Management of prolonged wrench penile entrapment: A case report & literature review

Penile entrapment is a rare urological emergency that may lead to mechanical and vascular complications. It commonly occurs due to the use of constrictive devices during sexual activity. Delayed presentation, often due to embarrassment or psychiatric disorders, can worsen outcomes. We present a case of prolonged penile entrapment involving a wrench, successfully managed using an electric grinder.

A 61-year-old male presented with penile swelling and urinary retention for three days. He reported placing a wrench around the base of his penis three weeks prior during a delusional episode. Examination revealed significant oedema with the wrench firmly embedded. Laboratory evaluation showed type 2 diabetes mellitus, acute kidney injury, and electrolyte imbalances. The device was removed under local anesthesia using an electric grinder, with protective measures to avoid thermal injury. The patient experienced moderate erectile dysfunction postoperatively but reported no other urological complaints during follow-up.

Prompt recognition and management of penile entrapment are crucial to prevent ischemia, necrosis, and permanent damage. The method of device removal should be tailored to the severity of injury and type of constricting object. Mild cases may respond to manual or non-invasive techniques, while severe cases require mechanical tools. A multidisciplinary approach, including surgical, urological, and psychiatric input, improves outcomes and addresses underlying causes.

Penile entrapment requires timely and tailored management. Mechanical tools such as electric grinders can be safely used in selected cases. Comprehensive care, including psychiatric evaluation, is vital for optimal recovery and prevention of recurrence.