Penile Strangulation Research Articles

Penile Strangulation by a Plastic Band With an Unknown Time of Onset: A Report of a Rare Case

Penile Strangulation by a Plastic Band With an Unknown Time of Onset: A Report of a Rare Case

Injuries to the male external genitalia in the material of the Department of Urology of the Military Institute of Medicine – National Research Institute, using the AAST trauma scale

Introduction and objective: Injuries to male external genitalia account for 2% of all injuries. Most affected patients require surgical intervention. This study aimed to retrospectively analyse the diagnosis and treatment of male external genital injuries using the American Association for the Surgery of Trauma (AAST) scale to assess their severity. Materials and methods: A total of 998 men with abdominal and pelvic injuries were admitted to the Emergency Department of the Military Institute of Medicine – National Research Institute in Warsaw, Poland, between October 2017 and August 2022. Injuries to male external genital organs were identified in 26 patients (3%). The mean age of this group was 37 years (21 to 72 years). Direct trauma to external genital organs was diagnosed in 14 patients (54%). In 12 patients (46%), external genital trauma was an accompanying injury to multi-organ injuries resulting from traffic accidents or falls from heights. All patients underwent a detailed history taking and physical examination, as well as ultrasound and/or trauma scan, followed by AAST. Results: In the group of 26 patients with external genital trauma, 14 patients (54%) were classified for urgent surgical treatment, including 8 patients (31%) with penile fractures and 6 patients (23%) with scrotal and testicular injuries. In one case, penile fracture was accompanied by urethral damage. In another case, orchidectomy was necessary in the group of patients with scrotal injuries. Among the 12 patients (46%) with multi-organ injuries following traffic accidents or falls from heights, bed regimen and antibiotic therapy allowed full recovery. According to the AAST scale for penile, scrotal, and testicular injuries, grade I was observed in 14 patients, grade II in 6 patients, grade III in 5 patients, grade IV in 3 patients, and grade V in 1 patient. Conclusions: The AAST scale is an effective and practical tool for assessing injuries to the male external genitalia. Early diagnosis and surgical treatment of male genital injuries reduce the risk of complications, whereas delayed diagnosis and treatment may result in infection and reproductive dysfunction.

Successful management of a combined penile and urethral fracture.

This case highlights a rare occurrence of combined penile fracture and urethral injury in a 35-year-old male, emphasizing the critical need for accurate diagnosis and precise surgical intervention in such cases. After a mishap during sexual intercourse, the patient faced intense penile pain, swelling, and urethrorrhagia. Advanced diagnostic methods, particularly MRI, confirmed a disruption in the tunica albuginea within the left corpora cavernosa. The patient underwent emergent surgical repair, addressing both urethral and corpora cavernosa injuries, leading to a successful postoperative course. This case report underscores the paramount importance of comprehending and effectively managing complex urological traumas. Timely and appropriate surgical intervention is crucial for ensuring optimal patient recovery and well-being in instances of combined penile and urethral injuries.

Traumatic penile amputation managed at Usmanu Danfodiyo University Teaching Hospital Sokoto, Nigeria: a case series

BackgroundTraumatic penile amputation is a rare surgical emergency and a cause of anxiety and psychological distress to patients, spouses, or parents, especially when it occurs in children. Several mechanisms are involved in penile amputation and the management options also vary. We report two cases of penile amputation that our institution handled in the past year to draw attention to the risks associated with firearm confrontations and grinding machines as causes of genital injuries. In a similar vein, we look over the literature for management options.Case presentationIn the first case, a grinding machine resulted in an isolated total penile amputation of a 6-year-old boy. In contrast, the second patient was a 25-year-old man who had bilateral testicular injuries and near-total penile amputation as a result of gunshot injury as part of polytrauma. Both patients had a history of profuse bleeding from the penile stump associated with severe pain. Both patients were resuscitated and subsequently underwent emergency wound debridement and stump refashioning/meatoplasty. The first patient had a satisfactory outcome and was discharged home on follow-up visits while the second patient died from overwhelming sepsis with pulmonary embolism as a differential.ConclusionPenile injuries may increase in tandem with civilian firearm-related incidents. Similarly, grinding machines are an important cause of penile injuries. In emergencies, wound debridement followed by stump refashioning is an appropriate treatment option.

