Penile garrotting is a rare presentation for Urology that can have severe consequences for the patient. The constricting agent used can be variable and the indication is usually for erectile dysfunction or incontinence. It can be managed conservatively, with delayed primary repair or two stage procedures. We present a 69-year-old man who presented with extensive erosion of the penis requiring reconstructive surgery. A plastic bottle cap was fashioned into a penile constriction device and used to treat erectile dysfunction. The ring had been on his penis for 4 weeks when he presented to the emergency department (Image 1). The ring was urgently removed with a ring cutter. On examination, there was erosion through corpora cavernosa and corpora spongiosum with urethra on display, which is a Grade 2 Bashir and El-Barbary injury. A 16Fr IDC was inserted under direct vision of urethra externally and managed conservatively with intravenous antibiotics with the plan for a delayed reconstructive surgery. Two weeks later, he was taken to the operating theatre for reconstruction. His penis was degloved to assess the corpora cavernosa and urethra. His urethral defect was closed with 3-0 vicryl interrupted sutures with an IDC in situ and then the urethra was examined internally with a flexible cystoscopy to ensure closure. Both corpora cavernosa were also repaired with 3-0 vicryl interrupted sutures, followed by closure of Bucks’s fascia and skin. He was left with a 16Fr IDC for three weeks and given 10 days of oral amoxicillin and clavulanic acid. He was followed up periodically to assess wound healing. At his three-month post-operative appointment, his penile wound had completely healed. He was able to successfully void for a short period, however unfortunately due to other health issues he was required to have the catheter reinserted long-term.

Case report complete with patient consent. Literature review performed.

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