(286) Goldmember: A Novel Approach to Remove Entrapped Metal Rings Around a Penis
Authors: Lee J , Tennenbaum D , Schulman A , Khurgin J , Martel E 
Published: May 2023

Abstract

Introduction
Penile strangulation with metal objects is a rare urologic emergency that can present considerable challenges. The treatment approach can vary depending on the type of constricting device, degree of injury, and available equipment. Prior medical reports document the use of various instruments such as bolt cutters, oscillating saws, and power drills. Our case demonstrates a safe and reproducible means to remove metal rings entrapped around a penis using the Midas Rex® drill.

Objective
To describe a novel treatment approach in penile strangulation with the use of the Midas Rex® drill.

Methods
A 70-year-old male with a history of paranoid schizophrenia presented to our institution’s emergency department with urinary retention and penile pain due to the placement of five rings onto the penis two weeks prior. On exam, he had swelling of the glans and skin necrosis underneath the rings (Figure 1). After initial bedside attempts to remove the rings proved unsuccessful, he was promptly taken to the operating room. Further attempts to remove the rings using orthopedic pin cutters were also unsuccessful. Next, the Midas Rex® drill (Figure 2a) was used to cut each ring into two segments. The penis was protected from traumatic and thermal injury with careful retraction and continuous irrigation (Figure 2b). All five rings were successfully removed without sustaining iatrogenic injuries (Figure 2c). The injuries were limited to pre-existing superficial wounds of the penile skin (Figure 3a). A cystoscopy was performed and did not reveal any evidence of urethral injury. A suprapubic catheter (SPC) was placed to allow for urethral rest with 1,200 ml of urine drained. Postoperatively, the patient was stable and was transferred to the inpatient psychiatric unit the next day. After adjustment of his psychiatric medications and six days of observation, he was discharged. At his two-week urology follow-up, he had near-complete healing of the penile skin (Figure 3b). His SPC was also removed with low post-void residual noted.

Results
We present a case where mechanical methods could not be used to remove entrapped metal rings around a penis. In cases requiring the use of electrical tools, it is of utmost importance to protect the penis from iatrogenic injuries. Although the use of non-medical devices such as electric saws have been described in penile strangulation, they can often be bulky. Also, in several reports these devices have caused thermal injuries, leading to urethral strictures and urethrocutaneous fistulae. We were able to use the Midas Rex® drill, an instrument typically used in neurosurgical and orthopedic procedures, with excellent results. By using the diamond-tipped metal cutter attachment and powering the drill with compressed nitrogen set at 120 psi, all five metal rings were safely removed in under 30 minutes.

Conclusions
Penile strangulation represents a rare urologic entity requiring prompt removal of constricting devices to avoid ischemic complications. From our experience, we demonstrated that the Midas Rex® drill can be safely and expeditiously used to remove metal rings entrapped around a penis with minimal risk of iatrogenic injury.

Disclosure
No