Womens Review of Glans Ring With Perssure Ball
Int J Surg Case Rep. 2016; 18: 15–17.
Mail coital penile band entrapment: A report of a not-surgical extrication method
Thaddeus Chika Agu
aImo Country Academy, Owerri, Nigeria
bFirst Selection Specialist Hospital, Nkpor, Nigeria
NJA Obiechina
cNnamdi Azikiwe University, Nnewi, Nigeria
Received 2015 Sep 26; Revised 2015 Nov xix; Accustomed 2015 November 21.
Abstract
This case report shows how a simple but painstaking method of milking and levering in a glace field was used to remove a thick metallic ring entrapped at the root of the penis after sexual intercourse. A ring tin can be removed easily from an organ if the inter-phase is fabricated glace. However this must exist weighed against the handling difficulties posed by a wet slippery surface. With perseverance and the use of anarchistic instrument, the ring was successfully extricated as a mean solar day instance and without a surgical incision.
Keywords: Mail coital, Penile, Ring entrapment
1. Introduction
Penile ring entrapment is a rare urological emergency that can lead to dissimilar degrees of vascular and mechanical complications. The utilize of metal rings on the penis for erotic purposes has been described in men and adolescent boys [i]. There are some unconventional likewise as surgical methods of extricating entrapped penile rings that accept been reported in the literature. A useful algorithm that outlines direction options based on the object type, object strength, object size and course of penile strangulation is likewise available in the literature [1]. Nosotros believe that an entrapped ring should be removed by the fastest, safest, most efficient, and if possible, a not-surgical method then that recovery can exist quick and uneventful. This method of extrication presented combines the merits of safety, efficiency, no morbidity and early belch from hospital. The aim of this report is to create an sensation of penile ring entrapment in our sub-region and to review the common methods of extrication.
2. Case presentation
The patient is a 26 yr one-time male who presented in a specialist orthopaedic & trauma centre on the 17th of September, 2015 with a painful engorged penis, xiii hours after sexual intercourse. He complained of weak and poorly sustained erections. During foreplay he removed his thick completely circular ring from his finger, put it on the glans and slid information technology all the way to the root of his penis. He and his partner tried to remove the ring subsequently. In the agitation and manipulation, he noticed that the penis continued to engorge and pain ensued. He saw a physician ten hours later who tried to remove it without anaesthesia before referral to our center.
On examination, he was broken-hearted and distressed. The penile shaft was grossly oedematous, mildly tender, cold, sensate, engorged just not turgid. The glans was besides oedematous, cyanosed, cold and sensate. The circumference of the penis at the widest betoken was 16 cm (measured with a strip of gauze thread intra-operatively and cross-checked with a measuring record afterwards). A thick stainless steel band, six.5 cm in circumference (measured later extrication) was seen at the root of the penis (Fig. i). He had a full urinary float which was mildly tender but there was no urgent demand to micturate. The haemoglobin was 12.8 k/dl and urinalysis was normal. The programme was to remove the band urgently.
Oedematous penile shaft and glans, thick circumferially continued hard metal ring at root of penis, note the differential size, note as well the wrinkles on the penile skin.
Under general amazement, the entire penile shaft was soaked with savlon to provide a fairly slippery field. The surgeon operated from the right paw side of the patient, steadied the ring with the left hand as he milked the oedematous skin and corpora from the shaft towards the root of the penis with the right paw. At the same time the assistant pulled any advanced tissue from beneath the ring towards the root of the penis. This maneuver was repeated severally and every bit the ring shifted distally, it was prevented from sliding dorsum with the left manus. In addition, a blunt paediatric os lever (Fig. 2) was a handy armamentarium [At1] used to lever the ring gradually and steadily until it got to the corona. The glans was squeezed and the band slipped off. The procedure lasted twenty 1 minutes.
A edgeless concluded paediatric os lever used equally an unconventional tool in levering the ring.
He had some minor pare abrasions. A size 12 Foley urethral catheter was passed to evacuate the float and a articulate urine was noted. The catheter was removed and in that location was no blood stain. The glans penis turned pink some minutes after the procedure (Fig. 3) and likewise became warm. The recovery from amazement was uneventful and patient was discharged on the same 24-hour interval on antibiotics and analgesics. He was referred to an erectile dysfunction dispensary.
