Treatment Options and Outcomes of Penile Constriction Devices

Abstract

Purpose: To study the effect of penile constriction devices used on a large series of patients who presented at our emergency facility. We explored treatment options to prevent a wide range of vascular and mechanical injuries occurring due to penile entrapment. Materials and Methods: Between January 2001 and March 2016, 26 patients with penile entrapment were admitted to our facility and prospectively evaluated. Results: The time that elapsed from penile constrictor application to hospital admission varied from 10 hours to 6 weeks (mean: 22.8 hours). Non-metallic devices were used by 18 patients (66.6%) while the other nine (33.4%) had used metallic objects. Acute urinary retention was present in six (23%) patients, of whom four (66.6%) underwent percutaneous surgical cystotomy and two (33.4%) underwent simple bladder catheterization. The main reason for penile constrictor placement was erectile dysfunction, accounting for 15 (55.5%) cases. Autoerotic intention, psychiatric disorders, and sexual violence were responsible in five (18.5%), five (18.5%), and two (7.4%) cases, respectively. The mean hospital stay was 18 hours (range, 6 hours to 3 weeks). Conclusion: Penile strangulation treatment must be immediate through the extraction of the foreign body, avoiding vascular impairments that can lead to serious complications. Most patients present with low-grade injuries and use penile constrictors due to erectile dysfunction. Removal of constrictor device can be challenging. The use of specific tools for achieving penile release from constrictors is a fast, safe and effective method. Patients with urinary retention may require urinary diversion.

Penile entrapment by metal ring: Case reports of effective non-surgical management

“…Patient may delay seeking medical attention due to embarrassment and patient's own attempt to release the entrapment individually. 3 In our cases, patient used a bolt ring of 1.5 cm in thickness and sook medical treatment more than 8 hours following a failed attempt of releasing the strangulation.…”

“…Prolonged reduction of venous return may eventually result in distal penile edema from the entrapment site, blocked the arterial supply, and eventually damages the sensitive soft tissues of the male external genitalia. 3 After several hours of compromised circulation, penile strangulation may eventually lead to ischemic necrosis, urinary retention, fibrosis of the tissue, even multiorgan failure due to septic shock. 4 Bhat et al have developed a grading system to describe the severity spectrum of penile entrapment ( Table 1 ).…”

Retained Penile Ring: Case Reports

“…4,6,7 These objects are inserted with various intentions ranging from treatment of erectile dysfunction, autoerotic intention, psychiatric disorder and sexual violence. 8 Different types of injuries can be produced by a metal ring through a combination of vascular and mechanical means. Initially, there is obstruction to lymphatic and venous drainage which leads to increase in hydrostatic pressure and tissue edema.…”

“…10 In a recent case series, Bhat Odusanya Benjamin Olasunkanmi et al, IJCR,2020 4:116 grade I occurred in 55.5% and grade V in 11.1 %. 8 Various methods of anesthesia has been described by different authors. Some have employed penile blocks while others used general anaesthesia.…”

“…Some have employed penile blocks while others used general anaesthesia. 2,3,8 In our patients we utilised sedation with benzodiazepine and opioid in the first patient and the second patient had general anaesthesia.…”