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Skalak M, Jirjis R, Anderson BG, Miller BD. Robot-Assisted Repair of Bladder Rupture following Penile Ring Entrapment. Case Rep Urol 2023; 2023:5523569. [PMID: 37719234 PMCID: PMC10501845 DOI: 10.1155/2023/5523569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/06/2023] [Accepted: 08/11/2023] [Indexed: 09/19/2023] Open
Abstract
Penile rings have been used to help sustain erection and enhance sexual pleasure for centuries. Constriction of the penis reduces the outflow of blood from the cavernosal tissue. However, if left for an extended time period, a condition called penile ring entrapment can occur. This may result in severe edema, gangrene, necrosis, and even penile amputation. Penile ring entrapment is a very rare condition; complete urinary obstruction with concomitant bladder rupture as a result renders this case even more extraordinary. We discuss our experience in the management of a 64-year-old man, who presented with altered mental status and inability to urinate, found to have penile ring entrapment and intraperitoneal bladder rupture. Removal of the constricting ring was performed in the ED, and bladder injury and penile necrosis were subsequently repaired with robot-assisted laparoscopic cystorrhaphy, penectomy, and perineal urethrostomy.
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Affiliation(s)
- Matthew Skalak
- Detroit Medical Center Urology Residency, Harper Professional Building, 4160 John R St., Suite 1017, Detroit, MI 48201, USA
| | - Rami Jirjis
- Detroit Medical Center Urology Residency, Harper Professional Building, 4160 John R St., Suite 1017, Detroit, MI 48201, USA
| | - Barrett G. Anderson
- Detroit Medical Center Urology Residency, Harper Professional Building, 4160 John R St., Suite 1017, Detroit, MI 48201, USA
| | - Brandi D. Miller
- Detroit Medical Center Urology Residency, Harper Professional Building, 4160 John R St., Suite 1017, Detroit, MI 48201, USA
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2
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Vedhanayagam M, Rajagopalan R, Revathi K, Dasar H, Balamurugan BR, Srinivasahan KG. Self-inflicted genital ulcer: An intriguing case report. Indian J Sex Transm Dis AIDS 2023; 44:82-84. [PMID: 37457511 PMCID: PMC10343112 DOI: 10.4103/ijstd.ijstd_18_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/09/2023] [Accepted: 03/16/2023] [Indexed: 07/18/2023] Open
Abstract
Self inflicted genital ulcer due to penile constriction injury is a rare clinical entity, which requires urgent management to prevent its devastating outcomes such as penile gangrene and auto amputation. Although this is common, definitely, it is of interest because of the genital involvement. Here, we present a case report on an unusual case of rubber band induced penile constriction injury.
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Affiliation(s)
| | - Rajesh Rajagopalan
- Department of DVL, Government Erode Medical College Hospital, Perundurai, Tamil Nadu, India
| | - K. Revathi
- Department of DVL, Government Erode Medical College Hospital, Perundurai, Tamil Nadu, India
| | - Hareeshkumar Dasar
- Department of DVL, Government Erode Medical College Hospital, Perundurai, Tamil Nadu, India
| | - B. R. Balamurugan
- Department of DVL, Government Erode Medical College Hospital, Perundurai, Tamil Nadu, India
| | - K. G. Srinivasahan
- Department of DVL, Government Erode Medical College Hospital, Perundurai, Tamil Nadu, India
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3
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Nguyen TT, Ngo XT, Chau QT, Hoang KC, Dinh LQV, Ly HT, Hoang TD, Dobbs RW, Thai MS. Use of dental drill handpiece to remove steel nut causing penile strangulation: a case report and review of the literature. J Med Case Rep 2022; 16:158. [PMID: 35440026 PMCID: PMC9020065 DOI: 10.1186/s13256-022-03342-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 02/21/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Penile strangulation is an uncommon urological emergency that requires prompt intervention to avoid potentially serious sequelae including loss of the distal penis secondary to ischemia and subsequent gangrene. We present a case report of a patient who presented to the hospital with penile strangulation injury of 10-hour duration secondary to the presence of a thick hexagonal steel nut. This case is presented in accordance with Consensus Surgical Case Report guidelines. CASE PRESENTATION A 24-year-old Vietnamese man presented to the emergency room with urinary retention and decreased penile sensation following a 10-hour history of penile strangulation due to the presence of a thick hexagonal steel nut that he had placed around the shaft of the penis for the purpose of sexual enhancement during masturbation. The hexagonal nut was tightly entrapping the penile shaft, resulting in edema, congestion, and swelling of the distal 5 cm of the phallus. Given the thickness of the foreign body as well as the degree of penile swelling, we were unable to remove the hexagonal nut using traditional methods of alleviating penile strangulation injuries. Following consultation with a dental colleague, a dental diamond drill handpiece was utilized to cut the foreign body without injury to the underlying penile skin. Subsequent follow-up in clinic demonstrated no significant urinary or sexual sequalae from this episode. CONCLUSION We report a case of penile strangulation requiring novel instrumentation and collaboration for successful treatment.
