It Looks Like Someone Tied a String Around My Babys Penis

Turk J Urol. 2019 Jul; 45(4): 322–324.

Pilus tourniquet syndrome of penis: A rare situation in boys with serious complications if not recognized

Burak Özçift

¹Pediatric Urology Unit, İzmir Dr. Behçet Uz Child'south Diseases and Surgery Pedagogy and Research Hospital, İzmir, Turkey

Koray Ağras

²Clinic of Urology, Pediatric Urology Unit, Ankara Atatürk Training and Enquiry Hospital, Ankara, Turkey

Received 2017 Sep 21; Accepted 2017 Oct 30.

Abstract

Penile Pilus Tourniquet Syndrome (HTS) is a rare event but a serious syndrome characterized by the presence of a hair coiled effectually the coronal sulcus of penis which causes a range of pathologies from glandular swelling to necrosis and amputation of penis. If diagnosis is delayed, long-term complications such as urethral fistula, urethral transection, and penile gangrene or amputation develop. Penile HTS is almost exclusively described in circumcised boys. Prevention of such major complications depends on awareness of the etiology and presence of a high index of suspicion. Herein, nosotros aimed to present a boy who was four years old with a penile HTS caused past wrapping of his mother'south hair coil.

Keywords: Hair, penis, tourniquet

Introduction

Hair Tourniquet Syndrome (HTS) of penis is a very rare entity and caused by a hair coil wrapped around the sulcus coronarious of penis, causing progressive penile strangulation and compromised blood menstruum.^{[one–three]} Information technology is near unremarkably found in boys between 0 and six years of age and about described in circumcised boys.^[4] It causes a morphological appearance that ranges from unproblematic edema to necrosis.^[one] Awareness of the etiology, presence of a high index of suspicion, conscientious inspection of the affected area with a magnifying glass are helpful for diagnosis. The patient unremarkably presents with astute symptoms. Treatment consists of removal of the tourniquet which includes unwrapping, cut or dissolving the offending hair curl and the patients respond well to treatment.^[5] Herein, we aimed to report a four-year-former boy with a penile HTS who underwent physical exam in the operating room for definitive diagnosis and further treatment.

Instance presentation

A 4 year-one-time circumcised male child applied to the Pediatric Urology Outpatient Dispensary with an increasing swelling on his penis. His family unit reported that his complaints started ii months ago. They had applied to iii urology outpatient clinics of different hospitals with the same complaints. He was prescribed peroral and topical antibiotics, however his complaints and swelling connected to increase. There was no history of fever, merely the child was having intermittent voiding issues lately. Physical exam of the penis showed an edematous glans with suspicion of a constructed hair band around the sulcus coronarius of penis causing a tourniquet-similar compression, merely the hair ring was non visible fifty-fifty with magnification due to severe edema (Figure 1).

Glandular swelling at the time of exam

He was admitted to emergency operation room for definitive diagnosis. Informed consent was obtained prior to treatment. Nether full general anesthesia, we observed sharp demarcation line and a coil of hair which was found to wrap the sulcus coronarious deeply (Effigy 2). The patient was catheterized with a 8F urethral catheter and the urethra was intact at inspection. The hair ringlet was cutting dorsally, unwrapped and removed carefully (Figure 3). The procedure was completed by circumferentially and firmly applied wound dressing. Afterwards the functioning, peroral antibiotics and anti-inflammatory medication were given. The patient was discharged on the first postoperative day. Complete recovery was observed at the end of starting time postoperative calendar month (Effigy 4).

Pilus coiled effectually the penile sulcus coronarious

The pilus coil removed from the penis

The appearance of penis at the beginning postprocedural calendar month

Discussion

The term HTS was showtime used in 1971 by Quinn, but the very commencement clarification of the status dates back to 1832.^[6] Penile HTS is a rare outcome but serious syndrome characterized by the presence of a hair coiled around the coronal sulcus of penis. Equally pilus has a very high tensile strength and stretches when moisture and contracts while drying, it constricts tightly the structure it is coiled effectually and may even lead to its amputation. The mechanism of injury in hair thread tourniquet involves ischemia in the distal part to the tourniquet.^[five] Since human being hair is very thin, the problem may exist hands missed, especially in the presence of severe edema and swelling of the glans penis.^[7,8]

Acute HTS presents usually with erythema, swelling, circumferential constriction and distal edema with trivial discomfort to the child.^[5,9] During this phase, the hair is embedded in the edematous penile skin and cannot be easily identified. If the tourniquet is non removed in this early stage, it may progress to peel infection and ulceration, just removal of the constriction at this stage prevents long-term complications such as urethral fistula, urethral transection, and penile gangrene or amputation. Nosotros reviewed the cases with penile strangulation in babies caused by mother'southward hair in the literature between the years of 1967 and 2016 with its specific nomenclature telogen fetor (mother's postpartum excessive hair loss). It was significantly encountered in circumcised boys. The circumcision has been considered to be a major risk gene of strangulation because information technology bares the coronal sulcus. And so the hair coil seems to strangulate a circumcised penis more than hands than a normal prepuce.^[10,11] In our circumcised case, the hair roll acquired only glanduler swelling with only pare lesion without urethral injury.

Management of HTS requires sensation of the etiology, presence of a high index of suspicion, conscientious inspection of the affected surface area with magnification, proper examination recommended under anesthesia and early intervention, that volition prevent the occurrence of astringent complications. The pilus whorl should be removed promptly to avoid urethral harm and glandular necrosis.^[12,13] Harouchi et al.^[xiv] and Bashir et al.^[15] classified the degree of injury from grade I (superficial skin lesion only) to grade Four (the loss of the glans) and course 0 (constriction of skin without urethral injury) to grade 3 (gangrene, necrosis and complete amputation of the glans). All of them recommended repair surgery only for the severe cases of penile injury. In our example, nosotros used blunt probe for entering between the hair curl and penis, cut pilus curlicue dorsally, unwrapped and removed hair coil later detailed concrete examination under general anesthesia.

In conclusion, penile HTS is a rare entity and may cause astringent deformities ranging from simple penile edema and swelling to penile necrosis and amputation. When the tourniquet like compression symptoms exist, such as edema and sharp demarcation line, penile HTS should be idea in the differential diagnosis. Penile HTS must be considered every bit a surgical emergency that should be intervened immediately. Early diagnosis and rapid treatment can prevent serious complications. The selection of the treatment depends on the severity of the injury.

Footnotes

Informed Consent: Written informed consent was obtained from patient parents who participated in this case.

Peer-review: Externally peer-reviewed.

Writer Contributions: Concept – B.Ö.; Design – B.Ö.; Supervision – B.Ö., M.A.; Resources – B.Ö., One thousand.A.; Materials – B.Ö., K.A.; Data Drove and/or Processing – B.Ö.; Analysis and/or Interpretation – B.Ö., K.A.; Literature Search – B.Ö., G.A.; Writing Manuscript – B.Ö., G.A.; Disquisitional Review – B.Ö., Thousand.A.; Other – B.Ö., 1000.A.

Disharmonize of Interest: Authors have no conflicts of interest to declare.

Financial Disclosure: The authors declared that they didn't receive any financial support for this written report.

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It Looks Like Someone Tied a String Around My Babys Penis

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6619851/