塑膠寶特瓶瓶頸造成之延遲性陰莖絞扼傷，併發尿滯留與遠端陰莖缺血：即刻減壓與傷口處置

徐英傑¹、吳振宇^1、2、吳俊賢^1、2、林嘉祥^1、2

¹義大醫療財團法人義大醫院 泌尿科；

²義守大學 醫學系

Delayed Penile Strangulation by a Plastic Bottle Neck Complicated by Urinary Retention and Distal Penile Ischemia: Prompt Decompression and Wound Management

Ying-Jie Hsu¹, Richard C. Wu^{1, 2}, Chun-Hsien Wu^1,2, Victor C. Lin^1,2

¹Department of Urology, E-Da Hospital, Kaohsiung, Taiwan;

²School of Medicine, College of Medicine , I-Shou University, Kaohsiung, Taiwan

Introduction:

Penile strangulation injury caused by constricting foreign bodies is a rare urologic emergency that may result in progressive edema, ischemic change, and urinary retention, particularly when decompression is delayed. It most often occurs in adult men and is commonly associated with sexual activity, curiosity, or psychosocial factors. We report a 48-year-old man with a three-day plastic bottle-neck strangulation causing urinary retention and distal penile ischemia, treated with prompt decompression.

Case Presentation:

A 48-year-old divorced man with a history of hypertension presented to the emergency department with penile-base entrapment by the neck of a plastic bottle for three days, accompanied by urinary retention and progressive black discoloration of the distal penis. On arrival, he was hemodynamically stable and afebrile. Physical examination demonstrated a rigid constricting plastic ring at the penile base with severe distal edema and diffuse dark discoloration of the penile shaft, with the glans showing black necrotic change concerning for threatened tissue viability. Bedside bladder ultrasonography revealed post-void residual urine >1,000 mL, and laboratory testing showed WBC 9,800/μL.

Urgent urinary diversion was performed with suprapubic catheterization, and empiric antibiotics were initiated. The patient underwent emergent foreign body removal by a bone cutter. A 16 Fr two-way Foley catheter was inserted, and the suprapubic catheter was removed intraoperatively. The patient developed postoperative fever later that day and was managed with ongoing antimicrobial therapy and wound care.

On postoperative day 1, marked preputial edema raised concern for compromised distal penile perfusion; therefore, a dorsal slit was performed and left open for decompression, and primary closure was avoided due to wound contamination. Subsequent local care included wet dressings, topical silver sulfadiazine cream, and serial removal of nonviable tissue during dressing changes. Penile Doppler ultrasonography on postoperative day 6 demonstrated patent penile blood flow with no visible tunica albuginea rupture. The Foley catheter was removed on postoperative day 10, and the patient resumed spontaneous voiding without difficulty. After decompression, the glans demonstrated signs of reperfusion with gradual return of a pink hue; however, by postoperative day 32, necrosis of the prepuce and portions of the penile shaft skin persisted. The Department of Plastic and Reconstructive Surgery recommended debridement of devitalized skin followed by skin grafting once wound margins were clearly demarcated, but the patient elected discharge and was subsequently lost to follow-up.

Conclusion:

Delayed penile strangulation injury can present with threatened distal penile viability and urinary retention. Prompt decompression with timely urinary diversion is essential to restore perfusion and prevent irreversible ischemic damage. After initial salvage, ongoing management should include monitoring distal penile perfusion, assessment of urethral integrity and voiding function, and wound surveillance for infection and necrosis. Definitive reconstruction may be considered after the wound is demarcated and stabilized, ranging from skin grafting for cutaneous loss to phalloplasty for total penile defect.