(053) Penile Entrapment Due to Metal Constriction Rings: Removal, Recovery and Complications

Abstract

Abstract Introduction Penile incarceration due to a metal constriction ring is a rare urologic emergency. Improper ring sizing, use of makeshift rings or prolonged length of use can cause penile/penoscrotal entrapment with resulting sequelae including genital ischemia, necrosis, and urinary retention. Metal rings are prone to this exigent situation, as they tend to be denser and thicker than typical constriction rings which presents a challenge for safe removal. Objective We aim to report a multi-institutional experience characterizing the presentation, removal methods, and outcomes after prolonged penile entrapment in patients with metal constriction rings. Methods We performed a retrospective chart review from 2000 to 2023 at participating institutions to identify men presenting with penile incarceration due to metal constriction ring use using the following ICD-10 codes: S30.842A, S30.843, W49.04XA, S31.24X, and T19.4. Operative/procedural tools and duration were recorded from the initial emergency room encounter and follow-up notes were reviewed for any subsequent complications. Results Twelve patients with median age 55 with interquartile range (IQR) of 26 were identified (Table 1). The metal rings varied in size, and most were composed of stainless steel. The length of time the constriction ring was in place before seeking medical attention ranged from 3 hours to 10 days with a median time of 42 hours, (IQR, 60). Removal instruments included a powered drill cutting tool, ring cutter, and bolt cutters. Median operative/procedural time was 90 minutes (IQR, 63). Cool irrigation was used in all cases where powered rotary cutting tool was used in combination with a mechanism to protect the underlying skin such as a metal retractor. Additionally, a barrier such as saline-soaked towels and/or lubricating jelly was used to protect the surrounding skin during operative intervention with a powered tool. Most patients reported full recovery despite prolonged entrapment; however, one patient developed a urethrocutaneous fistula and one patient reported diminished erectile function. Interestingly, one patient with concomitant substance abuse and vasoconstrictive agents use presented with penile skin necrosis requiring concurrent debridement which was further complicated by Fournier’s gangrene 1 month later in the setting of continued substance use and non-adherence to prescribed antibiotics. Conclusions Penile incarceration by metal constriction ring is a rare urologic emergency. This study represents the first multi-institutional and largest investigation evaluating the management of this condition. Manual and powered cutting tools are effective in removing metal constriction rings. If powered tools are employed, irrigation and retractors are necessary to prevent thermal injury. Despite most patients fully recovering after removal, significant complications have been observed. Therefore, prompt management and proper follow-up are recommended. Disclosure No.