Penile Calciphylaxis: The Use of Radiological Investigations in the Management of a Rare and Challenging Condition

Abstract

Penile calciphylaxis is a rare phenomenon of penile necrosis observed in patients with hemodialysis-dependent end-stage renal failure. Multiple treatments have been proposed including conservative management, surgical debridement and penectomy; yet, the prognosis remains extremely poor. Here, we describe a patient with protracted resolution of dry gangrene of the glans, which failed conservative management of wound care and pain management. Radiological studies revealed extensive calcification of abdominal aorta and branching vessels including the penile arteries. Due to intolerable pain, the patient required total penectomy. Earlier surgical intervention guided by findings on radiological studies may improve quality of life in this population.

Penile necrosis by calciphylaxis leading to gangrene in a patient with chronic renal failure on dialysis: A case report

“…In previously reported cases [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] ] ( Table 1 ), all patients including the present case had chronic kidney disease (78% were reported on dialysis) and diabetes mellitus which could be a predisposing factor [ 16 ]. Seven reported cases, including our patient’s case, had a high blood pressure and two of them had a long history with smoking [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] ]. In our case, other risk factors were found such as obesity and anticoagulant treatment that may worsen pre-existing atherosclerosis.…”

“…In our case, the histopathological diagnosis of calciphylaxis shows diabetic microangiopathy that is accompanied by vascular calcification of both the tunica intima and media of blood vessels with intimal fibroblastic proliferation. In other cases [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] ], the histopathological diagnosis was performed in 6 patients including our case and 8 patients who received at least one radiological assessment. In our case, the patient received an arteriography that showed multiple vascular calcifications at the level of the internal iliac artery and its branches.…”

“…The rest of the imaging exams were not performed. In a review about the use of radiological investigations in the management conducted by Campbell et al, it was shown that the used radiological exams, including Doppler ultrasound, MRI and CT, may be helpful in choosing early surgical intervention due to the rapid extent of necrosis [ 10 ].…”

Ischemia of the Penis and Fingertips Secondary to Calcifying Uremic Arteriolopathy

“…Imaging can help diagnose the disease. Doppler ultrasound makes it possible to assess the permeability of the penile arteries; the pelvic and abdominal CT scan shows pelvic vascular calcification, and MRI studies can show the extent of ischemic lesions [7].…”

Penile calciphylaxis in a patient with end-stage renal disease: a case report and review of the literature

“…A total of 50 cases of penile calciphylaxis have been reported in the English literature ( Table 1 ) [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. The average age was 54.5 years (range 32 to 81).…”