Penile Entrapment Caused by Five Metallic Rings: A Case Report.

Penile strangulation is a rare urological emergency that can lead to severe complications such as ischemia, necrosis, and urethral injury. We present a case of a 76-year-old man who presented to the emergency department with severe penile pain and swelling after applying five metallic rings to enhance erection during sexual intercourse. The patient had a history of erectile dysfunction and had been using phosphodiesterase inhibitors with a moderate response. Physical examination revealed significant edema distal to the glans, but capillary refill and sensation were intact, indicating preserved perfusion. Initial attempts to remove the rings with lubrication and manual manipulation were unsuccessful due to the extent of the swelling. A ring cutter was used to cut through each ring while protecting the underlying tissue, and the entire process lasted approximately 90 minutes. After removal, no signs of laceration, urethral injury, or necrosis were observed. The patient was discharged with anti-inflammatory medication and oral antibiotics. This case highlights the challenges associated with the management of penile strangulation injuries, particularly when multiple metallic objects are involved. Prompt evaluation, creative procedural approaches, and multidisciplinary collaboration are critical for minimizing morbidity. Elderly individuals engaging in sexual experimentation should be informed about the potential risks associated with the use of constricting devices.