Refining Penile Trauma Management: Introduction of the Penile Trauma Score

ObjectivesTo introduce the Penile Trauma Score (PTS), a new statistically driven classification system aimed at enhancing the management of penile trauma by providing clinically relevant treatment protocols. MethodsA retrospective review was conducted of 34 men with penetrating penile injuries at the Elvis Presley Level 1 Trauma Center, Memphis, from January 2014 to December 2016. Variables assessed included injury mechanism, location, depth, and follow-up outcomes related to voiding and erectile function. Odds-ratios were calculated using superficial penile injury as the control group. ResultsBased on physical examination findings and odds ratios calculated, the PTS was developed. Results indicated that higher PTS scores necessitated surgical intervention, while lower scores could be managed nonoperatively. Follow-up showed no missed injuries or reported dysfunctions, validating the PTS's effectiveness. ConclusionsThe Penile Trauma Score (PTS) represents an important modification in the classification and management of penile trauma. By integrating practical, easily identifiable injury characteristics, the PTS facilitates more streamlined surgical decision-making and potentially reduces unnecessary diagnostic procedures. However, further prospective studies with larger sample sizes and longer follow-up are needed to fully validate the PTS’s clinical utility.

Penile Injury: Four Years’ Experience of a Single Surgeon in a Limited Resources Setting

Background: Penile injuries (PIs) are uncommon, with the management of severe cases being difficult. This study aims to examine the causes of PIs and present experience for their management using the limited facilities available in a hospital with low-resource settings. Methods: The management of PIs in a limited-resource hospital in eastern Sudan was recorded over four years. Records of 32 cases of emergency penile surgical conditions between January 2016 and March 2020 were retrospectively reviewed, and 17 cases of significant PI were included in the study and divided into pediatric and adult groups with further subdivision of each group according to the nature of the injury. Results: Seventeen patients with PIs were treated during the study period. The pediatric group (n = 4) were victims of traditional circumcision; two of them presented with glans penis (GP) amputation, one with gangrenous GP, and one with mild GP injury. The patients in the adult group were divided into three subgroups; the first group had penile fractures (n = 8), the second group had degloving PIs (n = 2), and the third group had penile amputation injuries (n = 3). Management included various surgical techniques tailored to the individual patients. The outcome of the intervention was presented on a case-by-case basis. Conclusion: Severe PIs should be managed using a case-by-case approach. To enhance the effectiveness of surgical interventions, the field of reconstructive penile surgery must be established and developed. Community orientation and work safety measures should be implemented to avoid PIs that may result from traditional circumcision and machinery trauma.

Innovative techniques in the treatment of penile strangulation: a case report

Introduction and importance: Penile strangulation is a medical emergency characterized by the encirclement of the penis by an external object, resulting in circulatory compromise. Case presentation: A 35-year-old male presented with penile pain and urinary obstruction due to the inability to remove the ring. Upon examination, the ring was firmly lodged at the base of the penis, causing significant swelling and discoloration in the distal region. Interventions and outcomes: Initial attempts to cut the ring using standard tools were unsuccessful, leading to the engagement of a rescue team equipped with an air cutter. The cutting procedure, complicated by the ring’s thickness and hardness and the significant edema, took ~90 min. Safety measures, including the use of a surgical brain spatula and forceps, were employed to protect the penile skin from damage during the operation. Relevance and impact: This case underscores the necessity for timely intervention in penile strangulation cases and highlights the effectiveness of collaboration with specialized rescue teams equipped with appropriate cutting tools. It also emphasizes the importance of safety considerations when employing nonmedical devices in medical emergencies. The patient experienced a favorable outcome, with significant improvement in swelling and discoloration postprocedure, and no complications during follow-up. This report contributes to the limited but crucial literature on managing penile strangulation, particularly regarding the methods and timeframes for safely removing constricting objects.

US of the Penis: Beyond Erectile Dysfunction.

