Chronic Penile Strangulation by Embedded Metal Ring: Five-Year Case Study

Overview

This case study details a rare instance of chronic penile strangulation caused by a metal ring embedded subcutaneously for five years. Surgical removal was successfully performed with minimal complications, and normal urinary and erectile functions were preserved postoperatively.

Background

Penile strangulation is an uncommon urological emergency often caused by foreign objects leading to edema, ischemia, and tissue necrosis. Most cases present acutely and require urgent intervention. Chronic penile strangulation due to subcutaneous embedding of foreign bodies is exceedingly rare, with few documented reports. Prompt diagnosis and appropriate management are critical to prevent severe complications.

Data Highlights

A 37-year-old male presented with swelling and purulent urethral discharge after five years of a metal ring placed at the penile base. Physical exam showed swelling and skin ulceration without visible foreign body. X-ray confirmed a 2 cm metal ring embedded subcutaneously. Urinalysis and STI screening were negative. Erectile function assessment (IIEF-5) indicated mild dysfunction. Urodynamic studies showed normal voiding parameters. Postoperative follow-up at one and three months revealed proper wound healing, no urinary complications, and stable erectile function.

Key Findings

• The metal ring had been embedded subcutaneously for five years without causing ischemic necrosis or severe complications.
• Physical examination failed to detect the ring due to skin erosion and embedding; diagnosis was confirmed by plain x-ray imaging.
• Surgical removal via dorsal penile skin incision was successful, preserving the dorsal neurovascular bundle and urethra.
• No postoperative complications such as urethral fistula, voiding difficulty, or infection were observed during three months of follow-up.
• Erectile function remained stable compared to preoperative status despite mild dysfunction reported prior to surgery.
• The patient declined psychiatric consultation despite low psychological assessment scores.

Clinical Implications

Clinicians should consider imaging studies when physical examination does not reveal a suspected foreign body in cases of chronic penile swelling and discharge. Surgical removal of embedded foreign objects can be safely performed with careful dissection to preserve neurovascular structures and urethral integrity. Early intervention may prevent progression to severe ischemic injury and preserve urinary and sexual function.

Conclusion

This rare case of chronic penile strangulation by a metal ring embedded for five years demonstrates that timely surgical intervention can achieve successful removal with minimal morbidity. Awareness of such presentations is important for appropriate diagnosis and management.

References

1. Bhat et al. 1991 -- Penile strangulation: classification and management
2. Silberstein et al. -- Refinement of penile strangulation injury classification
3. Gauthier 1755 -- First reported case of penile strangulation
4. Campbell et al. -- Acute penile strangulation case report