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

Abstract

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.

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

“…As the pressure increases because of the lymphatic obstruction and venous congestion, the continuous constriction force results in compartment syndrome type situation. This eventually leads to obstruction of the arterial inflow to the distal part of the penis, resulting in strangulation [1][2][3][4][5]. If the offending object is not removed timely, then the strangulation would lead to soft tissue ischaemia, necrosis, local infection, and gangrene [1,3,4].…”

“…The delay in presentation results in penile swelling out of proportion to the inner diameter of the object stuck, thus making the task of removing the foreign body even more difficult. The prolonged placement and delayed removal of these objects are likely to cause high-grade injuries [1,4,5].…”

“…The objects reported are metal rings, bands, pipes, bottles, threads of metal or plastic or latex of all shapes and sizes [3,4]. These objects have constriction force on the penis which hampers blood and lymphatic flow, resulting in strangulation.…”

Strangulation of the Penis by a Metallic Ring: Prevention Is Better Than Cure

“…These people are, therefore, more likely to have bizarre and dangerous sexual behaviors, such as the case of our patient who believed to have eternal pleasure in incarcerating a metal ring in the penis. In the pediatric population, this maneuver has been attempted to prevent enuresis [ 3 ]. The most frequent questioned objects, besides the metal also found in our observation, are hair, threads, fabrics, plastics, laces, and ropes [ 2 , 4 ].…”

Penile incerceration—A tight affair

“…It was prolonged and caused penile pain and blistering. Penile incarceration therefore is a urological emergency that requires prompt decompression to restore perfusion and prevent ischaemia [7] .…”