The Queen Elizabeth Tuck Technique - A Novel Technique For Removal Of A Strangulating Penile Ring.

摘要

Penile strangulation is a urological emergency. It occurs most commonly secondary to an external device such as a penile ring used for sexual gratification. Prompt and safe removal is of the utmost importance. Herein we discuss 'The Queen Elizabeth Tuck Technique' of removing a penile ring. We have found this technique superior to previously described methods as it avoids the need for more invasive procedures. Furthermore the device can be removed expediently preventing additional ischemic injury and with minimal damage to the skin. Introduction Strangulation of the penis is an uncommon [1] urological emergency requiring prompt diagnosis and management in order to avoid the complications of ischemic necrosis and auto-amputation. It can present with varying clinical scenarios depending on the degree of vascular obstruction; from insignificant, easily-reversible obstruction to severe gangrene and the accompanying complications [1]. In order to avoid these severe complications, every attempt at prompt removal of the strangulating device needs to be made [2-4]. This case report details ‘The Queen Elizabeth Tuck Technique' used to remove a large metallic ring lodged at the base of a young patient’s penis. This technique is efficacious even with severe oedema. Furthermore it is time efficient. Case Report A 29-year-old welder presented to the Emergency Department of the Queen Elizabeth Hospital complaining of swelling and discolouration of his penis. On further questioning, the patient revealed that he had placed a large metallic ring around the base of his penis 16 hours earlier. He admitted to doing this regularly for the past 9 years as a method of sexual gratification. On this occasion he had placed the ring around his penis, but had then fallen asleep. On waking, he discovered his penis was very swollen and discoloured, and when he was unable to remove the device himself, he presented to the Emergency Department.Examination in the Emergency Department revealed a discoloured and grossly engorged (approximately 6cm in diameter) penis with a thick metallic device at the base. The metallic ring measured 4cm in diameter with an inner diameter of only 2.5cm (figure 1-3). The skin beneath the device was macerated, presumably from the multiple attempts at removal. The patient reported voiding the previous evening and was not in urinary retention. The Emergency Department Physicians attempted to reduce the penile swelling by application of ice, sugar and compression with minimal results.