Successful management of near-total penile amputation secondary to neglected hair tourniquet syndrome

¹Pediatric Surgery Unit, Sidi Mohamed Ben Abdellah Hospital, Essaouira, Morocco

^&Corresponding author
Ahmed El Mouloua, Pediatric Surgery Unit, Sidi Mohamed Ben Abdellah Hospital, Essaouira, Morocco

Image in medicine    

Penial Hair Tourniquet Syndrome (PHTS) rarely occurs in children; maternal hair circumferentially constricts the coronal sulcus of a penis, causing severe damage. A 4-year-old circumcised male, without notable history, was presented to the outpatient clinic with increasing swelling on his penis and split urine stream. His mother reported that his complaints started 1 month prior. Physical examination showed a tight hair tourniquet, lodged in the balano-prepucial sulcus with a deep circumferential dorsal laceration, and a complete urethral section (A). The glans were viable with the appropriate capillary refill. We removed the constricting hair with scissors and required no sedation (B). In the operating room, we proceeded to close the urethral fistula with a termino terminal urethral anastomosis, after removing the fibrotic tissue, and debriding the two fibrotic extremities of the urethral fistula. We then reinforce by adding a second interposing dartos layer. The postoperative course was uneventful, and complete recovery was observed in about one month (C, D). Penial Hair Tourniquet Syndrome (PHTS) is a well-established phenomenon that affects children. It is described as a strangulation of the penis's glans by a constricting hair coil. The diagnosis of PTHS is not immediate; it is hardly observable in the presence of swelling and edema. A high degree of suspicion and awareness is therefore essential. Delayed diagnosis can lead to serious complications. It is easily preventable, and when recognized early, it can be treated simply by removal of the coil under local anesthesia or by applying depilatory cream, with the active ingredient calcium thioglycolate. Surgical treatment is required in case of complications as in our case. Penial Hair Tourniquet Syndrome (PHTS) is a serious condition that requires early diagnosis, and prompt management, to ensure anatomical and functional preservation.

Figure 1: A) hair tourniquet of coronal sulcus with complete urethral section; B) maceration line after removing the coiled hair; C,D) final appearance of penile 1-month post-operative