Management of Ischemic Penile Gangrene: Prompt Partial Penectomy and Other Treatment Options

Abstract

Introduction Penile gangrene is a rare but troublesome problem with high mortality rates. The etiologies could be infectious, traumatic, or vasculogenic. The treatment algorithm is controversial because of limited case numbers. Aim To describe our experiences in treating the patients with ischemic penile gangrene, to review the related literatures, and to try to summarize a practical algorithm for penile gangrene. Methods We retrospectively reviewed the medical records of five patients with penile gangrene treated between 1996 and 2006. Data obtained include the patients’ ages initial presentation, detailed histories, comorbidity, renal status, other vascular diseases, coagulation profile, treatment course, histology presentations, and prognosis were obtained. Main Outcome Measures Comparison of the patients’ ages, presentations, underlying diseases, the duration of conservative treatments, surgical options, resected penile length, and prognosis. Results All of the five patients underwent partial penectomy. One patient underwent immediate surgery while the other four had delayed partial penectomy because of progressive distal penile gangrenous change. There was no postoperative wound infection noted in any of the five patients and all had survived after 1 year follow-up. Three of them could void independently with a neourethra meatus. Two of them kept suprapubic cystostomy as a result of bladder outlet obstruction caused by an enlarged prostate and bed-ridden status. Conclusions Penile dry gangrene is an irreversible process. Early partial penectomy and correction of the underlying disease can prevent wound liquefaction, preserve more penile length, and improve quality of life.

Elective gangrene of the corpus spongiosum of idiopathic origin: A case report

“…So, early partial penectomy and treatment of underlying conditions can prevent infection and will retain more length of the penis and improve the quality of life. 4 Several authors have reported that the alleged preoperative extension of gangrene is often underestimated compared to intraoperative findings. 4 Even though no signs of secondary infection were observed and the gangrene seemed to be localized on the glans penis in our case, we opted for partial penectomy as our patient was young.…”

“…1 Dry gangrene often originates from ischemia 3 or a venoocclusive disease. 4 It is often secondary to diabetes or endstage renal disease leading to secondary hyperparathyroidism. This situation will lead to calciphylaxis of the penile arteries and thus a reduced blood flow.…”

“…1,5 Less frequent causes include tourniquet effect, priapism, venous thrombosis, anticoagulant treatment and injection of heroin in the femoral vessels, 1,5 or penile prosthesis. 4 Arterial vascularization of the penis is provided by 3 branches of the internal pudendal artery: dorsal artery, cavernous artery, and the Bulbourethral artery. Physiological variations include an extra penile alternative arterial system from the external obturator or iliac arteries; 6 this important vasculature explains the rarity of ischemic gangrene of the penis.…”

“…In patients with voiding difficulties, debridement and partial or full penectomy is suggested. 4 These surgical procedures can be performed independently or in sequence, considering the patient's comorbidities and wound conditions. 4,9 Penile revascularization is an option in patients.…”

“…2 Some authors recommend circumcision when conservative treatment is undertaken to allow better monitoring and dry healing of wounds. 4,9 Surgical treatment options include dorsal slits, supra-pubic cystostomy, and urethral catheterization. In patients with voiding difficulties, debridement and partial or full penectomy is suggested.…”