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[PENILE STRANGULATION CAUSED BY A METALLIC RING SUCCESSFULLY TREATED BY PENILE PUNCTURE PLUS BLOOD REMOVAL INSTEAD OF
Koki Anan1, Kenji Kuroda1, Yuhei Segawa1
1Department of Urology, National Defense Medical College Hospital.
Abstract:
A 63-year-old man visited our hospital with a complaint of penile swelling caused by metallic ring entrapment in the penis. He had put the ring around his penis 4 hours prior and was subsequently unable to remove it. We attempted to remove the ring using a ring cutter but that was unsuccessful. We then inserted two 18 G needles into the corpus cavernosum through the glans penis and removed blood by manual compression according to a technique called the "string method." The swelling gradually decreased, and we successfully removed the ring without destroying it. The total duration of strangulation was about 5 hours. The patient was subsequently discharged after ensuring he had no urinary difficulties. No complications were observed during the follow-up period.In almost all penile strangulation cases caused by hard objects, such as metallic rings, reported in Japan, the objects were typically destroyed and penile puncture and blood removal, as was performed in our case, was rare. Although penile puncture and blood removal is not commonly performed in Japan, this technique can be performed quickly and inexpensively in the emergency room and should be considered an initial treatment for penile strangulation caused by hard objects.
Insights
Penile strangulation by a metallic ring was treated using the string method, involving needle insertion into the corpus cavernosum to reduce swelling. This technique successfully removed the ring without damage, offering a quick, cost-effective emergency treatment option.
Area of Science:
- Urology
- Emergency Medicine
Background:
- Penile strangulation, often caused by constrictive devices like metallic rings, presents a urological emergency requiring prompt intervention.
- Traditional management in Japan frequently involves destructive removal of the constricting object, potentially damaging the penis.
Observation:
- A 63-year-old male presented with penile swelling due to a metallic ring, irreducible for 4 hours.
- A ring cutter failed; the 'string method' was employed, involving needle insertion into the corpus cavernosum to aspirate blood via manual compression.
Findings:
- The string method effectively reduced penile swelling, allowing successful non-destructive removal of the metallic ring after approximately 5 hours of strangulation.
- The patient experienced no urinary difficulties and had no complications during follow-up.
Implications:
- The string method offers a rapid, inexpensive, and effective alternative for managing penile strangulation by hard objects in emergency settings.
- This technique should be considered as a primary treatment option, particularly when object destruction is undesirable or unsuccessful.
