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Case Study TheScientificWorldJOURNAL (2008) 8, 896–900 TSW Urology ISSN 1537-744X; DOI 10.1100/tsw.2008.128

Dry Gangrene of the Penis Induced by a Bullring for Sexual Stimulation Purposes

A p o s t o l o s P . L a b a n a r i s 1 , * , V a h u d i n Z u g o r 2 , R o b e r t S m i s z e k 1 , R e i n h o l d N ü t z e l 1 , a n d R e i n h a r d K ü h n 1

1 2

Department of Urology, Martha Maria Medical Center, Nurnberg, Germany; Department of Urology, Salzgitter Medical Center, Salzgitter, Germany

E-mail: labanaris@web.de

Received August 13, 2008; Revised September 11, 2008; Accepted September 15, 2008; Published September 21, 2008.

Dry gangrene of the penis is a critical clinical condition provoked by vascular compromise that can lead to severe complications. Although usually caused by diabetes mellitus or due to end-stage renal disease, in these last years, there has been an increase of penile gangrene incidents induced by penile strangulation due to constricting devices for sexual stimulation purposes. We present such a case and discuss the correct approach for treatment of this unusual condition.

KEYWORDS: penile strangulation, ischemia, dry gangrene, therapeutic approach


The attachment of constricting devices to the penis is used by some men for sexual stimulation and in an effort to increase their sexual performance, since strangulation of the penis can increase sexual interest and can also result in a longer erection. Attaching such devices on the semi-erected penis often leads to the impossibility of their removal after erection. As a result, not only mechanical injuries can be caused, but also severe vascular complications, such as vascular insult, ischemia, and dry gangrene of the penis. Dry gangrene of the penis is a rare emergency situation that requires urgent intervention in order to alleviate penile pain due to ischemia, as well as to improve the quality of life of the patient in regard to wound care, sexual function, and lower urinary tract management.


A 58-year-old patient presented with dry gangrene of the distal penis, comprising the glans and a part of the shaft. He explained that 5 days previously, a bullring had been placed over his external genitalia. The bullring was left in place for 3 days and then removed with a bolt cutter. The patient reported that the day the bullring was removed, the distal one-third of the penis had begun to turn black. He also admitted that it took him 2 days to present to us, not only because his pain had just begun, but also because was feeling ashamed about this uncomfortable incident. The patient had consulted with his urologist and decided to present to our department. He mentioned that he was able to void spontaneously and did not exhibit any signs of dysuria, hematuria, or fever. His medical history revealed Parkinson’s disease, but no history of

*Corresponding author. ©2008 with author. Published by TheScientificWorld; www.thescientificworld.com


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