High-frequency US, with a linear transducer and gray-scale, color, and spectral Doppler US techniques, is the primary imaging modality for evaluation of the penis. It can allow delineation of anatomy and assessment of dynamic blood flow; it is easily available and noninvasive or minimally invasive; it is cost effective; and it is well tolerated by patients. US assessment after pharmacologic induction of erection is an additional tool in assessing patients with suspected vasculogenic impotence, and also in selected patients with penile trauma and suspected Peyronie disease. Penile injuries, life-threatening infections, and vascular conditions such as priapism warrant rapid diagnosis to prevent long-term morbidities due to clinical misdiagnosis or delayed treatment. US can facilitate a timely diagnosis in these emergency conditions, even at the point of care such as the emergency department, which can facilitate timely treatment. In addition, color and spectral Doppler US are valuable applications in the follow-up of patients treated with endovascular revascularization procedures for vasculogenic erectile dysfunction. Image optimization and attention to meticulous techniques including Doppler US is vital to improve diagnostic accuracy. Radiologists should be familiar with the detailed US anatomy, pathophysiologic characteristics, scanning techniques, potential pitfalls, and US manifestations of a wide spectrum of vascular and nonvascular penile conditions to suggest an accurate diagnosis and direct further management. The authors review a range of common and uncommon abnormalities of the penis, highlight their key US features, discuss differential diagnosis considerations, and briefly review management. ©RSNA, 2024 Supplemental material is available for this article.

Legal Outcomes of Litigation After Iatrogenic Genitourinary Trauma

INTRODUCTIONTo evaluate plaintiff and defendant characteristics associated with iatrogenic genitourinary trauma litigation and outcomes of closed claims. METHODSLexisNexis was queried in April 2023 using terms related to genitourinary organs and injury, and manually reviewed for iatrogenic cases. Case details including defendant, organ involvement, and legal outcome were obtained. Multinomial regression analysis was performed to identify factors associated with outcome. RESULTS410 cases involving 611 defendants were identified, with the ureter the most commonly affected organ (202/410, 49.3%). Most cases involved adult plaintiffs (380, 92.7%) and resulted in favor of the defense (227, 55.4%). Injuries resulted most frequently from gynecologic surgeries (179, 43.7%). Defendants were most commonly obstetricians/gynecologists (243/611, 39.8%) and urologists (168, 27.5%). Penile (OR 6.3 [95% CI 2.5-16.1]) and urethral (OR 4.8 [2.0-11.7]) injuries were associated with greater odds of a plaintiff verdict relative to ureter injury. A plaintiff verdict was also more likely when defendants were academic hospitals compared to individual practitioners (OR 4.3 [1.9-9.9]). In cases ruling in favor of the plaintiff, indemnity payments were larger when the defendants were comprised of individual practitioners compared to a hospital or medical group (median $549,613 vs. $250,000, p < 0.001). CONCLUSIONUrologists may be involved in medical malpractice lawsuits for iatrogenic injury even when they are uninvolved in the index procedure. Most cases that reach litigation result in defense verdicts regardless of the genitourinary organ injured. Defendant characteristics associated with plaintiff verdicts are more nuanced, and providers should be aware of potential downstream effects of litigation.

Multi-Institutional Bladder Exstrophy Consortium After 8 Years: The Short- and Intermediate-Term Outcomes.

