The trapped penis: contemporary management and outcomes of penile constriction injuries

Abstract Background Penile constriction injury is a rare urological emergency that may progress from distal edema to ischemia, gangrene, and penile loss if treatment is delayed. Owing to its rarity, evidence is largely limited to case reports and small case series. Objective To evaluate the demographic characteristics, clinical presentation, injury severity, management strategies, and outcomes of patients with penile constriction injuries treated at a tertiary referral centre. Materials and methods We retrospectively reviewed consecutive adult patients presenting with penile constriction injuries between January 2020 and December 2025. Demographic data, type of constricting device, duration of incarceration, Bhat injury grade, management, complications, and functional outcomes were analyzed. Results Twelve patients were included (mean age 42.0 ± 16.6 years). Sexual gratification was the commonest indication (91.7%); one had an iatrogenic condom catheter–associated injury. Metallic rings were the most frequent devices (58.3%). Median presentation time was 72 h, with injuries ranging from Bhat grade I to V. The string technique was the commonest removal method (41.7%), followed by metallic and electric cutters. Urinary drainage was required in 7 (58.3%) patients: four received Foley and three suprapubic catheterization. Mean procedure duration was 37.7 ± 22.7 min; median hospital stay was 3 days. Complications included skin necrosis, gangrene, urethral stricture, Fournier’s gangrene, penile fracture, painful erections, and testicular atrophy. At follow-up, 5/10 (50.0%) had erectile dysfunction and 5/10 (50.0%) preserved erectile function; 10/11 (90.9%) voided adequately and 1/11 (9.1%) remained on suprapubic drainage. Median follow-up was 24 months (range, 6–36 months). Conclusions Prompt recognition and individualized management are essential to preserve penile viability and function. Delayed presentation appeared to be associated with more severe injuries and adverse outcomes in our series, consistent with previous reports. Structured follow-up is important to identify urethral and sexual sequelae.