A Golden Snare: A Penile Ring Entrapment Case Report and the GEM II Solution
Introduction
Rings and ornaments are used by some individuals to improve their sexuality by placing them over/on their sex organs as commonly seen among males. Some people patronizing this act may have underlying mental health conditions1. When these rings are placed but fail to be removed after serving its purpose, they now become a urological emergency, diagnosed as penile ring entrapment2. Penile ring entrapment is characterized by features such as venous stasis, edema with or without skin ulceration, reduced lymphatic and arterial blood flow and eventual gangrene3.
Rings placed over the male sex organ may be referred to as penis ring or cock ring or tension ring as well as constriction band. Materials used in these acts may be made of plastic whereas others use heavy metals such as gold and tungsten ring and sometimes nuts2. Using rings to improve the sexuality of male persons might be popular in some cultures3, however, this is rare in my setting or there is scarce data to that effect.
Various ring removal methods have been described prior to this report. Some techniques used to remove entrapped rings include use of lubricants or soapy water; traction technique such as the string pull methods and caterpillar methods; and the rotation- based method that dates back to19404. However, we write to report on the effectiveness yet simple use of the battery-powered GEM II ring cutter. The product contains different cutting discs used for cutting both simple and heavy metals as well a protective guard to prevent untoward injury to underlying skin tissue5.
Keywords: Rings and ornaments; Entrapment; Penis; Skin tissue; Ulceration
Case presentation
A 28-year-old male was brought to the Emergency Department with
inability to urinate, penile swelling and discomfort. He was accompanied by his
mother who had been caring for him after sustaining spinal injury a couple of
months prior presentation. He admitted to placing a gold ring over to the base
of his penis to “have and maintain” an erection as his injury had impaired him
from experiencing one. He admitted to being depressed and having had thoughts
of ending his life. He presented more than 72 hours after the incident and
after multiple failed attempts at removing the ring. Examination at the ED
showed swelling at the suprapubic region with edematous penile shaft and glans.
There was a constricting band, made of gold, at the base of the penis with dorsal
ulceration of the skin over the penile shaft (Figures 1 and 2).
Figure 1: swollen penile shaft with
ulceration and yellow metal at penile base(left); penis after metal ring has
been safely removed (right)
Figure 2: picture of the ring after
removal. Ring cut in two places for easy removal
Treatment
Multiple options were considered for ring removal but were going to
inflict more injury to the surrounding skin and tissue and/or would just be
unsuccessful. The options included the lubricating method and compression-based
techniques, both of which were impossible and would cause more injury. The
decision to use the GEM II ring cutter was accepted as it had been used for
finger ring entrapment without damage to skin and its use guaranteed rapid ring
removal. The procedure was explained to the patient and consent sort. Patient
was placed supine, area cleaned and the guard safely placed between the ring
and skin with aid of water- soluble lubricant. The diamond disc cutter was
mounted on the 4 AA battery- powered device and the ring was cut in 2 places
for safe removal. There was immediate leak of urine via the urethra after the
first cut was made. Brief pauses were made to prevent heat build and thermal
burns hence avoiding further skin damage. The procedure lasted less than 6
minutes. Bedside urinalysis done and the urology and psychological teams
consulted for further evaluation and care.
Discussion
The use of rings of different makes, to achieve sexual gratification
is real and are sometimes, likely to get trapped over the penis and/or scrotum3. This is an
uncommon finding in my emergency department hence not witnessed by many
physicians. It is reported that some people engage is this act to enhance their
sexual response, self-treatment of erectile dysfunction and because of
psychiatric disturbances1. Penile ring entrapment is indeed a urologic emergency as is
threatens the integrity of the tissue within the distal penis1,6. Trapping
the penile base with a ring causes a series of vascular events, spanning
through venous stasis, edema, reduced lymphatic and arterial flow and then
gangrene3. The aim of this case report is to inform clinicians in my setting
and others of the possibility of obstructive urinary symptoms due to ring
entrapment and discuss a simple, yet efficient technique to saving the penile
organ.
Conclusion
While various methods for ring removal exist, including lubrication
and compression techniques, these were deemed unsuitable due to the severity of
the edema and potential for further injury. The GEM II ring cutter proved to be
a rapid and safe solution, preventing thermal burns and ensuring the
preservation of the penile organ. This case emphasizes the importance of
clinician awareness regarding penile ring entrapment as a potential cause of
obstructive urinary symptoms, particularly in settings where such occurrences
are rare. The GEM II ring cutter offers a simple, effective and readily
available method for managing such emergencies, preventing severe complications
and improving patient outcomes.
Funding
This research received no external funding
Conflict of
Interest
The author declares no conflict of interest.
References