Penectomy in Diabetic Patients Undergoing Maintenance Dialysis

Abstract

Penectomy was performed to sustain life in 2 patients with insulin-dependent and non-insulin-dependent diabetes mellitus, respectively, who were undergoing maintenance hemodialysis. Both patients previously had manifested a series of serious macro- and microvascular diabetic complications. The histopathologic findings in both cases included gangrenous necrosis of penile tissue, while case 2 also evinced calcification of penile arteries. Penectomy has been reported as the result of penile malignancy, anticoagulant toxicity, self-inflicted injury, and criminal assault. Other reports document penectomies attributed to perineal infection (Fournier’s syndrome) in diabetic patients with uremia. In five previously reported cases of penectomy in diabetic patients undergoing dialysis, systemwide arteriopathy was present in all. There is an association between uremia in diabetics and predisposition to an ischemic-infectious lesion of the penis that fails to respond to antimicrobial therapy.

Penile gangrene in diabetes mellitus with renal failure: A poor prognostic sign of systemic vascular calciphylaxis

“…[3] Rarely, diabetic vasculopathy (including microangiopathy) may also directly lead to penile gangrene in the absence of the above mentioned phenomena, especially in the presence of infection. [4] There was no evidence of infection in the index case.…”

Die Penisnekrose, ein seltenes Krankheitsbild

“…6 In der Anamnese des Patienten waren ein langjähriger schwerer Nikotinabusus und eine aus-geprägte Hypercholesterinämie bekannt.…”

“…Der erste Bericht in der medizinischen Literatur stammt aus dem Jahre 1881 von Boyer [1]. Bei Diabetikern treten diese meist erst im Endstadium der Erkrankung bei Vorliegen zahlreicher anderer Komplikationen wie Nephropathie, Neuropathie, Retino-pathie und generalisierter und peripherer Arteriosklerose auf [6]. Als mögliche Ursachen für eine Penisnekrose werden in der Literatur eine Fournier-Gangrän, Pyoderma gangränosum, Herpes-simplex-Typ-I-Infektionen, traumatische Läsionen mit Strangulation, Diabetes mellitus und schwere arteriosklerotische Gefäßveränderungen genannt.…”