Penile and Scrotal Strangulation due to Metal Rings: Case Reports and a Review of the Literature

Table 1

Penile strangulation classification system by Bhat et al.

Grade I	Distal penis edema. No evidence of skin ulceration or urethral injury.
Grade II	Distal penile edema with decreased sensation. Injury to skin, constriction of corpus spongiosum. No urethral injury.
Grade III	Injury to skin and urethra, without urethral fistula. Loss of distal penile sensation.
Grade IV	Complete division of corpus spongiosum leading to urethral fistula and constriction of corpus cavernosum with loss of distal penile sensation.
Grade V	Gangrene, necrosis, or complete amputation of penis.