[Self-inflicted penile strangulation].

BACKGROUND

Constricting devices or misappropriated means are either used to increase sexual performance or for autoerotic actions. They can lead to edema, maceration, to local infections up to Fournier gangrene or penile necrosis with or without involvement of the urethra. Injuries by these means are often challenging for the treating urologist.

METHODS

A 22-year-old patient presented to the urological emergency clinic with strong penile pain and voiding difficulties. Within the scope of the clinical investigation a foreign body (frying pan handle) was found around the penis. The penis appeared to be edematous, and necrosis of the distal superficial penis segments was noted. Under local anesthesia the frying pan handle, after procurement of suitable instruments, was removed. Subsequently, a suprapubic catheter was inserted and a broad antibiotic therapy was initiated. An antiseptic local therapy completed the primary treatment. Eight weeks after the event an orthograde urethrogram was performed. The urethra appeared to behave a normal caliber without evidence for strictures or other patho-morphological changes. The final examination showed a nearly completely epithelialized glans penis, with an approximately 1-cent piece small epithelial defect.

CONCLUSIONS

Constricting devices for the penis are used to increase the sexual performance or with autoerotic intentions. Removal of the constricting devices can become impossible secondary to a hefty swelling of the penis. The treatment consists, primarily, of an immediate decompression of the strangulated penis to ensure a free blood flow and an uninhibited micturition. The removal of the various objects requires in part craft instruments. A supplementary therapy must be selected based on existing additional complications.