Acute glans ischemia after circumcision successfully treated with low-molecular-weight heparin and topical dihydrotestosterone

Abstract

Rationale: Circumcision like any other surgical procedure is not devoid of complications. Serious complications are rare and include iatrogenic hypospadias, glans ischemia/necrosis, and glans amputation, all of which require an emergent treatment. Patient concerns: We report here a case of 6 months-old-boy with a superficial glans ischemia following circumcision. Diagnosis: Physical examination revealed a severely cyanotic glans with the moderate edema of the dorsal penile skin. Plasma levels of D-dimer were 8.57 mg/L. Urine passage was unremarkable while color Doppler ultrasonography revealed a normal blood flow. Interventions: The patient was successfully treated with subcutaneous injection of enoxaparin (low-molecular-weight heparin) and topical 2.5% dihydrotestosterone. Outcomes: The appearance of the glans penis on the 5th day was close to normal while the control levels of D-dimer dropped to the reference range. The patient was discharged from the hospital on the 6th day. At 6-month follow-up, the appearance of the glans penis was normal. Lessons: Acute glans penis ischemia following circumcision is a rare complication. Its successful treatment with enoxaparin and topical dihydrotestosterone has not been previously reported in the literature.

Severe Acute Ischemia of Glans Penis after Achieving Treatment with Only Hyperbaric Oxygen Therapy: A Rare Case Report and Systematic Literature Review

“…Hyperbaric oxygen therapy (HBOT) has been used with success in patients undergoing urological reconstructive surgery due to the fact that it improves graft integration. HBOT presents clinical benefits by accelerating tissue regeneration by increasing oxygen levels and improving angiogenesis and tissue reperfusion [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. Pablo Garrido-Abad et al described acute ischemia of the penis in a 3-year-old boy after circumcision.…”

“…In cases of GI to prevent septic complications, taking into consideration that studies note the susceptibility of urinary infection (Gram-negative bacteria) and urological wound infection (Gram-positive/negative bacteria), these pathogens are well covered with the combination of amoxicillin/clavulanic acid, showing a low resistance to E. coli and Staphylococcus aureus haemolyticus [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. We note that the overuse of antibiotics may result in microbiota alterations and even complications in cases of Clostridioides difficile colitis [ 12 , 15 , 16 , 17 ].…”

Acute ischaemia of the glans penis post-circumcision managed with pentoxifylline, topical nitroglycerin and epidural

“…[3][4][5][6][7] Aminsharifi et al 11 reported the success of topical 10% testosterone in improving foreskin vascular density. Zvizdic et al 12 further demonstrated the success of a 5-day course of topical 2.5% dihydrotestosterone and low molecular weight heparin (LMWH) in completely resolving glans ischaemia at 43 hours. Mittino et al 13 reported the efficacy of LMWH with acetylic acid 100 mg/day.…”

Glans Penis Ischemia after Circumcision in a 15-Year-Old Patient Managed with Intravenous Pentoxifylline: A Case Report and a Diagnostic-Therapeutic Guideline Proposal

“…The potential anatomical, functional, aesthetic, and psychological sequelae of this entity and the fact that this is a time-dependent pathology reinforce the importance of developing a standardized therapeutic-diagnostic approach, which does not exist to date. Based on the potential etiopathogenic mechanisms previously mentioned, different therapeutic alternatives have been tested, including low molecular weight heparins [3], topical testosterone [3, 4], hyperbaric oxygen [5], caudal sympathetic blockade [6], intravenous pentoxifylline [1, 7, 8], and antiplatelet therapy [9]. Similarly, some of the reported cases have had a multimodal approach, with several concomitant therapeutic modalities [1, 3, 5, 9].…”

“…Based on the potential etiopathogenic mechanisms previously mentioned, different therapeutic alternatives have been tested, including low molecular weight heparins [3], topical testosterone [3, 4], hyperbaric oxygen [5], caudal sympathetic blockade [6], intravenous pentoxifylline [1, 7, 8], and antiplatelet therapy [9]. Similarly, some of the reported cases have had a multimodal approach, with several concomitant therapeutic modalities [1, 3, 5, 9]. Our experience, in this case, has been favorable with intravenous pentoxifylline.…”