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Affiliation(s)
- Tuan Thanh Nguyen
- Cho Ray Hospital, Ho Chi Minh City, Vietnam.,University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Xuan Thai Ngo
- Cho Ray Hospital, Ho Chi Minh City, Vietnam.,University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | | | | | | | | | - Ryan W Dobbs
- Cook County Health and Hospitals System, Chicago, IL, USA
| | - Minh Sam Thai
- Cho Ray Hospital, Ho Chi Minh City, Vietnam. .,University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
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Fischer J, Krishnamurthy J, Hansen S, Reeves PT. Austere Foreign Body Injuries in Children and Adolescents: A Characterization of Penile, Rectal, and Vaginal Injuries Presenting to Emergency Departments in the United States From 2008 to 2017. Pediatr Emerg Care 2021; 37:e805-e811. [PMID: 30870345 DOI: 10.1097/pec.0000000000001803] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Pediatric foreign body (FB) injuries to the nasal, aural, and/or oral cavities are well documented. Description of austere foreign body (AFB) injuries involving the rectum, vagina, or penis eludes the current pediatric literature. Austere FBs can be difficult to identify and have the potential to cause serious consequences. We aim to characterize AFB injuries by children and adolescents presenting to emergency departments (EDs) in the United States. METHODS The National Electronic Injury Surveillance System was queried to include subjects aged 0 to 25 years using a primary search term for diagnosis of foreign body from the period of January 2008 to January 2017. The consumer product and the body part involved (ie, rectal, vaginal, penile) were analyzed. Taylor series linearization generated national estimates. A trend analysis was performed using the Cochrane Armitage test of trend. RESULTS There were 27,755 (95% confidence interval, 21,170-34,338) national estimated childhood ED visits for suspected AFB injuries during 2008 to 2017 including an estimated 7756 vaginal FBs, 7138 penile FBs, and 8359 rectal FBs (RFBs). Over the timeline, there was a significant up trend in the frequency of annual RFBs (P < 0.01). CONCLUSION Austere FB injuries appear to cluster around age of 7 years. Most AFB injuries are able to be treated and released from the ED. It appears that RFB injury frequencies are rising and tend to require more frequent admission. Providers must be vigilant in the diagnosis and management of these potentially hazardous injury types.
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Affiliation(s)
- Julie Fischer
- From the Department of Pediatrics, Brooke Army Medical Center, San Antonio, TX
| | - Jayasree Krishnamurthy
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
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Forrester MB. Penis Ring Injuries Treated at Emergency Departments. JOURNAL OF SEX & MARITAL THERAPY 2021; 48:103-111. [PMID: 33734034 DOI: 10.1080/0092623x.2021.1900003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The purpose of this study was to determine the pattern of penis ring-related injuries in the US. During 2000-2019, 162 penis ring-related injuries (for a national estimate of 6,344 such injuries) were treated at US emergency departments (EDs). Of the estimated injuries, 32.3% occurred during 2000-2011 and 67.7% during 2012-2015. The patients were 49.8% age 30-49 years. The most common types of injuries were ring stuck on the penis or scrotum (75.3%), edema (29.9%), pain (18.7%), and contusion or abrasion (7.6%). In 81.9% of the estimated injuries, the patient was treated or examined at the ED and then released.
