title: Strangulation of penis by a ball bearing device.
abstract: BACKGROUND
  Penile strangulation is rare and usually results following placement of constricting objects to enhance sexual stimulation. It requires urgent treatment as delay may lead to irreversible penile ischemia and gangrene. Various objects causing penile strangulation have been reported. Nonmetallic and thin metallic objects can be removed easily as compared to heavy metallic objects. Cutting is the commonest method described, although procuring special cutting tools may be difficult and the process of cutting may be tedious with the possibility of iatrogenic penile injury.
  
  
  OBJECTIVE
  To present a simple, safe, minimally invasive, effective, and feasible technique for removing heavy metallic objects constricting the penis.
  
  
  METHODS
  The published English literature (PubMed™) was searched for cases of "penile strangulation" using the keywords penile strangulation, penile injury, penile trauma, penile constriction, penile entrapment, and penile incarceration. The described treatment modalities were carefully reviewed and studied.
  
  
  METHODS
  Reviewed published English literature on the various causes of penile incarceration and the various techniques used for their extrication.
  
  
  RESULTS
  Search results yielded several cases of penile strangulation caused by a variety of metallic and nonmetallic objects. Various modalities have been described in the English literature for their safe removal, each with its own merits and demerits.
  
  
  CONCLUSIONS
  Penile strangulation should be viewed and managed as an emergency in order to prevent penile necrosis and urethral injury and to preserve erectile function. The modified method described herein for managing penile strangulation due to heavy metallic rings is minimally invasive, safe, effective, does not require any special cutting instrument(s) or skill, and is free of causing iatrogenic collateral thermal or mechanical damage to the penile organ. A stepwise algorithm depicting a rational and comprehensive approach to the diagnosis and management of penile incarceration is also suggested for the clinicians.
authors.affiliation: Division of Urology (Surgery), University College of Medical Sciences (University of Delhi) & GTBH, Delhi, India. iqbalsinghp@yahoo.co.uk
authors.forename: Iqbal
authors.initials: I
authors.lastname: Singh
authors.forename: Mohit K
authors.initials: MK
authors.lastname: Joshi
authors.forename: Maninder S
authors.initials: MS
authors.lastname: Jaura
mesh_terms: D000328:Adult; D001237:Asphyxia; D003251:Constriction, Pathologic / Q000150:complications / Q000601:surgery; D005547:Foreign Bodies / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D010409:Penile Diseases / Q000601:surgery*; D010410:Penile Erection; D010413:Penis / Q000293:injuries* / Q000601:surgery; D016728:Self-Injurious Behavior; D012725:Sexual Behavior