Nandakishore Bhat
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Dear all,
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Comments(6)
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Utsav Shah
05 Jul 2021 08:52:30 AMWonderful Sir!
In my residency (which I completed last year) we encountered three such cases and all were of different variety.1)One was a middle aged male who used his wedding ring for sexual stimulation.2)An octogenarian used a rubber band to stop his urinary incontinence.3)An adolescent who inserted it into the penis while playing with it.I'm attaching the POSTER I presented on the same topic in a zonal conference back then. Great memories! -
Venugopal P
08 Jul 2021 10:00:27 AMDear All,
Nanda has rekindled the need for a discussion on ‘Penile Strangulation by Foreign Objects’. There are many case reports addressing this issue and the management adopted.
Penile strangulation is a rare clinical entity which may lead to serious complications if not treated promptly and judiciously. The reasons for applying foreign bodies to the external genitals are varied and depend on the patient's age group. In middle-aged and elderly men, the leading cause of application of foreign bodies is to increase sexual performance or because of autoerotic intentions, while masturbation and sexual curiosity are the leading causes in male adolescents. In infants and children, the foreign body is usually a string, thread, rubber band, or hair tied around the penis. In some patients, different concomitant psychiatric abnormalities were registered.
In 1991, Amilal Bhat et al presented an original classification for penile incarceration composed of five grades. This is the most Cited Classification.
Grade
Classification
1
Distal penis oedema. No evidence of skin ulceration or urethral injury.
2
Distal penile oedema with decreased sensation. Injury to skin, constriction of corpus spongiosum. No urethral injury.
3
Injury to skin and urethra, without urethral fistula. Loss of distal penile sensation.
4
Complete division of corpus spongiosum leading to urethral fistula and constriction of corpus cavernosum with loss of distal penile sensation
5
Gangrene, necrosis, or complete amputation of penis.
Harouchi et al (1980) described four grades of injury ranging from superficial skin loss (Grade I) to loss of glans (Grade IV). Silberstein et al (2008) developed a grading system with two broad categories as low- and high-grade penile injuries. Based on this Classification, it is possible to evaluate the severity of complications that occurred after incarceration as well as to determine the treatment strategy.
Conventional methods described to remove the incarcerating object include: aspiration of blood from the glans; use of saws, drills and cutters; the string technique, and various surgical procedures.
In general, string techniques and aspiration procedures, alone or more commonly in combination, are suitable for grade 1–3 injuries, while use of cutting devices like ring cutters, metal saws, hammer and chisel, drills etc has been described in all grades of injuries with reasonable degree of success.
Use of electrical cutting devices requires utmost care and safety precautions to avoid iatrogenic injuries.
One of the articles that I would recommend reading for all was published from MS Ramiah Medical College by Sandeep Puvvada, Priyatham Kasaraneni* D Ramesh et al (2019). Additionally, it has a link for a short video on the Technique of Cutting Metal Ring.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830290/pdf/TAJU_17_1647677.pdf
As mentioned, there are several articles addressing this and surprisingly most are of Indian Origin.
With warm regards,
Venu
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Amilal Bhat
25 Jul 2021 03:42:54 PMNon-metallic, thin objects are easy to remove but can cause severe injury. These injuries usually found in the children. High index of suspicion is needed to diagnose these injuries in the children presenting with severe penile oedema. The strigulating object is buried deep down. The injury in the infants may be by hair tourniquet usually not visible. Other one are thread rubber band etc. Rubber band sometimes used by the mother in incontinent child to make the child dry and forgotten. A rare injury knot tied by bark of the tree childish play .we published with this in 2001. Early diagnosis is important , timely removal leads to complete recovery by missed one may lead amputation of penis, we had such case, the tied thread caused the amputation of glans. Our grading is an important tool to diagnose as well prognosis in these cases. Prognosis based on the classification , has to be explained to the patients before surgery , avoid the blame on the surgery.
The metallic objects are either put by the patients for sexual gratification or erection ,some times by female partner for erection. Though metallic objects are difficult to remove but the injuries are usually less severe. Carefully early removal the strangulating objects leads to better outcome.
1. Bhat AL, Kumar A, Mathur SC, Gangwal KC. Penile strangulation. Br J Urol. 1991 Dec;68(6):618-21. doi: 10.1111/j.1464-410x.1991.tb15426.x. PMID: 1773293.
2. Bhat AL, Saxena G, Goyal R, Patni M. A rare foreign body on penis leading to incarceration. Int Urol Nephrol. 2001;32(3):399-401. doi: 10.1023/a:1017565520257. PMID: 11583360.
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Amilal Bhat
25 Jul 2021 03:42:56 PMNon-metallic, thin objects are easy to remove but can cause severe injury. These injuries usually found in the children. High index of suspicion is needed to diagnose these injuries in the children presenting with severe penile oedema. The strigulating object is buried deep down. The injury in the infants may be by hair tourniquet usually not visible. Other one are thread rubber band etc. Rubber band sometimes used by the mother in incontinent child to make the child dry and forgotten. A rare injury knot tied by bark of the tree childish play .we published with this in 2001. Early diagnosis is important , timely removal leads to complete recovery by missed one may lead amputation of penis, we had such case, the tied thread caused the amputation of glans. Our grading is an important tool to diagnose as well prognosis in these cases. Prognosis based on the classification , has to be explained to the patients before surgery , avoid the blame on the surgery.
The metallic objects are either put by the patients for sexual gratification or erection ,some times by female partner for erection. Though metallic objects are difficult to remove but the injuries are usually less severe. Carefully early removal the strangulating objects leads to better outcome.
1. Bhat AL, Kumar A, Mathur SC, Gangwal KC. Penile strangulation. Br J Urol. 1991 Dec;68(6):618-21. doi: 10.1111/j.1464-410x.1991.tb15426.x. PMID: 1773293.
2. Bhat AL, Saxena G, Goyal R, Patni M. A rare foreign body on penis leading to incarceration. Int Urol Nephrol. 2001;32(3):399-401. doi: 10.1023/a:1017565520257. PMID: 11583360.
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PANKAJ JOSHI
04 Jul 2021 01:34:17 PMThis are challenging cases, usually come at night ,when non Medical help is limited (The Carpenters and their instruments).