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There are five published grades of injury resulting from penile strangulation (9): Grade I: Penile edema with no urethral or skin injury Grade II: Skin injury with constriction of the corpus spongiosum with penile edema and decreased sensation Grade III: Injury to both the skin and urethra without urethral fistula Grade IV: Urethral fistula formation due to division of the corpus spongiosum Grade V: Penile necrosis or amputation of the distal segment Multiple different tools can be used to remove these rings, including ring cutters found in most emergency departments, dental drills or pliers (8)

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