Nonaccidental penile and scrotal strangulation: a case series from Vietnam.

INTRODUCTION: Penile and penoscrotal strangulation are rare but serious urologic emergencies. Delayed decompression can lead to venous obstruction, ischemia, tissue necrosis, and irreversible functional loss. This report presents four cases to illustrate management strategies for metallic constricting devices in resource-limited settings. PRESENTATION OF THE CASES: Four male patients, aged 28-60, presented with strangulation caused by metallic nuts or rings used for sexual enhancement or masturbation, with entrapment durations ranging from 10 hours to 1 week. Clinical findings included penile swelling, pain, and bruising, while sensation and the ability to void were preserved. Initial bedside removal attempts using lubricant were unsuccessful. All patients underwent emergency removal in the operating room with a handheld rotary electric saw, aided by continuous saline irrigation to prevent thermal injury and by a metal plate for protection. All devices were successfully removed, and postoperative recovery showed minor skin burns but no major complications. DISCUSSION: Early recognition and prompt decompression are essential to avoid severe penile injury. Treatment should be individualized based on the constricting device's characteristics, edema level, incarceration severity, and available resources. In settings lacking standard urologic tools, nonconventional methods can be effective, and continued postoperative monitoring is crucial for detecting complications. CONCLUSION: Penile strangulation is an urgent condition requiring swift intervention. Early removal of the device can maintain penile function, and adaptable techniques can ensure positive outcomes even in resource-limited environments.