The Iron Grip: A Rare Case of Penile Strangulation by a Metallic Ring.

Penile strangulation by foreign objects is a rare but serious urological emergency, most often associated with attempts to enhance sexual performance. Metallic rings are common offenders, and delayed intervention can lead to vascular compromise, ischemia, necrosis, and even penile loss. Management is particularly challenging when standard equipment is insufficient. We report the case of a 23-year-old male who presented with penile swelling and mild pain 5 h after symptom onset, following self-application of a metallic ring 12 h earlier. Manual removal attempts using lubrication were unsuccessful. Examination revealed marked edema with the ring firmly lodged at the penile base, without signs of necrosis or gangrene. Emergency removal was performed under spinal anesthesia. Tissue viability was confirmed intraoperatively. Due to the hardness of the ring and the lack of appropriate cutters, orthopedic instruments were utilized. An Alis bone gouge protected the underlying tissue while a Harrington jumbo rod cutter was used to cut the ring at two opposing points. The ring was successfully removed with minimal skin excoriation. Postoperatively, at 1-month follow-up, the patient had normal urinary and erectile function. Early intervention and innovative use of available tools are essential for the successful management of complex penile strangulation cases, especially in resource-limited settings.