A penile ring entrapment: a rare case report and review of management options

Introduction: Penile ring entrapment is a rare urological emergency requiring prompt management otherwise it gets complicated and results in penile amputation and death. We present the management of a case of an entrapped penile ring in a psychiatric patient with penile skin loss in a resource-limited setup treated by a multidisciplinary team. Case presentation: A 28-year-old male psychiatric patient presented after 72 hours of a penile ring insertion for a delusional belief of obeying his father's command with associated painful penile swelling, skin blistering, and acute urinary retention. The ring was cut using a manual ring cutter and K-wire, with full penile recovery on wound care followed by grafting in 6 months of follow-up. Discussion: A penile ring typically results in the constriction of the penile tissue with subsequent vascular compromise and development of complications. The principles of management of penile ring entrapment involves treating the underlying reason for penile ring application, removal of the ring, and managing complications. The options of removing the ring include sliding, cutting, and penile surgical interventions. The choice which option to use depends on the size of the constricting object, incarceration time, injury level, available instruments, and experience of expertise. Conclusion: Eroticism, erectile dysfunctions, and underlying untreated psychiatric disorders are the most common reasons for penile ring insertion. Delayed ring removal due to embarrassment, psychiatric disorder, and multiple self-trials of ring removal at home can result in the development of complications. Prompt ring removal requires standard gadgets, a multidisciplinary approach, and local management protocols.