whereas females most commonly presented with edema and pain. General anesthesia was used for tourniquet excision in most cases. Male and female genital HTTS were mostly managed by urologists and emergency medicine physicians, respectively. Conclusion:This systematic literature review of more than 150 cases of male and female genital HTTS describes evaluation and management of genital HTTS spanning 7 decades. The main treatment of genital HTTS remains prompt diagnosis and removal of the tourniquet, as well as education on prevention strategies. Delayed diagnosis due to lack of recognition of the HTTS can lead to serious sequelae. Development of national guidelines regarding best practices in management of genital HTTS disseminated to all providers taking care of pediatric and adolescent patients will lead to improved patient care.

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Section: Female Genitalia Httsmentioning

confidence: 99%

Systematic Literature Review of Pediatric Male and Female Genital Hair Thread Tourniquet Syndrome

et al. 2022

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“…Jennifer and Jean reported 1 case of penile strangulation in a 30 year old man with coronal urethrocutaneous fistula due to a neglected condom ring on the coronal sulcus (11). Bouassida and coworkers reported a single case of penile hair coil strangulation in a 9 year old circumcised boy (12) while Qamar from Pakistan reported 15 cases in 27 years caused by hair and thread (13) . We are not aware of the exact number of children who presented to our outpatient clinic in the decade 2010-2020, but the rough estimate is more than 11,000 children.…”

Section: Discussionmentioning

confidence: 99%

Hair coil strangulation of the penis in children: Single center experience in a decade.

Shouman

Wahab²,

Elgharably³

et al. 2022

Pediatric Sciences Journal

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Background: Penile hair coil strangulation is a rare condition that might culminate in penile gangrene and amputation. Aim of work: To report clinical presentation, management, complications and outcomes of hair coil strangulation of the penis in the pediatric age. Material and Methods:We reviewed the data of 31 patients who presented with penile hair coil strangulation between January 2010 and December 2020 to the Urology Department at Cairo University Specialized Pediatric Hospital. Injury was graded as proposed by Bashir and El Barbary. Data regarding presentation, surgical intervention, complications and the outcomes were recorded. Results: Mean age at presentation was 4.43 ±2.5 years. Thirty (97%) patients presented in the strangulation phase. Onset of symptoms was estimated to be 1-4 weeks earlier. All boys were circumcised. None had any neurological disease. Hair coil removal and medical management (antiseptic, antibiotics, anti-inflammatory) was done for all patients on the day of presentation. Examination under anesthesia and hair removal was done for 7 (22.5%) boys. Urinary diversion was not done on day of presentation. Mean follow up period was 22.5±8.65months (6 -36). Five (16%) boys had superficial skin injury grade (0) and were managed conservatively, 19 (61%) had partial transection of the urethra grade (1), 6 (19%) had complete transection of the urethra grade (2) and 1 (3%) had transection of the spongiosum and the cavernosum with amputated glans grade (3). Surgical intervention was delayed for 3 months after hair coil removal. Twenty six boys (84%) needed surgical intervention. Mean duration until catheter removal was 7.65±3.05 days (5-14). Twenty four boys (92%) had satisfactory cosmetic outcome (normal looking glans, no constriction ring), 2 (8%) had persistent constriction ring which was surgically corrected later and 4 (15.38%) had small urethrocutaneous fistula which was repaired after 6 months. None of our boys developed anastomotic strictures. Success rate was 77% after primary surgery. Conclusion: Penile hair coil strangulation is a rare condition that can be easily misdiagnosed as balanitis, proper diagnosis requires high index of suspicion. Delayed single stage surgical intervention gives chance for inflammation to subside with satisfactory functional and cosmetic outcome. Level of Evidence of Study: III (1).

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“…Penile strangulation has also been reported in pediatric population with hair tourniquets, rubber bands and threads as common constricting objects [ 8 , [14] , [15] , [16] ]. Penile strangulation has also been associated with psychiatric disorders [ 4 ]. In our case, the child was diagnosed with moderate oppositional defiant disorder and her mother reported the child to have argumentative and defiant behavior, vindictiveness, angry and irritable mood for more than six months [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Despite being rare, mostly occurs in adult and adolescent due to erotic or autoerotic or enhancement of sexual performance or sometimes from devices applied to collect urine in patients with enuresis or urine incontinence [ [1] , [2] , [3] ]. There are more than 16 case report of pediatrics penile strangulation with metallic nut in one case [ 4 ]. Moreover, most patients also have associated psychiatric illness [ 1 , 2 ].…”

Section: Introduction and Importancementioning

confidence: 99%

Penile strangulation by a metallic nut in an 8-year-old male: A rare case report of urological emergency

Mbwambo

Kiattu

Mbwambo

et al. 2021

International Journal of Surgery Case Reports

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Introduction and importance Penile strangulation due to metallic objects in pediatric age groups is a rare urological emergency that warrant emergency management. Removal of metallic ring from strangulated penis poses a great challenge to urologist as it may require industrial gadgets. Multidisciplinary management involving psychiatrist is required. To the best of our knowledge, this is the first reported novel case of penile strangulation by a metallic nut in children in Tanzania. Furthermore, this case report shows that Industrial Manual Scissor metal (IMSMC) cutter offers a safe way of removing metallic nut from strangulated penis with few complications. Case presentation We report a case report of penile strangulation in an 8 year-old boy by a metallic nut which stayed for 11 h prior to arriving at a tertiary hospital in Northern Tanzania. The reason for insertion of nut by a child was not clear. Clinical discussion On arrival to the hospital the child was clinically stable but in pain. Local examination revealed a metallic nut at proximal penis with grossly edematous penis. A diagnosis of penile strangulation by metallic nut was reached and the child was planned for emergency surgery to remove the metallic nut. The metallic nut was successful removed by IMSMC. This technique has been used in adult with success with few complications and therefore opted in our setting. The child was also diagnosed with oppositional defiant disorder. Conclusion Industrial Manual Scissor Metal cutter is a safe way of managing penile strangulation by a metallic nut in children.

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Penile strangulation injury in children — Reconstructive procedure and outcome

Cited by 7 publications

References 13 publications

Systematic Literature Review of Pediatric Male and Female Genital Hair Thread Tourniquet Syndrome

Systematic Literature Review of Pediatric Male and Female Genital Hair Thread Tourniquet Syndrome

Hair coil strangulation of the penis in children: Single center experience in a decade.

Penile strangulation by a metallic nut in an 8-year-old male: A rare case report of urological emergency

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