La tunisie Medicale - 2017 ; Vol 95 ( n°012 ) : 505-506
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Article


Introduction
The first Case report of penile strangulation was published since the late 18th century (1). The method of desincarceration depends on disponibility,severity of incarceration and penile edema, Penile skin,cavernouscorporea,anduretra can be damaged by the constriction and ischemia . The solution to prevent complications and salvage the penis is to quickly relieve the constriction. Observation We report the case of a 44 year old man known schizophrenic who presented to the emergency with acute retention of urine (fig 1) for 3 days with a large distended bladder and penis swollen and cyanotic and necrotic area following strangulation by a metal ring at the base of the penis cannot be reduced manually. A supra pubic catheterization was performed due to the impossibility to perform urethral catheterization, as well as reduced congestion by catheterization of the corpora cavernous. The metal ring has been cut by an electric saw; we realized a cooling of the operative field with saline (fig 2). Immediate evolution was marked by a refill of the penis, resorption of edema and loss of skin substance. Three months later a skin plasty was performed with satisfactory results (fig 3)

Figure 1 : Acute retention of urine with penile constriction by metallic ring

Figure 2: Metal ring cut by an electric saw

Figure 3 : Evolution three month after skin plasty.

Discussion
The use of various objects for penile constriction for erotic gratification has been reported since 18 th century. Constriction with inextensible ring is associated with a lot of complications as acute urinary retention, skin necrosis and urethral injuries. The mainstay of treatment in emergency is to realize the urinary diversion .In this case, urinary diversion was achieved with a supra -pubic catheter .The second step is the constriction removal which is a priority for re vascularise the penis and limited ischemia .Ponction Aspiration of glans can be used to minimize the blood stockage and the oedema .Decisions as to which method or tool to use should be made quickly and be based on resources that are readily available in the hospital (2,3).Thus, penile gangrene or urethral scarring due to prolonged ischemia, as well as a necessity for penile amputation, can be prevented. Another injury to skin, cavernous corpora and urethra by the rotating blade are prevented with perfusion of cold physiological serum In our case Loss of substance were Important and necessitate large decapage of necrosis tissues and self skin plasty.
Conclusion
Penile incarceration by metallic ring is a very rare emergency Schizophrenic men seem to be the most concerned by this circumstance ; Ischemia can lead to rapid necrosis of skin, cavernous corpora and urethra The first challenge is to cut the ring without provoking another lesions The second goal is to repair the lesions due to ischemia In our case we were face to urinary retention managed by cystostomy The ring was cut by artisanal electric saw Skin lesions were the most important and were managed succefully by skin plasty

Références
  1. Sangeeta L , Nitin N. P,Sandra R. S. Penile Incarceration Secondary To An S-Shaped Lead Pipe:Removal With Dremel Moto-Tool. The Journal Of Emergency Medicine. 2012;42(6):659-661.
  2. Detweiler MB. Penile incarceration with metal objects: a review of procedure choice based on trauma grade. Scand J UrolNephrol 2001;35:212 –7.
  3. Santucci RA, Deng D, Carney J. Removal of metal penile foreign body with a widely available emergency -medical -services -provided air -driven grinder. Urology 2004;63:1183 – 4.
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Enfant traitement pronostic Chirurgie Tunisie diagnostic Maladie de crohn dépistage Cancer Cancer du sein Coelioscopie Immunohistochimie Mortalité mammographie prévention
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