Penile Strangulation: Two Case Reports and Review of the Literature

Abstract

Introduction Entrapment or strangulation of the penis is a rare emergency situation that can lead to a wide range of vascular and mechanical injuries. Aim 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. Methods We performed a computerized MEDLINE search followed by a manual bibliographic review of cross-references. These reports were analyzed and the important findings summarized. Results 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. Conclusion 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.

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

“…When it occurs, it may be due to Fournier's gangrene, 8 peripheral occlusive vascular disease, 9 or in some occasional patients a complication of diabetes. 10,11 Strangulating agents used on the penis (an important cause of gangrene) was reported in the literature as far back as 1755 12 and since then about 60 cases have been reported in the world literature 1 . The majority of strangulating penile injuries are self inflicted and the motives are as varied as the constricting agents.…”

“…1,2 Cases caused by metal rings, 2,3 plastic or glass bottles, 1,4,6 hammer heads 5 and many other objects have been described. The motive behind the action varied as the objects responsible for the injury but could be delibrate for mastubation or to improve sexual performance.…”

Genitalia strangulation – fireman to the rescue!

“…Delay in removing the constriction can cause tissue loss. 1 Removal should ideally take place under general anaesthesia and extreme care should be taken to avoid any iatrogenic injury to the genitalia. Removal may require instruments not available in the theatre, as in this case.…”

Case report. Het verwijderen van een penoscrotale ring na scrotuminfusie

“…Waarom dit wordt gedaan, is vooralsnog onduidelijk. Penoscrotale beknelling is geassocieerd met complicaties, zoals huidlaceraties, oedeem, penisnecrose, testisnecrose, erectiele disfunctie, urethrale stricturen en soms zelfs sepsis met multiorgaanfalen, die zelfs tot de dood kan leiden [2][3][4][5].…”