AB184. SOH26AB_0308. An unusual case report of penile strangulation by a metal ring

Background: Penile strangulation is an uncommon but serious urological emergency that can lead to rapid vascular compromise, tissue necrosis, and long-term functional deficits. Prompt recognition and timely surgical management are essential to prevent irreversible damage. This case highlights a severe presentation involving extensive penile tissue necrosis and urethral injury caused by a metallic fashion ring.

Case Description: The patient presented with marked penile swelling, pain, and necrotic changes following prolonged entrapment by a metallic ring placed at the base of the penis. Initial removal of the device alleviated constriction, but progressive soft-tissue breakdown, cellulitis, and signs of infection necessitated operative evaluation. Clinical deterioration raised concerns regarding deeper tissue viability and urethral integrity. The patient underwent serial surgical interventions. The first procedure included exploration of the penile wound, drainage of purulent cellulitis, identification of a ventral urethrocutaneous fistula, and debridement of necrotic dorsal penile tissue. A 14-Fr Foley catheter was inserted for initial urinary drainage, and the wound was irrigated and dressed with non-adherent materials. Due to ongoing necrosis, a second procedure was performed. Flexible cystoscopy confirmed a ventral urethral defect with preserved proximal urethral patency and normal bladder mucosa. A 16-Fr suprapubic catheter was inserted to divert urine and support urethral healing, followed by limited repeat debridement and referral to plastic surgery.

Conclusions: This case demonstrates the complex challenges of high-grade penile strangulation injuries. Early intervention and multi-disciplinary management can optimise structural and functional outcomes in severe penile entrapment injuries

Keywords: Penile strangulation; penile necrosis; urethrocutaneous fistula; multi-disciplinary management; case report