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

Abstract

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).