Two cases of penile strangulation: varied presentations and vastly different outcomes

Abstract

Background Penile strangulation by various metallic and non-metallic objects is a true urological emergency that requires prompt emergency management. The cases in this report will help in highlighting the varied presentations one can face in the emergency department. Management of such cases at times needs out-of-the-box thinking and improvised skills as resources to remove the foreign body are often scarce within the hospital. Case presentation We present two such cases of penile strangulation in adult patients. Both patients presented to us in the emergency department, one with a large metallic cone and another with a rubber band constricting their penises. Both the patients had hugely different grades of injuries and were managed accordingly. Both the patients required different methods to remove the constriction objects as per the need of the situation. One of the patients required total penectomy with permanent perineal urethrostomy; however, in the other case, we were able to save the penis. Conclusion Penile strangulation needs urgent medical attention and timely removal of the offending object. Grade of injuries and complications are directly proportional to the type of object and the duration of the strangulation. The non-metallic objects are easy to cut and remove. However, one should be aware of the challenges and the complications in managing metallic foreign bodies which at times may need out-of-the-box thinking, like use of motorized cutting tools.

Use of dental drill handpiece to remove steel nut causing penile strangulation: a case report and review of the literature

“…In contrast, metallic objects are challenging to remove safely. These objects causing penile strangulation in the literature are diverse, including heavy metal rings, hammerheads, metal cones, pipes, plastic bottle necks, sprockets, and plumbing cuffs [ 8 , 9 ]. Metal objects represent a particularly challenging clinical conundrum as standard surgical equipment in hospital or emergency departments may not be able to cut through these objects.…”

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

“…Penile metallic ring strangulation is one of the challenging urological emergencies that can have devastating consequences if not intervened in an emergency manner. 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 ].…”

“…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 ].…”

“…Penile strangulation may result from objects such as metal rings, bands, pipes, bottles, threads of metal or plastic or latex of all shapes and sizes [ [5] , [6] , [7] , [8] ]. In children usually is due to typical objects such as rubber bands, threads or hair [ 1 , [9] , [10] , [11] ]. Non-metallic objects usually are easy to remove while metallic objects are difficult to remove and usually result in penile damage [ 5 ].…”