Bladder exstrophy (BE) poses challenges both during the surgical repair and throughout follow-up. In 2013, a multi-institutional BE consortium was initiated, which included utilization of unified surgical principles for the complete primary repair of exstrophy (CPRE), real-time coaching, ongoing video capture and review of video footage, prospective data collection, and routine patient data analysis, with the goal of optimizing the surgical procedure to minimize devastating complications such as glans ischemia and bladder dehiscence while maximizing the rate of volitional voiding with continence and long-term protection of the upper tracts. This study reports on our short-term complications and intermediate-term continence outcomes. A single prospective database for all patients undergoing surgery with a BE epispadias complex diagnosis at 3 institutions since February 2013 was used. For this study, data for children with a diagnosis of classic BE who underwent primary CPRE from February 2013 to February 2021 were collected. Data recorded included sex, age at CPRE, adjunct surgeries including ureteral reimplantations and hernia repairs at the time of CPRE, osteotomies, and immobilization techniques, and subsequent surgeries. Data on short-term postoperative outcomes, defined as those occurring within the first 90 days after surgery, were abstracted. In addition, intermediate-term outcomes were obtained for patients operated on between February 2013 and February 2017 to maintain a minimum follow-up of 4 years. Outcomes included upper tract dilation on renal and bladder ultrasound, presence of vesicoureteral reflux, cortical defects on nuclear scintigraphy, and continence status. Bladder emptying was assessed with respect to spontaneous voiding ability, need for clean intermittent catheterization, and duration of dry intervals. All operating room encounters that occurred subsequent to initial CPRE were recorded. CPRE was performed in 92 classic BE patients in the first 8 years of the collaboration (62 boys), including 46 (29 boys) during the first 4 years. In the complete cohort, the median (interquartile range) age at CPRE was 79 (50.3) days. Bilateral iliac osteotomies were performed in 89 (97%) patients (42 anterior and 47 posterior). Of those undergoing osteotomies 84 were immobilized in a spica cast (including the 3 patients who did not have an osteotomy), 6 in modified Bryant's traction, and 2 in external fixation with Buck's traction. Sixteen (17%) patients underwent bilateral ureteral reimplantations at the time of CPRE. Nineteen (21%) underwent hernia repair at the time of CPRE, 6 of which were associated with orchiopexy. Short-term complications within 90 days occurred in 31 (34%), and there were 13 subsequent surgeries within the first 90 days. Intermediate-term outcomes were available for 40 of the 46 patients, who have between 4 and 8 years of follow-up, at a median of 5.7 year old. Thirty-three patients void volitionally, with variable dry intervals. Cumulative efforts of prospective data collection have provided granular data for evaluation. Short-term outcomes demonstrate no devastating complications, that is, penile injury or bladder dehiscence, but there were other significant complications requiring further surgeries. Intermediate-term data show that boys in particular show encouraging spontaneous voiding and continence status post CPRE, while girls have required modification of the surgical technique over time to address concerns with urinary retention. Overall, 40% of children with at least 4 years of follow-up are voiding with dry intervals of > 1 hour.

(PM-17) THE ROLE OF PHOSPHODIESTERASE-5 INHIBITORS IN THE TREATMENT OF COMPLEX PENILE WOUNDS: A CASE REPORT AND LITERATURE REVIEW

Abstract Introduction/Objective Phosphodiesterase-5 inhibitors (PDE5i) are traditionally employed for the management of erectile dysfunction and lower urinary tract symptoms. However, their role in the healing of complex penile wounds remains scarcely discussed. This study aims to describe the case of a 27-year-old man who suffered from penile strangulation, treated with sildenafil. Additionally, a literature review concerning the use of PDE5i for the treatment of complex penile injuries will be conducted. Methods A 27-year-old man presented to the emergency room after a self-induced penile strangulation using a ring placed at the base of the penis. Extensive necrosis of the corpus cavernosum was identified through magnetic resonance imaging. Considering the psychosocial implications of penile amputation, organ preservation was chosen, and conservative treatment with sildenafil and daily local dressings was initiated. Thirty days after admission, Doppler ultrasound revealed symmetrical corpus cavernosum with normal echogenicity and usual blood flow patterns. Subsequently, the patient underwent superficial necrotic tissue debridement followed by partial skin grafting in a second stage, leading to hospital discharge after 55 days of hospitalization. Results PDE5 inhibitors enhance nitric oxide bioavailability, promoting vasodilation and improved tissue oxygenation, thereby facilitating various phases of the healing process. Evidence indicates their benefit in microvascular perfusion in skin and soft tissues. Reports suggest satisfactory outcomes of topical PDE5i application in radiation-induced lesions, implying their role in epidermal cell expansion, reduction of inflammatory infiltrates, enhanced vascularization, and decreased collagen deposition. Conclusion This study presents a successful case of sildenafil use in treatment of a complex penile wound, shedding light on an unconventional application of PDE5i. Financing No conflict.

Accurate diagnosis and effective treatment of abnormal meridians in erectile dysfunction patients based on infrared thermography: an electrophysiological technique study.

