Successful treatment of post circumcision glanular ischemia–necrosis with hyperbaric oxygen and intravenous pentoxifylline

Elemen, Levent; Topçu, K. Meltem Çolak; Gürcan, Nagihan İnan; Akay, Alper

doi:10.1016/j.acuroe.2012.05.008

Cited by 4 publications

(4 citation statements)

References 5 publications

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“…Hyperbaric oxygen therapy has been demonstrated to be effective alone in treating glans ischaemia or at 2.5 atm of pressure for 90 min with intravenous pentoxifylline 10 mg/kg. [14][15][16] Burke et al 17 treated temporary ischaemia of glans after DPNB (0.75% ropivacaine) with infusion of iloprost 0.52 µg/hour. Studies have shown complete resolution of severe glans ischaemia with oral 10 mg/kg/day pentoxifylline for 5 days 3 or 8 days.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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Acute ischaemia of the glans penis is a rare and serious complication following circumcision. We report the case of a teenage boy with glanular ischaemia shortly after circumcision with dorsal penile nerve block. This was successfully treated with total 11 days of topical 2% nitroglycerin ointment, 14 days of oral pentoxifylline 400 mg three times a day and 3 days of epidural (0.2% ropivocaine). There was marked clinical improvement at 4 days with a few patches of cyanosis remaining. Surgical intervention was not required, and the patient was discharged with follow-up review. At 12 days, there was complete resolution of ischaemia and the glans penis appeared normal. We suggest that oral, topical and epidural regimen of vasodilators and anti-sympathomimetic agents can be used in combination for acute ischaemia of the glans penis.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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“…It showed a reverse effect on ischemic lesions observed in the glans after local anesthesia for circumcision (efficiency in only 43 hours) [9] and on fingers and hands after radial-artery buprenorphine injections [10,11]. Sometimes, medical treatment is not enough, and surgical management is necessary in the case of major ischemia and/or necrosis [1][2][3][4][5][6][7][8]. For glans necrosis secondary to subcutaneous injection of buprenorphine, Hornez et al suggested glans amputation and reconstruction by mucous membrane transplant or by penis skin transplant or thin-skin transplant.…”

Section: Discussionmentioning

confidence: 99%

“…Glans ischemia is rare and can be of various origins. However, the major cause described in the literature is necrosis after child circumcision, as a complication of either the electrocoagulation of the dorsal artery of the penis or the local injection of a vasoconstrictor [5–8].…”

Section: Discussionmentioning

confidence: 99%

“…Enoxaparin, a low‐molecular weight heparin, was revealed to be efficient alone after 5 days of treatment at curative dose for a severe glans ischemia complicating local anesthesia for circumcision in a 7‐year‐old child with d‐dimer elevation. Two other severe postcircumcision glans ischemias in children had favorable evolutions after successful 5‐day treatment combining intravenous injection of pentoxifylline and hyperbaric oxygen therapy [5–7]. Pentoxifylline is a strong vasodilatator that has shown benefits in preventing ischemic lesions associated with vascular illness, such as obliterating arteriopathy of the lower limbs.…”

Section: Discussionmentioning

confidence: 99%

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Successful Medical Treatment of Glans Ischemia After Voluntary Buprenorphine Injection

Brecheteau¹,

Grison²,

Ábrahám³

et al. 2013

The Journal of Sexual Medicine

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Introduction The diverted use of synthetic opioid buprenorphine by drug addicts can be responsible for serious ischemic and infectious complications, particularly in the case of intravenous injection. Aim We present a case of serious glans ischemia after buprenorphine injection directly into the deep dorsal vein of the penis. Analysis using new medical imaging techniques and treatments is detailed below. Methods A 26-year-old male drug addict presented with glans pain 4 days after self-injection of buprenorphine into the deep dorsal vein of the penis. The patient was apyretic and presented a urethral discharge. His glans was blue without discoloration on digital pressure. Additionally, his biologic and serologic tests were normal while bacteriology showed the presence of Enterobacter cloacae urethritis. Results After 48 hours of intravenous antibiotic treatment without improvement, a specific medical treatment using enoxaparin and ilomedin was initiated, with the assumption that there was an ischemic complication. Laser speckle contrast imaging allowed confirmation of the presence of distal penis ischemia and provided an accurate mapping of the ischemic zone. A 28-day treatment combining antibiotics, subcutaneous heparin at curative dose, antiplatelet drug, ilomedin, and hyperbaric oxygen therapy resulted in clinical improvement of the lesions with no functional complications. Conclusions To date, no consensus exists on the proper diagnostic and treatment approach to severe glans ischemia due to buprenorphine injection into the deep dorsal vein of the penis. The results of laser speckle contrast imaging were of real interest during the process of diagnosis. In addition, the combination of ilomedin with hyperbaric oxygen therapy and anticoagulant and antiplatelet drugs appeared to be an effective therapy.

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Glans ischemia after circumcision and dorsal penile nerve block: Case report and review of the literature

Garrido-Abad

Suarez-Fonseca

2015

Urol Ann

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Circumcision is an easy commonly performed surgical procedure in childhood. However, it is not free of a low number of complications, (1-5-5%). Here we report a case of a 3-year-old boy with glans superficial necrosis after circumcision, managed with topical (nitroglycerin, gentamicin), oral (pentoxifylline) and epidural (urgent caudal block with bupivacaine) treatment. A review of the literature and the different treatments reported by other authors was done. After 7 days of treatment, local signs of ischemia and severe pain disappeared, without adverse events related to treatment. Although the ischemia or necrosis of the glans after circumcision are rare, we may suspect them in case of presence of severe acute pain or dark color. We report the successful management of this complication.

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Successful treatment of post circumcision glanular ischemia–necrosis with hyperbaric oxygen and intravenous pentoxifylline

Cited by 4 publications

References 5 publications

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

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

Successful Medical Treatment of Glans Ischemia After Voluntary Buprenorphine Injection

Glans ischemia after circumcision and dorsal penile nerve block: Case report and review of the literature

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