(294) A CASE OF METAL RING ENTRAPMENT CAUSING PENOSCROTAL STRANGULATION

Abstract Introduction Penile “tension rings” have been described as early as the 3rd century in Chinese literature as men were described as wrapping goat eyelids around the base of their penis for increased erection potency. There have been other materials used to prevent blood outflow from the penis during an erection such as rubber bands, plastic bottlenecks, rubber bands, silicone rings, and metal rings. Wearing a penile/penoscrotal constriction device for longer than 30 minutes can lead to serious complications such as tissue edema, ischemia, and eventual necrosis. Thus, if unable to remove a constrictive device, emergent medical intervention is required. Objective We report a case of an otherwise healthy 56 year-old male who presented to the emergency department with a titanium metal ring around his penis and scrotum for 72 hours. Methods We studied the details of patient presentation, our various treatments attempted, and patient outcome at our institution. We additionally performed a literature review on PubMed (keywords: penile ring entrapment, penile ring strangulation, penile ring treatment) to review other treatment options. Results A 56 year-old male with a history of HIV who presented to the emergency department with a titanium metal ring around his penis and scrotum for 72 hours (Fig. 1). Patient was afebrile, hemodynamically stable, and with unremarkable labs. Initial attempts at reducing penoscrotal edema by compression to subsequently slide off the ring using mineral oil were unsuccessful. We then attempted the “string pull” technique by sequentially advancing 0 silk sutures over the ring which was also unsuccessful. We then used an orthopedic bone cutter which was also unsuccessful as the titanium material was too strong. Finally, we resorted to using a Dremel circular rotary saw (which provided to the hospital by the local fire department) to cut the titanium metal ring off in the operating room (Fig. 2). The patient did well post-operatively and passed his trial of void before being discharged on post-operative day one. The patient did not follow up in clinic afterwards. Conclusions Penile ring entrapment is a true urologic emergency. Treatment aims to remove the ring while protecting underlying tissue. Treatment is based on case severity and what tools a physician may have at their respective hospital. Noninvasive techniques such as edema compression, lubricant use, and the “string pull” method. When these noninvasive techniques fail, various bone/bolt cutters or saws may be used. Disclosure No.