An increasing body of research has demonstrated that appropriate stimulation of the meridians and acupoints in the human body can play a preventative and therapeutic role in diseases. This study combines the use of infrared thermography with intelligent electrophysiological diagnostic system (iEDS) to accurately diagnose and apply transdermal low-frequency electrical stimulation to treat abnormal meridians in patients with erectile dysfunction (ED). The treatment protocol included 6 treatments (each lasting 30 min and performed twice a week). The International Index of Erectile Function-5 (IIEF-5), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Erection Hardness Scale were used to assess treatment results. A total of 62 patients were included in this study, with 31 patients in the treatment group and 31 patients in the sham therapy group. After six treatments, the treatment group improved significantly in IIEF-5 (15.52 ± 2.06 vs. 18.84 ± 2.67, p < 0.001), PHQ-9 (8.32 ± 6.33 vs. 4.87 ± 4.41, p < 0.001), GAD-7 (5.32 ± 5.08 vs. 2.94 ± 3.31, p = 0.003), and EHS (2.48 (2.00, 3.00) vs. 2.90 (2.00, 3.00), p = 0.007). After six sham treatment sessions, no improvements in any of the scores were reported in the sham therapy group. Following that, this group had an additional six treatments of regular therapy, which resulted in statistically significant improvements in IIEF-5 (16.65 ± 1.96 VS. 19.16 ± 2.40, p < 0.001), PHQ-9 (8.81 ± 6.25 VS. 4.97 ± 4.36, p < 0.001), GAD-7 (5.74 ± 5.18 VS. 3.68 ± 3.42, p < 0.001), and EHS (2.61 (2.00, 3.00) VS. 3.03 (2.00, 4.00), p = 0.003). No adverse events were reported regarding penile discomfort, pain, injury, or deformity. CLINICAL TRIALS: The study protocol is registered in the Clinical Trials Registry with the identification number ChiCTR2300070262.

Liar, liar, Pants on Fire’ – Management of Genitorinary Injury Sustained post ‘Cherry Bomb’ Explosion

Penile trauma comprised of 10-16% of genitourinary injury based on several single institution series [1]. Penetrating external genitalia trauma was 0.57%, of all trauma. 28% of it, was penile injuries, with concomitant urethra injuries occurred in 13% [2]. In ballistic injury, the penetrating wound could be superficial, however misleading and underrepresented of the actual extent of injury. Principle of treatment: immediate exploration, copious irrigation, excision of foreign matter, antibiotic prophylaxis and surgical closure [3]. The functional outcomes were excellent [4]. A case of 29 years old male with penetrating penile trauma with concomitant urethral trauma.

Early vs delayed insertion of penile prosthesis in patients with refractory priapism: a systematic review and meta-analysis.

Refractory priapism, characterized by persistent and prolonged painful erections despite initial treatment maneuvers, can significantly impair erectile function secondary to ischemia-induced corporal tissue fibrosis. These patients will likely require subsequent penile prosthesis (PP) surgery to regain sexual activity, yet consensus regarding the optimal timing of implantation remains lacking. To evaluate and compare the clinical outcomes associated with early vs delayed PP implantation in individuals with priapism-induced erectile dysfunction (ED). We included studies that focused on refractory priapism leading to ED and its management with PP implantation. We assessed cohort study bias with a risk-of-bias tool and case series bias with the modified Newcastle-Ottawa Scale. Pooled odds ratios (ORs) were calculated by a fixed-effect model. We included 9 studies, comprising 4 cohort studies and 5 case series, involving a total of 278 patients. Total complications were higher in the delayed group (OR, 4.16; 95% CI, 2.77-6.26). Fibrosis was significantly more pronounced in the delayed group (OR, 118.18; 95% CI, 20.06-696.32). The odds of erosion, infections, and penile injury did not show statistically significant differences between the groups (OR, 2.52 [95% CI, 0.67-9.49], 0.89 [0.38-2.10], 1.83 [0.79-4.26], respectively). Patients' satisfaction resulted in a pooled OR of 0.15 (95% CI, 0.04-0.49) in favor of the early PP insertion group. The results from this study favor an early approach to ED (within 30days) following ischemic priapism. However, it is important to consider patients' preferences, values, and psychological factors to make an informed decision.

