Treatment of Penile Incarceration by the String Method: 2 Case Reports

Vähäsarja, Vesa; Hellström, Pekka; Serlo, Willy; Kontturi, M

doi:10.1016/s0022-5347(17)36088-3

Cited by 56 publications

(35 citation statements)

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“…The purported motives for placement of constricting objects are almost always sexual in nature in adult population [2,3,5,7,14,15,16,17]. All the 3 patients in this series placed these metallic objects for sexual gratification.…”

Section: Discussionmentioning

confidence: 94%

“…All the 3 patients in this series placed these metallic objects for sexual gratification. Few of the published reports have analyzed the psychiatric status of these patients [7,14,16] and it is likely that a more detailed evaluation of cognitive state of these patients by trained psychologists may reveal underlying contributory factors. All the 3 patients in our series were assessed by a psychiatrist and one patient having severe depression was put on appropriate therapy while another patient was advised regular counseling sessions for psychological erectile dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…Yet, few reports about this peculiar entity are available in the literature and most of these are single case reports. The reported motives for placing an incarcerating object include attempted enhancement of sexual performance and heightening of sexual sensation and orgasm [2], self-treatment of erectile dysfunction [3,4,5] and psychiatric disorders [6,7] in adults, while in the pediatric population, this maneuver has been attempted for prevention of enuresis [8]. A plethora of objects have been reported like nuts, washers, plastic and steel rings, bottles, rubber bands, bottlenecks, ball-bearings and wedding rings.…”

Section: Introductionmentioning

confidence: 99%

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Penile Incarceration with Metallic Foreign Bodies: Management and Review of Literature

et al. 2013

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Introduction: Penile strangulation from constricting metallic objects disorders is an uncommon urological emergency which requires prompt intervention to prevent complications. The treatment modalities are diverse and characterized by lack of consensus. Material and Methods: Three cases with penile incarceration due to constricting metallic objects who presented to our department were included in this study. All 3 patients required different management options highlighting the diversity of clinical presentation and need for customization of treatment as per the clinical scenario. Results: The 3 patients required different approach for treatment. First patient could be managed by degloving of penile skin while second patient required mechanical removal of the foreign body and debridement of local necrotic tissues. The third patient had to undergo excision of gangrenous penile skin and skin grafting. Conclusion: The study emphasizes the diversity of clinical presentations and the need for employing different surgical techniques to achieve the desired results.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Penile Incarceration with Metallic Foreign Bodies: Management and Review of Literature

et al. 2013

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“…Vahasarja et al [7] reported two cases successfully managed by this method. Detweiler and Perkins [8] used latex band in a similar fashion calling it the Wrapping Technique.…”

Section: Discussionmentioning

confidence: 99%

Liamed Listare E-mail ISSUE 2, VOL. 9, 2013 EDITORIAL PROTON PUMP INHIBITORS BETWEEN BENEFITS AND RISKS Cătălina Mihai, Mihaela Dranga, M. Badea, Otilia Nedelciuc, Cristina Cijevschi Prelipcean Jurnalul de chirurgie (Iaşi) 2013; 9(2): 107-111. Abstract Full text: Format PDF (Română/Romanian) DOI: 10.7438/1584-9341-9-2-1 REVIEWS NECESSITY TO REVIEW ATLANTA CLASSIFICATION OF ACUTE PANCREATITIS V. Păunescu Jurnalul de chirurgie (Iaşi) 2013; 9(2): 113-126. Abstract Full text: Format PDF (Română/Romanian) DOI:

Kumar¹,

Gupta²

2013

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Abstract): INTRODUCTION: Application of constriction over penis by means of various objects for autoerotic purpose is a practice that may lead to dangerous consequences. A large variety of objects have been used for this purpose leading to a spectrum of complications. Management of such cases poses a great challenge to the treating surgeon, as it often requires teamwork involving not only doctors but also technical experts from engineering department. We report a case where a man presented with acute retention of urine with two metallic rings over his penis. CASE REPORT: A 50 years old man presented to the surgical emergency ward with complaint of acute retention of urine. He had pushed two metallic rings over his penis about two hours back in a bid to get sexual pleasure while he was under influence of alcohol. The rings later got impacted over the penis because of congestion of distal part of penis. Soon the patient developed the complaint of mild pain and swelling of penis and inability to pass urine and was brought to the hospital. The physical exam revealed that the part of penis distal to the rings was congested, swollen and slightly discolored. We started with urinary bladder emptying by putting a wide bore needle suprapubically and connecting it to a urobag through a drip set. Penile block was given. Blood was then aspirated from both corpora cavernosa distal to the rings and the rings were manipulated after generous application of lubricant jelly. This way, rings could be moved almost up to corona glandis obstructed only by a band of edematous skin. Now multiple needle punctures were given in this skin and the area was kept compressed for a while using a tape-gauze wrapped tightly over it. On removing the gauze, rings could be moved up to corona. Now the distal ring was placed with its wide stone bearing part against the ventral aspect of glans. Glans was then decongested by means of needle punctures and digital compression. Ring was rotated with traction while glans was compressed to negotiate through it. The attempt was successful and both rings were removed in this fashion. The post operative course was uneventful. CONCLUSIONS: Aspiration and puncture technique facilitates the removal of constricting objects from the penis. This technique is safe and does not require sophisticated equipment. KEY WORDS: PENILE ENTRAPMENT; METAL RINGS; ASPIRATION AND PUNCTURE TECHNIQUESHORT TITLE: Penile entrapment: aspiration technique HOW TO CITE: Kumar S, Gupta A. A case of penile entrapment in metal rings treated by aspiration and puncture technique. Jurnalul de chirurgie (Iaşi). 2013; 9(2): 185-188.