The penis after extrication of the ring. Notation the pink glans penis and minor skin abrasions.
3. Discussion
The practise of using metal rings to sustain penile erection is non common and the ring can go entrapped on the penis [ane]. Many clinicians are not familiar with this emergency because of its rare occurrence. The direction is challenging and ofttimes times, the surgeon considers many methods in an attempt to remove the ring from the inflamed penis. This case report intends to create an awareness of penile band entrapment in our sub-region and review the common methods of extrication. Tying rubber bands and hair coils effectually penises by children as part of childhood pranks or to prevent enuresis is encountered occasionally and removal by cutting is easy [2]. The injury acquired by this non-metallic ring is not always recognizable and the clinician should keep this in mind when a male child presents with unexplained penile swelling, ulceration and leakage of urine [iii] , [4]. In men and adolescent boys, penile ring entrapment results mainly from the apply of metallic rings for erotic purposes [1]. Early presentation and early extrication of the band will reduce the chances of vascular or mechanical complications [5]. Nonetheless, majority of patients do non seek medical advice early considering of the embarrassment [half dozen]. Our patient tried severally over a menstruum of 10 hours to remove the ring before presenting to the doctor. Patients presenting with incarceration afterward 72 hours are more than likely to sustain college grade injuries like pressure necrosis, urethral fistula, penile gangrene and stricture [7].
There is no standard method of removing an entrapped penile band and removal can be effected with not-medical tools. Some cases of penile band entrapment tin be difficult to care for and require resourcefulness and a multi-disciplinary approach [viii] , [9]. However at that place is a useful algorithm outlining treatment options that are determined by the object type, strength and size, form of injury and complications [ane]. Penile band entrapment is a urological emergency and should be treated by the easiest, fastest, withal safe method of extrication. This is to avoid the complications that may result from delay. The use of strings, cutters, aspiration decompression and surgical degloving have been explored past several authors depending on their experiences, preferences and results.
Cord method is simple and it tin be maneuvered to extricate a thin metallic ring in the early stages of penile entrapment. The cord is passed through the interphase between the ring and penile peel. This may be hard if at that place is gross oedema. The tightness of the string on the penile skin as the proximal part is unwound may cause penile peel lacerations and friction injury. For thick metal rings and brawl bearing metallic rings, string technique may not be the first line choice especially when at that place is marked oedema [1].
The commonest reported device that causes penile entrapment is metal ring [7] and the commonest method of extrication is cutting despite the tediousness and take chances of penile injury [1]. If a giant orthopaedic cutter can be insinuated below the ring to cut it, so it volition be the fastest only may not exist the safest method of removing a thick metal ring. On the other paw, a small cutter that tin get beneath the ring easily without injuring the penis is unlikely to cutting a thick metal. A hacksaw or gigli saw or angle grinder may too injure the penis from lack of adequate protection in the small operating field and from oestrus generation [nine] , [10]. Sprinkling ice packed normal saline on the interphase will help to reduce the heat and prevent burns [x].
Aspiration decompression is a surgical technique that is used to evacuate blood from the engorged corpora. This reduces the size of the penis then that the ring can exist removed [eleven]. This method will not evacuate the inflammatory oedema within the penile skin and interstitial spaces and then may exist combined with other maneuvers to upshot the extrication.
Surgical degloving of the penile skin and Bucks fascia from the corpora is similar to raising flaps that are used in urethroplasties and hypospadias repairs. The flaps are reduced through the ring which in plow is easily slipped distally over the degloved shaft [12]. The oedematous glans cannot be degloved and this poses additional problem. This method requires special training and there are likely complications of wound breakup, urethral injury and flap necrosis [12].
In our patient, we considered non-surgical method of milking and levering in a slippery field the fastest and safest method of extrication. The penile skin is lax and distensible. The patient's oedematous penis had wrinkles signifying that it can be squeezed (Fig. 1). General anaesthesia was used because past eliminating the visual and tactile stimuli, it was more likely to knock off the erectile inputs to the penis during the procedure. However, the surgeon should consider the run a risk of full general amazement in this emergency situation and take all the necessary precautions.
