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ACEP Now: Vol 40 – No 10 – October 2021Figure 3: IV drip set irrigation is being used to dissipate heat, the patient and clinicians are shielded from sparks, and a foam aluminum splint is used to protect the skin beneath the device. (In this case, a pneumatic grinding device supplied by EMS was used.)
The patient should be draped with towels with consideration of the path sparks will take during the procedure. Face masks or other eye protection are advised for all clinicians working near the site of spark generation.
Continuous fluid irrigation directly onto the site of cutting is advised, as a considerable amount of heat is produced by the grinding device (see Figure 3). The patient should be advised of this expectation and be asked to give feedback if they feel heat developing so that additional time can be allowed for heat dissipation. Once a cut has been made through the entirety of the ring, some relatively malleable metals can be spread apart wide enough to allow for removal from the genitals. More rigid materials may require the clinician to rotate the ring approximately 180° to make a second full thickness cut.
With these practices, we have had success managing this presentation in our department, but practice patterns may vary depending on the setting of practice. Urology involvement may be beneficial, if available, and there are additional techniques described by urological specialists that could be employed in particularly difficult cases.3
Dr. Barden is emergency medicine residency associate program director.
Dr. Rasheed is an emergency medicine resident at Eisenhower Health System in Rancho Mirage, California.
References
- Santucci RA, Deng D, Carney, J. Removal of metal penile foreign body with a widely available emergency-medical-services-provided air-driven grinder. Urology. 2004;63(6): 1183-1184.
- Lamba S, Patel NN, Scott SR. Penile incarceration secondary to an S-shaped lead pipe: removal with Dremel moto-tool. J Emerg Med. 2012;42(6):659-661.
- Detweiler MB. Penile incarceration with metal objects—a review of procedure choice based on penile trauma grade. Scand J Urol Nephrol. 2001;35(3):212-217.
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One Response to “How To Remove Incarcerating Metallic Penile Hardware”
October 31, 2021
Sam GradyMost people don’t necessarily have access to all those supplies. Instead, use a cast cutter and have cold saline to reduce excessive heating from the cutter.