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Case Reports
. 2023 Sep 7:2023:5523569.
doi: 10.1155/2023/5523569. eCollection 2023.

Robot-Assisted Repair of Bladder Rupture following Penile Ring Entrapment

Matthew Skalak  1 , Rami Jirjis  1 , Barrett G Anderson  1 , Brandi D Miller  1
Affiliations
Case Reports

Robot-Assisted Repair of Bladder Rupture following Penile Ring Entrapment

Matthew Skalak et al. Case Rep Urol. .

Abstract

Penile rings have been used to help sustain erection and enhance sexual pleasure for centuries. Constriction of the penis reduces the outflow of blood from the cavernosal tissue. However, if left for an extended time period, a condition called penile ring entrapment can occur. This may result in severe edema, gangrene, necrosis, and even penile amputation. Penile ring entrapment is a very rare condition; complete urinary obstruction with concomitant bladder rupture as a result renders this case even more extraordinary. We discuss our experience in the management of a 64-year-old man, who presented with altered mental status and inability to urinate, found to have penile ring entrapment and intraperitoneal bladder rupture. Removal of the constricting ring was performed in the ED, and bladder injury and penile necrosis were subsequently repaired with robot-assisted laparoscopic cystorrhaphy, penectomy, and perineal urethrostomy.

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Conflict of interest statement

RJ, MS, BGA, and BDM do not have any conflicts of interest or financial disclosures.

Figures

Figure 1
Figure 1
Initial presentation. On initial examination, a soda bottle found at the penile base was causing strangulation. The penis appeared entirely necrotic. Meatal stenosis was noted. The bottleneck was removed from the patient's penile shaft with cardiac wire cutters, and a Foley catheter was placed over a wire following urethral dilation.
Figure 2
Figure 2
Intraperitoneal bladder injury. Computed tomography cystogram sagittal view demonstrated an intraperitoneal bladder injury at the dome. Direct robot-assisted laparoscopic visualization is shown. Repair was performed in a standard 2-layer fashion using 3-0 and 2-0 V-Loc™ sutures.
Figure 3
Figure 3
Initial debridement of the penile shaft. Intraoperative and back table dissection demonstrated dry necrosis throughout most of the penile shaft and glans.
Figure 4
Figure 4
Partial penile amputation. Performed on hospital day 2 with creation of a 1.5 cm penile stump.
Figure 5
Figure 5
Post-partial penile amputation. As seen on postoperative day 7 following partial penile amputation.
Figure 6
Figure 6
Penile stump necrosis. On hospital day 14, postoperative day 13 from index operation, necrotic changes were noted to the penile stump.
Figure 7
Figure 7
Healing perineal urethrostomy. Urethrostomy able to accommodate a 30F Bougie.
See this image and copyright information in PMC

References

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