Case Report: Penile Constriction Injury from Nine Metal Rings — Immediate Care and Recovery

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Medical professionals at Gold Coast University Hospital in Queensland reported a notable clinical case in Urology Case Reports about a man who sustained penile injury after sleeping while intoxicated and wearing nine metal rings around his penis. The decision to publish stemmed from the unusual nature of the incident and the important lessons it offers about urgent care in penile constriction injuries.

The patient, a 44-year-old man, had chosen heavy steel rings with a diameter of about 1 centimeter to attempt to maintain an erection. He did not anticipate the danger that the metallic constriction would pose after a night of alcohol use, and he fell asleep. Upon waking, he experienced intense pain in the genital region and sought emergency medical care immediately. This rapid presentation was crucial in preserving tissue viability and preventing further complications.

Clinical evaluation revealed marked swelling and bruising of the penis and surrounding tissues, consistent with vascular congestion and tissue irritability resulting from prolonged constriction. The team administered pain relief with intravenous opioids to manage severe discomfort while preparing for definitive management. The situation highlighted the severity of constriction injuries and the multidisciplinary approach required to stabilize such patients effectively.

Initial removal attempts by paramedics using bolt cutters were unsuccessful due to the tight grip of the rings and the risk of causing further trauma. The patient was later transferred to the operating room, where under general anesthesia, a coordinated effort involving the fire department and medical staff executed a careful extraction using an electric circular saw suitable for controlled cutting of metal rings. The goal was to free the tissue with minimal additional injury while maintaining urinary and overall genital function.

Following the successful removal of all nine rings, the medical team performed cystoscopy to inspect the urethra and bladder intimately. This assessment confirmed mucosal irritation and swelling, but there was no evidence of perforation or structural damage requiring immediate surgical repair. The patient did not need subsequent surgical intervention, though he reported transient erectile difficulties during the ensuing two months, which gradually improved with time and conservative management.

Experts emphasize that timely hospital presentation is essential in constriction injuries, as prolonged compression can severely compromise blood flow to the penis. Delays may lead to tissue necrosis or, in extreme cases, the need for more drastic interventions. Awareness of the risks associated with constricting devices and early medical evaluation are critical for preventing lasting harm and preserving sexual function.

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