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Puvvada S, Kasaraneni P, Gowda RD, Mylarappa P, T M, Dokania K, Kulkarni A, Jayakumar V. Stepwise approach in the management of penile strangulation and penile preservation: 15-year experience in a tertiary care hospital. Arab J Urol 2019; 17:305-313. [PMID: 31723448 PMCID: PMC6830290 DOI: 10.1080/2090598x.2019.1647677] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/23/2019] [Indexed: 12/24/2022] Open
Abstract
Objective: To present our stepwise approach to the management of penile strangulation and penile preservation with 15 years’ experience in a tertiary care hospital, as penile strangulation is a rare urological emergency that requires immediate attention. Patients and methods: A prospective observational study was performed from March 2003 to December 2018 of patients presenting with penile strangulation to our hospital. Results: Nine patients with penile strangulation presented to us between March 2003 and December 2018. The most common motive for the application of a foreign body was sexual gratification (four patients). Three of the nine patients had a mental disorder. Objects used for strangulation included: metallic nut (three), metallic ring (two), plastic bottle (two), wooden hole (one), hammer head (one), and horse hair to control bleeding during circumcision (one). Most of the foreign bodies were located in the proximal penile region. The mean operative time was 38 min and three of the nine patients had complications. Conclusions: Penile strangulation is one of the rare urological emergencies experienced by a urologist. Removal of the foreign body can be difficult and there is no universal method of removal, as each case differs. So, following our stepwise approach can aid in removal of foreign body quickly and preserve the penis from fatal outcomes. Urologist should be aware of all the available armamentarium used for the removal of such foreign bodies. Abbreviation: SPC: suprapubic cystostomy
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Affiliation(s)
- Sandeep Puvvada
- Department of Urology, MS Ramaiah Medical College, Bengaluru, India
| | | | | | - Prasad Mylarappa
- Department of Urology, MS Ramaiah Medical College, Bengaluru, India
| | - Manasa T
- Department of Urology, MS Ramaiah Medical College, Bengaluru, India
| | - Kanishk Dokania
- Department of Urology, MS Ramaiah Medical College, Bengaluru, India
| | | | - Vivek Jayakumar
- Department of Urology, MS Ramaiah Medical College, Bengaluru, India
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Dawood O, Tabibi S, Fiuk J, Patel N, El-Zawahry A. Penile ring entrapment - A true urologic emergency: Grading, approach, and management. Urol Ann 2019; 12:15-18. [PMID: 32015611 PMCID: PMC6978966 DOI: 10.4103/ua.ua_16_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 09/30/2019] [Indexed: 11/07/2022] Open
Abstract
Penile rings are used to sustain erection in order to enhance sexual pleasure. They work by reducing the outflow of blood from the cavernosal tissue. However, if left for extended periods of time severe edema, urethral fistula, gangrene, and even complete loss of the distal penis can ensue, this is known as penile ring entrapment (PRE). Management poses particular challenges due to its rarity. Herein, we report our experience with three patients from our institution that presented with PRE and include a review of the approaches others have taken. We also propose a simpler and more effective grading scale to allow for easier communication between providers, as the current grading scales do not do so.
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Affiliation(s)
- Omar Dawood
- Department of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Seena Tabibi
- Department of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Julia Fiuk
- Department of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Neil Patel
- Department of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Ahmed El-Zawahry
- Department of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
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Campbell K, Terry R, Yeung L. Surgical reconstruction and follow-up of penile strangulation injury. Urol Case Rep 2018; 19:6-8. [PMID: 29888174 PMCID: PMC5991326 DOI: 10.1016/j.eucr.2018.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 02/09/2018] [Indexed: 01/15/2023] Open
Affiliation(s)
- Kevin Campbell
- Department of Urology, University of Florida, PO Box 100247, 1600 SW Archer Road, Gainesville, FL, 32610, United States
| | - Russell Terry
- Department of Urology, University of Florida, PO Box 100247, 1600 SW Archer Road, Gainesville, FL, 32610, United States
| | - Lawrence Yeung
- Department of Urology, University of Florida, PO Box 100247, 1600 SW Archer Road, Gainesville, FL, 32610, United States
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Low LS, Holmes M. The GEM ring cutter: An effective, simple treatment of penile strangulation caused by metal rings. Urol Case Rep 2018; 19:39-41. [PMID: 29888187 PMCID: PMC5991319 DOI: 10.1016/j.eucr.2018.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/01/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
- Li Sian Low
- Urology Department, Waikato District Health Board, Hamilton, New Zealand
| | - Michael Holmes
- Urology Department, Waikato District Health Board, Hamilton, New Zealand
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