Man nearly loses his penis after tourniquet syndrome cuts off circulation

A MAN nearly lost the tip of his penis after his circulation was cut off by his pubic hair.

The condition is known as tourniquet syndrome and in this case, resulted in strangulation of the penis.

The 57-year-old Australian man attended his GP complaining of extreme pain and swelling around his groin area.

He said that he had been suffering for around two weeks, but that he had no fevers or penile discharge.

Published in Urology Case Reports, the man reported that he rarely retracted his foreskin.

His medical history included type 2 diabetes, hypertension, psoriasis, anxiety and depression.

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He was a smoker and consumed alcohol moderately.

On initial examination he was diagnosed with balanitis, which is pain and inflammation of the head of the penis.

He was treated with topical steroids and after one week he was referred to the emergency department.

The patient however, waited another week before accessing the help he needed.

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Medics at the emergency department examined him and found that his pubic hair was unkept and that he also had psoriatic plaques across his body including trunk and all four limbs.

He was diagnosed with a psoriasis flare up and was urgently referred to the urology department due to concern around the findings on his penis.

When medics retracted his foreskin they found a band of hair which had wrapped around the tip of the penis and was therefore cutting off circulation.

This was easily removed but the patient needed to go for debridement surgery.

After medics explained the procedure to the patient he absconded, but returned two days later to be operated on.

What is Penile Hair Tourniquet Syndrome?

Penile Hair Tourniquet Syndrome is when hair gets wrapped around the penis, most commonly seen in young boys.

In teens and adults, sexual exploration often leads to penile strangulation as well as ill mental health.

Penile strangulation can be classified under five grades, which are:

  • Grade 1: Swelling.
  • Grade 2: Trauma to the skin, decreased sensation.
  • Grade 3: Same as above but with injury to the urethra.
  • Grade 4: “Division of corpus spongiosum” (spongy tissue at the tip of the penis) leading to a urinary fistula (opening in the urinary tract). 
  • Grade 5: Gangrene, necrosis, or complete amputation of the penis.

When operated on surgeons found that the urethra had been completely divided and that the glans were still attached by 1cm of corpus spongiosum, which underlies the lamina propria and the epithelial layer of the penile urethra.

After theatre the patient discharged himself against medical advice.

In order to look after himself post theatre, he was told to take daily salt baths and oral antibiotics.

He returned two weeks later when a hair ball was found under the foreskin.

Medics said there were many challenges with the patient.

This included that his wounds took longer to heal due to diabetes and the fact he is a smoker.

Writing in the case report they said: "Our case, a 57 year old man with an erosive hair tourniquet, reminds clinicians to have an index of suspicion with males presenting with penile pain, highlighting the importance of thorough physical examination with retraction of foreskin.

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"Some groups have suggested that circumcision is a risk factor as hair can constrict more easily around a circumcised penis.

"However in this case we believe the presence a foreskin delayed the diagnosis as the patient, general practitioner and emergency department clinicians all failed to diagnose the hair tourniquet syndrome."

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