Management of Plastibell circumcision ring migration and glans penis incarceration

Circumcision is one of the most common elective surgical procedures performed. Common complications of Plastibell circumcision, a popular method of neonatal circumcision performed in surgery outpatient clinics, include bleeding, wound infection, and technical issues related to the Plastibell ring. Delayed or incomplete separation of the ring occurs in some cases, and can result in proximal slippage of the ring with penile shaft or glans herniation. Despite the risk of adverse outcomes, a universal method for the safe, expedient management of retained Plastibell rings has not been described. We report three cases of delayed separation of the Plastibell ring with a novel approach for ring removal. Each case presented within several weeks post-circumcision. The presentations ranged from normal appearance of the phallus to mild dysuria, to glans erythema and disfigurement. An orthopedic ring cutter was successfully used to remove the ring in clinic, with no sequelae. This technique is simple and the instrumental design virtually eliminates the risk of further trauma to the penis. We propose use of the ring cutter as a safe, reliable approach to remove a retained Plastibell ring. Expectant management may include prophylactic ring removal if the ring has not separated within a reasonable post-operative time period.