PENILE STRANGULATION INJURY IN THE PEDIATRIC POPULATION
DOI:
https://doi.org/10.46793/PP250130015TKeywords:
penile strangulation, injury, pediatrics, urology, abuseAbstract
Introduction: Penile strangulation injuries in pediatric patients are a rare and urgent condition in urology. They are commonly seen in adolescents and adult males, often due to autoerotic suggestions, while in younger pediatric patients, they more frequently occur accidentally. Objects of causing strangulation are elastic and rigid items of various shapes and sizes. Reports of strangulation injuries as a result of abuse are rare.
Case outline: A 16-year-old boy was admitted to the University Children’s Hospital in Belgrade due to described penile strangulation injury inflicted by another person. The patient is under care of the Social Welfare Center ’’Sremčica’’ due to developmental and behavioral disorders. The boy is followed by psychiatrist for a psychopharmacologically treated underlying condition. Upon admission, there was a skin defect encompassing the entire circumference of the penis with fibrous deposits, pronounced lymphatic edema. Vascularization is preserved. The urethra was not damaged. The patient was hospitalized. Antibiotic and symptomatic therapy were included. Emergency surgical intervention was indicated. Psychopharmacological therapy for the boy’s underlying condition was suspended before and the day of the operation. Circumcision with penile skin reconstruction was performed. The postoperative course was uneventful, with no signs of infection or skin necrosis, and lymphatic edema was gradually subsided. The urinary catheter was removed and spontaneous urination was preserved. Therapy for the boy’s underlying condition was gradually reintroduced. After a satisfactory postoperative period, the patient was discharged with regular urological follow-up appointments and advice on maintaining hygiene of the surgical wound. It was instructed to use coban bandages and an ointment containing panthenol or antibiotic cream, and to avoid masturbation for three months after the operation.
Conclusion: Timely treatment is imperative in cases of penile strangulation injuries. Proper surgical intervention and reconstructive procedures are necessary to prevent the progression of damage and complications.
References
Campbell KJ, Kwenda EP, Bozorgmehri S, Terry RS, Yeung LL. Penile Strangulation: Analysis of Postextrication Follow-Up, Sequelae, and a Review of Literature. Am J Mens Health. 2024;18(1):15579883231223366. doi: 10.1177/15579883231223366. PMID: 38293721.
Mbwambo OJ, Kiattu E, Mbwambo J, Bright F, Mteta AK, Ngowi BN. Penile strangulation by a metallic nut in an 8-year-old male: A rare case report of urological emergency. Int J Surg Case Rep. 2021;89:106581. doi: 10.1016/j.ijscr.2021.106581. PMID: 34823162.
Acharya GB, Baral S, Poudel A, Neupane A, Kandel K. Penile strangulation, a study of two cases. Int J Surg Case Rep. 2022;94:107100. doi: 10.1016/j.ijscr.2022.107100. PMID: 35468381.
Nguyen V, Garg N, Cedars BE, Puri D, Ahmadieh K, Buckley JC. Delayed gangrenous penile necrosis following prolonged utilization of penile constriction ring. Urol Case Rep. 2024;55:102762. doi: 10.1016/j.eucr.2024.102762. PMID: 38911466.
Djokic D, Milani GP, Lava SAG, Gualco G, Corigliano T, Bianchetti MG, et al. Hair-thread strangulation syndrome in childhood: a systematic review. Swiss Med Wkly. 2023;153:40124. doi: 10.57187/smw.2023.40124. PMID: 37955631.
Templet TA, Rholdon RD. Assessment, Treatment, and Prevention Strategies for Hair-Thread Tourniquet Syndrome in Infants. Nurs Womens Health. 2016;20(4):421-5. doi: 10.1016/j.nwh.2016.06.005. PMID: 27520606.
Koushik P, Daniel B, Meyyappan V, Sekar H, Krishnamoorthy S. A Case Series on Penile Garroting: Causes, Considerations, and Consequences. Cureus. 2024;16(9):e70190. doi: 10.7759/cureus.70190. PMID: 39463593.
Klusmann A, Lenard HG. Tourniquet syndrome--accident or abuse? Eur J Pediatr. 2004;163(8):495-8; discussion 499. doi: 10.1007/s00431-004-1466-1. PMID: 15179509.
Djordjevic ML, Bumbasirevic MZ, Krstic Z, Bizic MR, Stojanovic BZ, Miocinovic R, et al. Severe penile injuries in children and adolescents: reconstruction modalities and outcomes. Urology. 2014;83(2):465-70. doi: 10.1016/j.urology.2013.10.015. PMID: 24275276.
Qamar J, Kazmi Z, Dilawar B, Nazir Z. Penile strangulation injury in children - Reconstructive procedure and outcome. J Pediatr Surg. 2020;55(6):1165-1168. doi: 10.1016/j.jpedsurg.2019.12.011. PMID: 31948668.
