Penile constriction injuries are rare urologic emergencies that can progress to ischemia if not promptly relieved. Metallic devices composed of titanium present unique challenges due to their strength and resistance to standard emergency department cutting tools. We report a 52-year-old male patient who presented with acute penile pain, swelling, and discoloration after a titanium wedding ring became entrapped at the penile base for four hours. Conventional ring cutters were ineffective, and no powered surgical tools were immediately available. The patient underwent ketamine procedural sedation and dorsal penile nerve block. Approximately 50 mL of blood was aspirated to reduce engorgement and allow safe placement of protective barriers. A nonpowered 24-inch bolt cutter obtained from hospital facilities was used to fracture the titanium ring without tissue injury. Penile color and edema improved immediately. The patient was observed, successfully voided, and was discharged with urologic follow-up. This case highlights a practical approach for emergent removal of titanium penile constriction rings when standard equipment fails, emphasizing multidisciplinary coordination and staff safety precautions.
Weston et al. (Sat,) studied this question.