Removal of a Steel Ring Causing Penile Strangulation Without the Use of Powered Tools or Sharp Blades

Penile strangulation is an uncommon urologic emergency that requires prompt evaluation and treatment to avoid disastrous consequences. Strangulation has been reported with objects ranging from hair tourniquets, to plastic rings, to iron rings. Strangulation with these devices can result in vascular congestion of the penis, swelling and eventual gangrene of the penis distal to the constricting device. We present a case report of a 43-year-old male who had a 2-day history of penile pain and swelling secondary to a metal ring constricting the proximal phallus. Ring removal was achieved with an orthopedic bolt cutter to cut the ring in two places, using a malleable retractor to act as a "backboard" to prevent iatrogenic injury to the penis.