Management of penile ring entrapment using the “two-pliers technique”: Two case reports

Penile ring entrapment is a rare urological emergency that can progress rapidly from simple vascular obstruction and edema to ischemia, necrosis, or even autoamputation if not managed promptly. The first case was reported by Gauthier in 1755, and since then, the condition has been documented mainly through case reports and small case series, which typically focus on the type of constricting object and the techniques used for its removal. Thick metallic rings pose a particular challenge because of their rigidity and the technical difficulty encountered during attempts at extraction. We report two cases of penile strangulation caused by hard metallic rings, a silver ring in a 22-year-old and a tungsten ring in a 46-year-old, both presenting within 15–18 h of entrapment. Each showed distal penile edema, tenderness, and difficulty voiding, without ulceration or necrosis. Both were successfully treated in the trauma unit under topical lidocaine using a simple, noninvasive “two-pliers technique,” with no additional interventions required. They were discharged the same day and demonstrated normal penile findings, normal voiding, and preserved erectile function at 1-week follow-up. Constricting penile rings, particularly rigid metallic ones, pose a significant challenge to urologists and require urgent removal. Numerous approaches have been described, with the choice of method often dictated by the type of object involved, the degree of injury, and the surgeon’s available resources and expertise. We recommend the “two-pliers technique” for early-presenting cases involving hard metallic constricting objects, as it provides a simple, rapid, and noninvasive method that can be performed under local anesthesia in cooperative patients, provided it is executed by skilled hands.