Penile Zipper Injury

JOURNAL OF UROLOGY (Baltimore), Volume 117, Number 5: Page 671,
May 1977.

MANAGEMENT OF PENILE ZIPPER INJURY

R. FLOWERDEW, I. J. FISHMAN and B. M. CHURCHILL

From the Division of Urology and the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada

Abstract

A penile problem that physicians are confronted with in the emergency room is entrapment of the foreskin by a zipper fastener. A case presentation and a simple technique for its management are described.

A 3-year old boy was brought to the emergency room after his mother had accidentally trapped the penile prepuce between the fastener and the zipper while dressing him. After several painless and fruitless attempts to free the entrapped foreskin she cut the zipper from the pants (fig. 1) and brought the child to the hospital. The child was anesthetized because of extreme anxiety and poor cooperation. Separation of the zipper from the teeth was accomplished by squeezing the median bar of the zipper with a bone cutter. There was minimal trauma to the foreskin and the child was sent home the same morning.

Discussion

Entrapment of the foreskin between the fastener and the teeth usually occurs when the zipper is being opened because the movement is downwards and toward the body. This factor allows for accessibility to the median bar of the zipper fastener. (fig. 1)

Management of this problem has included circumcision¹ or extraction of the foreskin by manipulation.² Problems with circumcision include pre-existing local edema, lack of psychological preparation and possible cultural taboos. Extraction by manipulation usually is prolonged, painful and often counterproductive.

We suggest the following approach. A bone cutting plier is applied to the median bar (fig.2). Squeezing this bar will permit the whole zipper to fall apart and release the trapped skin. If this maneuver is applied initially a cooperative and grateful patient is the result. However, previous attempts to extract the foreskin, especially in young children, may have caused considerable pain, and therefore, will require either local or general anesthesia.

References

Watson, C. C.: Zipper injuries. Clin. Pediatr., 10: 188, 1971.
Ezell, W. W. Smith, E. I., McCarthy, R. P. Thompson, I. M. and Habib, H. N.: Mechanical traumatic injury to the genitalia of children. J. Urol., 102:788, 1969.

Accepted for publication November 19, 1976.
Read at annual meeting of Northeastern Section, American Urological Association, Hot Springs, Virginia, September 19-23, 1976.

Citation:

Flowerdew R, Fishman IJ, and Churchill, BM. Management of penile zipper injuries. J Urol (Baltimore) 1977; 117(5):671.

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