Introduction: Penile incarceration or strangulation due to an external device is a rare urologic emergency. There are many different types of constriction rings that vary in composition and form. Metal constriction rings are particularly challenging to remove once the penis becomes entrapped as they are not only a harder material, but often are of increased thickness compared to typical constriction rings. We detail a case of prolonged penoscrotal incarceration due to a steel constriction ring and the method utilized for the ring’s removal. We aim to describe a specific and actionable technique for removing metal constriction rings Methods: We report the technique used to remove a stainless steel ring that cause penoscrotal entrapment and subsequent edema after being in place for 12 hours. Results: The patient was prepped in an operating room and a combination of saline soaked gauze and blue towels were used to protect the surrounding skin. The skin below and surrounding the ring was coated in lubricating jelly to prevent scatter of heated metal fragments. An army navy retractor was placed between the ring and the skin to protect the genitals from injury. An Ortho Core Metal Cutting Pneumatic Drill with a 3.2 mm x 18.3 mm metal cutting helicoidal rasp was used to cut the ring at the 3 and 9 ‘o clock positions. Cooled saline irrigation was applied throughout removal to prevent thermal injury. The patient was seen 6-weeks post-operatively. There were no visible external injuries, palpable penoscrotal pathology or voiding complaints. All swelling had resolved. The patient did endorse worsened erectile dysfunction, but no other complications were noted. Conclusions: Penile incarceration due to a constriction ring is a urologic emergency that necessitates timely evaluation and management. The Stryker Ortho Core Metal Cutting Drill with a metal cutting helicoidal rasp is a reliable tool for the removal of metal constriction rings. Measures to protect the genitals and surrounding skin from both direct mechanical injury and indirect thermal injury are critical. Lastly, staff should wear appropriate protective gear. SOURCE OF Funding: None.
