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The management of penile zip entrapment in children
1Department of Accident and Emergency, Royal Hospital for Sick Children, Edinburgh, UK.
Insights
Penile zip entrapment in boys is common, often occurring during dressing and with underwear on. Most cases can be treated without general anesthesia in pediatric emergency departments.
Area of Science:
- Pediatric Emergency Medicine
- Urology
- Trauma Management
Background:
- Penile zip entrapment is a common pediatric emergency.
- Previous studies have varied on the circumstances and management of these injuries.
Purpose of the Study:
- To analyze the incidence, mechanism, and management of penile zip entrapment in children.
- To develop a treatment algorithm for penile zip entrapment.
Main Methods:
- Retrospective review of pediatric patients presenting with penile zip entrapment over seven years.
- Classification of entrapment types to guide release strategies.
Main Results:
- Thirty cases of penile zip entrapment were identified over seven years.
- Entrapment most frequently occurred during zipping up trousers while wearing underwear.
- 26 out of 30 children were managed non-surgically in the emergency department without general anesthesia.
- No long-term sequelae or need for circumcision was observed.
Conclusions:
- Penile zip entrapment is a frequent pediatric emergency with specific common mechanisms.
- A simplified, non-anesthetic approach is effective for most cases.
- A treatment algorithm can guide efficient management in pediatric emergency settings.
Abstract:
Thirty boys, aged 2-12 years, presented with penile zip entrapment to one Paediatric Accident and Emergency Department over a 7 year period. The rate of presentation was one zip entrapment per 4068 new patient attendances. In contrast to previous reports, injuries occurred most commonly whilst the zip was being done up and whilst underpants were being worn. Two types of entrapment were seen, determining the way in which release was achieved. Contrary to previous suggestions, most children (26 out of 30) were easily managed in the Accident and Emergency Department without general anaesthetic. No patient required circumcision or suffered any sequelae. An algorithm for treatment based upon the experience of this study is presented.