4. Decision
Penile ring entrapment is a surgical emergency. After quick clinical assessment, the next action is to extricate the ring by any safe, constructive and possibly non-surgical method. This emergency can be handled by any readily available specialist surgeon who had participated in the treatment of similar ring entrapments every bit the principles of conservative treatment is the aforementioned. Comparatively, this extrication method is safe with little or no morbidity and should exist a first line method for early penile ring entrapment and only when it fails should riskier or invasive methods be explored.
Conflict of interest
There is no conflict of interest amongst the authors.
Funding
The work is self-sponsored by the start author who conceptualized and designed and wrote the manuscript. The second writer assisted in the surgery provided some literature review and made necessary correction which lead to the final manuscript.
Ethical approval
The upstanding committee of First selection Specialist Hospital where the authors carried out the procedure canonical the work. Ref no. FCSH 24/9/2015.
Consent
The patient gave an informed consent for this publication. He understood that part of his images will be published and as well understood that due to the rarity of the case, that it is worthwhile publishing it for education and for health care delivery. The consent was unconditional.
Writer contribution
The beginning writer carried out the procedure, designed and wrote the manuscript. The 2d author assisted during the surgery, provided firsthand care, provided some literature review and fabricated necessary correction which lead to the final manuscript.
Guarantor
Agu Thaddeus Chika.
References
1. Iqbal S., Joshi M.K., Jaura M. Strangulation of penis by a brawl bearing device. J. Sexual practice. Med. 2010;7(Nov (xi)):3793–3797. [PubMed] [Google Scholar]
two. Haddad F.Southward. Penile strangulation by human pilus: written report of three cases and review of the literature. Urol. Int. 1982;37(six):375–388. [PubMed] [Google Scholar]
three. Toguri A.Thousand., Light R.A., Warren M.M. Penile tourniquet syndrome caused by hair. Due south Med. J. 1979;72(May (5)):627–628. [PubMed] [Google Scholar]
4. Bhat A.L., Kumar A., Mathur South.C., Gangwal K.C. Penile strangulation. Br. J. Urol. 1991;68(December (6)):618–621. [PubMed] [Google Scholar]
5. Ivanovski O., Stankov O., Kuzmanoski Yard., Saidi S., Banev S., Filipovski V., Lekovski L., Popov Z. Penile strangulation: 2 example reports and review of the literature. J. Sex. Med. 2007;4:1775–1780. [PubMed] [Google Scholar]
6. Xu T., Gu G., Wang H. Emergency direction of penile strangulation: a example report and review of Chinese literature. Emerg. Med. J. 2009;26:73–74. [PubMed] [Google Scholar]
7. Silberstein J., Grabowski J., Lakin C., Goldstein I. Penile constriction devices: case report, review of the literature and recommendation for extrication. J. Sex. Med. 2008;v(July (7)):1747–1757. [PubMed] [Google Scholar]
8. Dell'Atti L. Penile strangulation: an unusual sexual practice that oft present a urological emergency. Curvation. Ital. Urol. Androl. 2014;86(March (one)):43. [PubMed] [Google Scholar]
9. Sathesh K.T., Hanna J.S., De Zoysa N., Saleemi A. Ballocks strangulation: fire-eater to the rescue. Ann. R. Coll. Surg. Engl. 2009;91(May (4)):15–sixteen. [PMC gratis article] [PubMed] [Google Scholar]
10. Kyei M.Y., Asante East.K., Mensah J.E., Klufio K.O., Paintsil A., Gepi-Atee Southward., Morton B., Ampadu Thou., Toboh B. Penile strangulation past cocky-placement of metallic nut. Ghana Med. J. 2015;49(March (1)):57–59. [PMC free commodity] [PubMed] [Google Scholar]
11. Chang S.J., Chiang I.North., Hsieh J.T., Liu Due south.P. Extrication of penile constriction device with corpora aspiration. J. Sexual practice. Med. 2009;6(March (3)):890–891. [PubMed] [Google Scholar]
12. Olajide A.O., Eziyi A.Yard., Olajide F.O. Novel surgical extraction of penile constricting metal ring: a example study. Int. J. Case Rep. Images. 2013;4(9):511–514. [Google Scholar]
Articles from International Journal of Surgery Case Reports are provided here courtesy of Elsevier
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4701856/
0 Response to "Womens Review of Glans Ring With Perssure Ball"
Post a Comment