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

Abstract

Penile gangrene associated with chronic renal failure is very uncommon. A 52-year-old man with diabetes mellitus, diffuse atherosclerosis, ischemic cardiomyopathy and end-stage renal disease presented with blackening of distal penis for 10 days. His general condition was poor and gangrene of prepuce and glans was noted. Doppler and magnetic-resonance angiography revealed bilateral internal iliac artery obstruction. He underwent trocar suprapubic cystostomy and was planned for partial penectomy. But he died of severe diabetic complications in the interim period. Penile gangrene is a manifestation of widespread vascular calcifications associated with end-stage renal disease and is a marker of poor prognosis.

Ischemia of the Penis and Fingertips Secondary to Calcifying Uremic Arteriolopathy

“…The conservative treatment must be quick, and it includes a posthectomy in which a suprapubic catheter is placed to facilitate the observation of the glans and to ensure dry scarring. Aggressive treatment is recommended in the event of gangrene progression or in patients without severe comorbidities; it includes a total or partial penectomy [12]. In the case of associated CRF, medical management involves correcting the phosphocalcic balance (which can go as far as surgical parathyroidectomy in the event of failure of medical treatment), optimizing dialysis, and the intravenous administration of sodium thiosulfate [8,13,14].…”

“…In the case of associated CRF, medical management involves correcting the phosphocalcic balance (which can go as far as surgical parathyroidectomy in the event of failure of medical treatment), optimizing dialysis, and the intravenous administration of sodium thiosulfate [8,13,14]. This last treatment is administered three times a week at a dose of 25 g at the last hour of hemodialysis [11,12]. In patients not on dialysis, the dose will be adapted based on renal function [15].…”

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).…”

Penile Gangrene with Abscess Formation after Modified Al-Ghorab Shunt for Idiopathic Ischemic Priapism

“…Penile gangrene is rarely encountered because of this rich collateral circulation of penis. However, the end-organ vasculature of the penile cavernous tree is susceptible to arterial insufficiency caused by a systemic vasculopathic state [ 5 , 6 ]. According to the literature, risk factors for penile gangrene include renal insufficiency, diabetes mellitus, thromboemboli, coagulopathy, operation, ligation of penile circulation, peripheral vascular disease, and Kaposi's sarcoma [ 7 – 10 ].…”