Treatment Options and Outcomes of Penile Constriction Devices

ABSTRACT Purpose: To study the effect of penile constriction devices used on a large series of patients who presented at our emergency facility. We explored treatment options to prevent a wide range of vascular and mechanical injuries occurring due to penile entrapment. Materials and Methods: Between January 2001 and March 2016, 26 patients with penile entrapment were admitted to our facility and prospectively evaluated. Results: The time that elapsed from penile constrictor application to hospital admission varied from 10 hours to 6 weeks (mean: 22.8 hours). Non-metallic devices were used by 18 patients (66.6%) while the other nine (33.4%) had used metallic objects. Acute urinary retention was present in six (23%) patients, of whom four (66.6%) underwent percutaneous surgical cystotomy and two (33.4%) underwent simple bladder catheterization. The main reason for penile constrictor placement was erectile dysfunction, accounting for 15 (55.5%) cases. Autoerotic intention, psychiatric disorders, and sexual violence were responsible in five (18.5%), five (18.5%), and two (7.4%) cases, respectively. The mean hospital stay was 18 hours (range, 6 hours to 3 weeks). Conclusion: Penile strangulation treatment must be immediate through the extraction of the foreign body, avoiding vascular impairments that can lead to serious complications. Most patients present with low-grade injuries and use penile constrictors due to erectile dysfunction. Removal of constrictor device can be challenging. The use of specific tools for achieving penile release from constrictors is a fast, safe and effective method. Patients with urinary retention may require urinary diversion.

ABSTRACT
研究目的：本研究针对就诊于我院急诊医疗机构的大样本患者群体，探讨阴茎束缚装置（penile constriction devices）的临床效应，并探索可预防阴茎嵌顿（penile entrapment）引发的多类血管性与机械性损伤的治疗方案。
材料与方法：2001年1月至2016年3月期间，共有26名阴茎嵌顿患者入院，并接受前瞻性评估。
结果：从佩戴阴茎束缚装置至入院的间隔时长为10小时至6周不等，平均时长为22.8小时。其中18名患者（66.6%）使用了非金属装置，剩余9名（33.4%）使用了金属物品。6名患者（23%）合并急性尿潴留（acute urinary retention），其中4名（66.6%）接受了经皮膀胱造瘘术（percutaneous surgical cystotomy），2名（33.4%）接受了单纯膀胱导尿术（simple bladder catheterization）。阴茎束缚装置的主要佩戴原因为勃起功能障碍（Erectile Dysfunction），共15例（55.5%）；自慰行为、精神疾病及性暴力分别导致5例（18.5%）、5例（18.5%）及2例（7.4%）病例。患者平均住院时长为18小时，范围为6小时至3周。
结论：阴茎嵌顿的治疗需尽快取出异物，避免引发可导致严重并发症的血管损伤。多数患者伤情较轻，且因勃起功能障碍使用阴茎束缚装置。移除束缚装置具有一定挑战性，采用专用工具实现阴茎脱离束缚是一种快速、安全且有效的方法。合并急性尿潴留的患者可能需要接受尿流改道治疗。