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Urol Ann. 2017 Jul-Sep; 9(3): 304.
PMCID: PMC5532907

Penile strangulation by iron metal ring

Sir,

I read an article by Paonam et al.[1] entitled, “Penile strangulation by iron metal ring: A novel and effective method of management” with great interest. I would like to congratulate the authors for their wonderful attempt and successful removal of the metal ring without injuring the penis. However, I have following observations in this connection.

I would like to state that this technique has already been described in the literature in 1982 by Greenspan for the treatment of tourniquet syndrome where a steel ring from engorged penile shaft after autostimulation was successfully removed by “a Dremel Moto Tool Kit.”[2] It was also published in pediatric EM Morsels in 2013 for the treatment of the same condition from the finger. Removal of the metal object with a dental drill for strangulated penis has also been mentioned in the 11th edition of Campbell-Walsh Urology.[3]

String technique is quite useful to remove such object. In the case of difficulty, glandular puncture with needle or blade allows escape of dark, trapped blood and improves the odds of removing the object with string method.[4]

I would also like to mention the important teaching points in the removal of an object from the strangulated penis: (1) a clinician should use least painful/traumatic methods to remove the objects, (2) anesthesia and analgesia are an important part of management, (3) selection of tools depends on the severity of the injury, size, and thickness of the object, and (4) availability and resourcefulness of clinician.[5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

REFERENCES

1. Paonam S, Kshetrimayum N, Rana I. Penile strangulation by iron metal ring: A novel and effective method of management. Urol Ann. 2017;9:74–6. [PMC free article] [PubMed]
2. Greenspan L. Tourniquet syndrome caused by metallic bands: A new tool for removal. Ann Emerg Med. 1982;11:375–8. [PubMed]
3. Morey AF, Zhao LC. Genital and lower urinary tract trauma. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, editors. Campbell-Walsh Urology. 11th ed. Philadelphia: Elsevier; 2016. pp. 2379–92.
4. Noh J, Kang TW, Heo T, Kwon DD, Park K, Ryu SB. Penile strangulation treated with the modified string method. Urology. 2004;64:591. [PubMed]
5. Purnell S, Lam C, Pinder D, Ahagotu C, Coleman P. Successful removal of metal rings causing penile strangulation. IOSR J Dental Med Sci. 2016;15:110–3.

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