(128) Penile Replantation in Patient with Klingsor Syndrome; Case Report and Review of Literature

Abstract Introduction Penile amputation has multiple etiologies including self-mutilation, work-related accidents, circumcision, assault motivated by jealousy, rage and feelings of betrayal and animal attacks. By far self –mutilation due to underlying psychiatric disorders (Klingsor Syndrome) are the commonest cause. Re-implantation is the gold standard for management, however it may always not be possible to achieve because of significant local ischemia, tissue damage and prolonged duration post trauma. Objective We are reporting our experience with one case of Klingsor Syndrome and its stepwise management. Methods A 31 years old male Schizophrenic patient self-mutilated his penile shaft due to fixed illusion (get rid of devil in his penis). He also attempted to remove his entire scrotum. His father brought his son with the amputated penile part put in ice. Immediate application of wet saline towel to penile stump and putting of amputated penile part into cold iced saline. Anti-tetanic serum was given together with i.v. antibiotics. Urology team, Plastic microsurgery team together with Psychiatry treating consultant all were emergently called at once. Amputated penile shaft was prepared by the microsurgeon to identify the dorsal artery, vein and nerves and marked by micro-bulldogs. Urology team started by fixation of s.p. cath and preparing, cleaning penile stump. End-to end anastomosis of the urethra was done. Next, the corporal bodies, were reattached using interrupted sutures. Dorsal vein and artery were re-anastomosed microsurgically Results Few days post-operatively skin necrosis started inspite of positive needle brick to the glans indicating healthy underlying glans. Second stage debridement of necrotic skin with later skin grafting resulted in cosmetically and functionally excellent penis regarding erectile and voiding functions Conclusions Penile amputation is a rare surgical emergency mostly found in the literature as isolated case reports. Klingsor syndrome is well known etiology for this type of penile injury and warrants psychiatric control. A multidisciplinary approach involving a urologist, micro-vascular surgeons as well as a psychiatrist ensures good outcome. Microvascular re-implantation remains the treatment of choice with the highest probability of adequate cosmetic as well as functional outcomes Disclosure No.

Assessment of the Characteristics of Traumatic Urogenital Injuries at a Tertiary Care Center: First Report from Somalia

&#x0D; Objective: Urogenital injuries (UGIs) are present in approximately 10% of adult and less than 3% of pediatric trauma patients. To date, no reports have been published regarding urogenital injuries in Somalia, a sub-Saharan African country. We aimed to analyze the data of urogenital trauma patients who presented to the emergency department of the only tertiary care center in Somalia.&#x0D; &#x0D; &#x0D; Materials and Methods: Patients who presented to the emergency department of our institution following trauma between January 2019 and December 2022 and were admitted with the diagnosis of UGI constituted the target population. The collected data included demographic characteristics, type of trauma, involved urogenital organ, admission site, patient management type, and survival. &#x0D; &#x0D; &#x0D; Results: Overall, 2426 trauma patients presented to the emergency department. Among these patients, 116 (4.8%) had UGI. The mean patient age was 28.31±5.2 [1-73]. Most (83.6%, n=97) patients were male. Kidneys were the most commonly injured organs (41.4%, n=48), followed by the urinary bladder (17.2%, n=20) and testis (13.7%, n=16). Nine patients with renal trauma underwent nephrectomy. Among 20 patients with bladder injury, half underwent surgical repair. Ten of 16 patients with testicular trauma underwent orchiectomy due to severe rupture. All 12 patients with penile injuries underwent primary repair. Among 10 (8.6%) patients with urethral injuries, 4 underwent immediate primary repair, 3 underwent endoscopic realignment, while the remaining 3 needed cystostomy and delayed urethroplasty. The mortality rate was 10.3% (n=12). &#x0D; &#x0D; &#x0D; Conclusions: Surgical exploration was commonly performed due to the severity of the traumas and the presence of adjacent organ injuries. This finding arises from the fact that Somalia is a country affected by terrorism and low-density war.&#x0D;

Penile Strangulation: Analysis of Postextrication Follow-Up, Sequelae, and a Review of Literature.