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“…Elle peut aussi etre associee une aspiration du sang par le gland ( Figure 3) [6]. Cette technique donne de bons resultats pour les grades I, II et III, permettant une decompression sans lesions des tissus [5,12,19].…”

Section: La M~thode Du Filunclassified

Gangrène du pénis secondaire à une strangulation par un anneau métallique

Dahami

Saghir

Elhaous

et al. 2007

Androl.

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Asbahani 1, n ~ 17, Gueliz Marrakech, 40 000, 174 place au niveau de la racine avec un important oedeme distal, et une necrose cutanee au niveau du fourreau penien (Figure 1). Le gland est engorg& cyanose, avec une perte totale de la sensibilit& On note par ailleurs I'absence de fistule uretrale ou de troubles mictionnels associes a type de retention d'urine.Une tentative pour couper I'anneau par une pince metaux se solde par un echec vu I'importance de son epaisseur et sa grande resistance. Un traitement chirurgical de decompression sous rachianesthesie est preconise. L'intervention consiste en une incision cutanee sur la base de la verge, avec denudation totale du corps caverneux et excision de la totalite du fourreau penien necrose et oedematie dans un premier temps permettant ainsi I'extraction du pignon de la verge sans difficulte ( III. DISCUSSIONLa strangulation penienne par un anneau metallique est un traumatisme grave mais rare qui peut entrer dans le cadre des automutilations s'il est realise dans un contexte de troubles psychiatriques avec auto agressivite [13], comme il peut ~tre un simple accident s'il est utilise pour ameliorer la fonction erectile ou comme methode d'auto-erotisme [3,4,14,16]. Dans tousles cas il requiert une decompression en urgence. Le retour veineux et lymphatique est interrompu en premier, engendrant I'oedeme qui apparaft au bout de quelques heures et gene I'extraction de ranneau. Si la compression evolue, le flux arteriel peut etre compromis [11,14].Plusieurs complications possibles de la strangulation peuvent survenir : la retention urinaire dans 50% des cas, les fistules urethrales, le priapisme, I'hypoesthesie distale, I'ulceration et la necrose cutanees pouvant evoluer vers la gangrene voire I'amputation de la verge. Ces complications dependent de la duree et de la gravite de la compression [1-3, 8, 9, 18].Le principe du traitement est simple : c'est la decompression rapide de la verge afin de permettre une bonne vascularisation des tissus. Par contre le choix de la methode therapeutique est un veritable challenge pour I'urologue vu la grande panoplie des anneaux utilises et la variabilite des lesions [14]. L'aspirationOn utilise des aiguilles pour aspirer le sang du gland et des corps caverneux ou pour faire des ponctions sous cutanees afin d'evacuer la lymphe qui cause I'oedeme. Seuls trois cas d'aspiration sont rapportes dans la litterature pour des strangulations de moins de 14 h, de grades II et III [3,11,17]. La chirurgie de decompressionElle est preconisee surtout pour les grades Vet consiste en une denudation de la verge jusqu'au fascia de Buck suivie d'une greffe de peau [1,9]. L'amputation reimplantation de la verge sous microchirurgieElle est preconisee pour les grades IV et V s'il n'y a pas de recuperation de la sensibilite et du pouls distal au doppler au bout d'une semaine post-operatoire [2,7].Apres la levee urgente de I'obstacle, une prise en charge psychiatrique s'impose. La strangulation volontaire de la verge n'est pathognomonique d'aucune affectio...

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Treatment of Penile Incarceration by the String Method: 2 Case Reports

Abstract: We report 2 cases of penile incarceration in a 10-year-old boy and a 40-year-old man. In both cases the penis was encircled by a metallic object. The string method described was successful, rapid, atraumatic and simple to use.

Cited by 56 publications

References 7 publications

Penile Incarceration with Metallic Foreign Bodies: Management and Review of Literature

Penile Incarceration with Metallic Foreign Bodies: Management and Review of Literature

Gangrène du pénis secondaire à une strangulation par un anneau métallique

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