case_images: PMC10501845_01
case_images: Initial presentation. On initial examination, a soda bottle found at the penile base was causing strangulation. The penis appeared entirely necrotic. Meatal stenosis was noted. The bottleneck was removed from the patient's penile shaft with cardiac wire cutters, and a Foley catheter was placed over a wire following urethral dilation.
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case_images: fig1
case_images: Initial physical examination revealed meatal stenosis, a bottleneck constricting the proximal penile shaft with findings concerning for penile dry gangrene (Figure 1).
case_images: Intraperitoneal bladder injury. Computed tomography cystogram sagittal view demonstrated an intraperitoneal bladder injury at the dome. Direct robot-assisted laparoscopic visualization is shown. Repair was performed in a standard 2-layer fashion using 3-0 and 2-0 V-Loc  sutures.
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case_images: fig2
case_images: A CT cystogram demonstrated contrast surrounding small bowel loops and a discontinuity of the bladder dome consistent with an intraperitoneal bladder rupture (Figure 2(a)). After docking, copious intraperitoneal urine was evacuated using a laparoscopic suction, and a roughly 3 cm defect was readily identified at the bladder dome (Figure 2(b)).
case_images: Initial debridement of the penile shaft. Intraoperative and back table dissection demonstrated dry necrosis throughout most of the penile shaft and glans.
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case_images: fig3
case_images: Figures 3 and 4 demonstrate dry necrosis of most of the patient's penile shaft and glans.
case_images: Partial penile amputation. Performed on hospital day 2 with creation of a 1.5 cm penile stump.
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case_images: fig4
case_images: Figures 3 and 4 demonstrate dry necrosis of most of the patient's penile shaft and glans.
case_images: Post-partial penile amputation. As seen on postoperative day 7 following partial penile amputation.
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case_images: fig5
case_images: The patient was observed closely during his hospitalization, and culture-appropriate antibiotics were continued through discharge per recommendations from the infectious disease physicians.  Figure 5 notes the healing process on postoperative day 7.
case_images: Penile stump necrosis. On hospital day 14, postoperative day 13 from index operation, necrotic changes were noted to the penile stump.
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case_images: fig6
case_images: On this day, new necrosis of the urethra was discovered, as pictured in Figure 6.
case_images: Healing perineal urethrostomy. Urethrostomy able to accommodate a 30F Bougie.
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case_images: fig7
case_images: The urethrostomy healed well (Figure 7).