Complications Of Penile Rings

Penile strangulation can occur from pressure around the entire penile circumference by rings, hair, or other devices. Since delay in relief of strangulation can lead to vascular compromise and other serious consequences, these devices must be removed rapidly. Penile-strangulating objects have been placed for masturbatory purposes, as adjuncts to vacuum erection devices, to prolong erections, enhance sexual performance, and often by children during experimentation. Such devices have also been used to prevent enuresis and nocturnal emissions. In the pediatric population, the possibility of child abuse must also be considered.

Patients often delay seeking medical attention secondary to embarrassment and present to the emergency department with extreme pain. Other presenting symptoms include edema, ulceration, urinary retention, and vascular compromise with and without necrosis. As strangulation occurs, decreased venous and lymphatic drainage leads to edema and swelling of the penis distal to the site of constriction. Further swelling may lead to compromised arterial flow and gangrene of the penile tissue. Necrosis tends to involve mainly the skin and the subcutaneous tissue. However, because each corpus cavernosum has its own artery and these deeper vessels are protected by the Buck's fascia and overlying corporal tissue, gangrene of the corpora cavernosa is rare. Grades of penile strangulation have been described ( Table 95-2).

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