Numerous case reports exist on penile strangulation injuries and extrication methods; however, the care and long-term consequences of penile strangulation injuries have been under-reported. Our aim is to investigate the long-term outcomes and sequalae following penile strangulation injuries. The PubMed Medline database was searched using the keyword string "penile strangulation," "penis strangulation," and "constriction" for all studies reporting outcomes of published penile strangulation injuries. Articles were evaluated for follow-up after strangulation injury, strangulating agent, extricating agent, and sequelae of injury. Fifty-six studies resulted with reports of 100 cases of penile strangulation and extrication from January 2000 to December 2019. The mean patient age was 41 (range: 3-86) years. Twenty-four (24/100) cases reported sequalae following extrication. Follow-up ranged from 2 weeks to 7 years with median follow-up time in the 7- to 12-month grouping. Metal rings comprised 36% (36/100) of strangulation agents and 50% of reported incidents were attributed to sexual activity. To our knowledge, this is the only study focusing on long-term outcomes after penile strangulation. This review provides a summary of 56 studies that document penile strangulation injuries over the last 20 years. Although a wide array of penile strangulation injuries have been documented in the literature, reports lack secondary management and long-term outcomes after removal of the strangulation device. We recommend that providers report long-term penile strangulation outcomes for future urologic evaluations after extrication.

Effects of ketamine on penile tissues in an experimental priapism model in rats.

This study aimed to evaluate the histopathological and biochemical effects of ketamine on penile tissues following ischemia-reperfusion injury induced by priapism. Twenty-four male rats were randomized into three groups. Group 1 served as the control group. Group 2 underwent the priapism model to induce ischemia-reperfusion injury. Group 3, the treatment group, experienced a similar ischemia-reperfusion model as Group 2; additionally, 50 mg/kg of ketamine was administered intraperitoneally just before reperfusion. Blood biochemical analyses and penile histopathological evaluations were performed. In Group 3, significant improvements were observed in all histopathological scores, including desquamation, edema, inflammation, and vasocongestion compared to Group 2 (p<0.001). Blood biochemical analyses showed that the malondialdehyde (MDA) levels were recorded as 10 in Group 2, with a significant decrease in Group 3 (p=0.013). Similarly, proinflammatory cytokine levels, including interleukin-1 beta (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α), were found to be suppressed in Group 3 compared to Group 2 (p=0.003, p=0.022, and p=0.028, respectively). Antioxidant enzyme activities, such as glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD), were higher in Group 3 compared to Group 2 (p=0.016 and p=0.024, respec-tively). Ketamine is an effective anesthetic agent in alleviating the effects of penile ischemia-reperfusion injury.

Gradual Approach for The Management of Penile Strangulation by Metal Ring: A Case Report

Penile strangulation by metal ring is a rare urological entity; it could be a truly urological emergency and requires a prompt resolution to avoid irreversible consequences. We present the case of a young male who received a successful gradual approach for the extraction of penile ring. This article provides to the readers some practical tips for the management of this rare condition.

The Medical, Sociological, Psychological, Religious, and Spiritual Aspects of Masturbation and a Potential Approach to Therapy Based on Catholic Teaching and Virtues Psychology.

Masturbation is common and generally accepted in Western society as a normal, healthy activity. In contrast, the Catholic Church holds that masturbation is immoral. Noting that the human person is a profound unity of body and spirit, if the Church is correct, masturbation should have negative effects on the human person. If the secular view is correct, masturbation should have conversely positive effects. This paper is divided into three parts. An in-depth literature survey was performed to evaluate the physical, medical, psychological, sociological and spiritual correlates of masturbation. The second part is a theological summary of the Catholic understanding of masturbation. The third part is an approach to therapy. Physically, masturbation was found to be less sexually satisfying than intercourse. Medical complications include penile injury and self-asphyxial behavior. Psychologically, masturbation was found to be associated with depression, anxiety, immature defenses, hypersexuality, guilt, poor body self-image and stress in the workplace. Sociologically most studies indicate a negative correlation between masturbation and relationship satisfaction, quality, intimacy, relational happiness, emotional satisfaction with the partner, trust, passion, and love. Spiritually, masturbation is highly positively correlated with pornography consumption and negatively with religion and religiosity. There is a higher rate of masturbation in homosexuals and bisexuals than in heterosexuals. Theologically, masturbation and pornography directly violate the religious virtue of chastity, undermining one's prayer life and the motivation to develop a spiritual life. Therapeutically, positive psychology, which emphasizes cultivating what it identifies as virtues, including justice, courage, temperance, wisdom (similar to prudence), transcendence (similar to hope) and humanity (similar to charity), can be used to counsel individuals struggling with masturbation. Once the harms are understood, a person can be counseled that this temptation represents a challenge, an opportunity to build self-control, and with self-control the capacity to develop character strengths and major virtues.