Penile strangulation by a substantial metal napkin ring: successful removal with medtronic midas rex ® legend ® stylus ® drill system

We report the case of a 34-year-old with penile constriction by a large solid steel ring napkin holder in whom attempts of removal by conventional techniques failed. Standard instruments available in urology and general surgical theatres proved too weak to sever the ring and those offered by the fire services were grossly oversized and dangerous to use around the genitalia. Orthopaedic staff offered an instrument not previously used within our urology department: the Medtronic Midas Rex^© Legend EHS Stylus High-Speed Surgical Drill. This intricate electronic powered drill allowed quick, controlled and safe incision of the metal ring, relieving the constriction. In addition to this first report of a metal penile constriction device removed using the Medtronic Midas Rex^® Legend^® Drill System, we review the literature on penile constriction and management strategies.