104 PENILE ENTRAPMENT BY CONSTRICTION DEVICE: A NOVEL TECHNIQUE FOR REMOVAL OF STUBBORN RINGS

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery (II)1 Apr 2013104 PENILE ENTRAPMENT BY CONSTRICTION DEVICE: A NOVEL TECHNIQUE FOR REMOVAL OF STUBBORN RINGS Daniel T. Oberlin, Puneet Masson, and Robert E. Brannigan Daniel T. OberlinDaniel T. Oberlin Chicago, IL More articles by this author , Puneet MassonPuneet Masson Chicago, IL More articles by this author , and Robert E. BranniganRobert E. Brannigan Chicago, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1482AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Penile entrapment via penile ring is an increasingly encountered clinical entity requiring urgent and effective treatment. Management poses unique challenges to the treating physician through variable presentation as well as the lack of a standardized approach to ring removal. Power-drive cutting tools, which include Dremel saws and oscillating orthopedic saws, have been utilized but have variable success and increased potential for morbidity. We present a novel technique to facilitate penile ring removal in patients presenting with this devastating condition. METHODS A retrospective single-institution study evaluating a novel strategy for penile ring removal was performed. Clinical parameters were assessed including duration of entrapment, method of entrapment, and degree of incarceration and/or tissue strangulation. Conservative attempts with manual compression and reduction of edema were initially attempted in all patients. When unsuccessful, the following steps were performed: 1) an anesthetic penile block was established with injection of 1% lidocaine at the 11 o'clock and 1 o'clock dorsal positions, 2) protection of the penile skin and reduction of penile edema by placing gauze circumferentially at the ring-skin interface, 3) insertion of the orthopedic Tungsten Carbide (T/C) pin cutter between the skin and gauze with avoidance of surrounding tissue, followed by controlled compression of cutter at 2 and 10 o'clock positions. Patients were monitored post-procedure to confirm appropriate healing and discharged home afterwards. RESULTS From 2009 to 2012, 9 patients presented with penile ring entrapment to the institution's emergency room. Manual decompression was attempted in all patients without success. All 9 patients underwent penile ring removal at the bedside using the proposed technique, with successful removal of the ring in 100% of cases. There were no complications during ring removal or evidence of tissue necrosis. All patients tolerated the procedure well and were discharged home the same day. CONCLUSIONS Penile entrapment is a urologic emergency and expeditious decompression is essential to prevent further penile injury. In situations where reduction of penile edema and removal of a constriction device are not attainable with conservative methods, there is no standardized approach to penile ring removal. This novel technique with the orthopedic pin cutter demonstrates excellent results with regards to safety and efficacy, and may be a reliable and efficient approach in the management of penile entrapment. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e41-e42 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel T. Oberlin Chicago, IL More articles by this author Puneet Masson Chicago, IL More articles by this author Robert E. Brannigan Chicago, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...