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

Risk factors, treatment modalities, and clinical outcomes of penile calciphylaxis: systematic review

PURPOSE

To perform a systematic review of case reports and case series to investigate risk factors, treatment modalities, and the outcome of penile calciphylaxis.

METHOD

We performed a systematic search of the MEDLINE and Scopus databases to identify case reports or case series of penile calciphylaxis. The patient characteristics, laboratory investigations, diagnostic modalities, treatment modalities, and outcomes were extracted. We compared clinical characteristics and treatment between patients who survived or demised and between patients with clinical improvement and those without to identify the poor prognostic risk factors.

RESULTS

Ninety-four articles were included from 86 case reports and 8 case series with 121 patients. Most of the patients were on hemodialysis (78.9%). The median time since starting dialysis was 48 months (24-96 months). Sodium thiosulfate was used to treat penile calciphylaxis in 23.6%. For surgical management, partial or total penectomy was performed in 45.5% of the patients. There was no association between sodium thiosulfate use, partial or total penectomy, and improvement in clinical outcomes. The mortality rate in patients with penile calciphylaxis was 47.8% and the median time to death was 3 months (0.75-9 months). The presence of extragenital involvement was significantly related to mortality (p = 0.03).

CONCLUSION

A calcified penile artery results in penile calciphylaxis, a rare vascular phenomenon associated with high morbidity and mortality. Management of penile calciphylaxis includes the medical management of risk factors, surgical debridement, or penectomy. Therefore, early prevention and diagnosis as well as immediate appropriate treatment are needed.

Treatment of Fournier's gangrene with negative pressure wound therapy in the course of sepsis - Case report

INTRODUCTION

Fournier's Gangrene is a severe and rapidly progressing necrotic infection of the skin and fascia that can affect the external genitals, perineum, anus, and abdomen. It can extend to the abdominal cavity and result in necrosis of the soft tissue with a high mortality rate. This case gives a unique perspective on managing such a complicated infection in a smaller community hospital.

PRESENTATION OF CASE

This report describes a particularly challenging case of Fournier's Gangrene in a 34 year old male with multiple pre-existing comorbidities, including alcohol use disorder, chronic kidney disease, and hepatitis B. Development of gangrene was preceded by sepsis. The patient's treatment was based on intravenous antibiotic therapy and early surgical intervention with extensive resection of necrotic tissue, supported by Hyperbaric Oxygen Therapy (HBOT) and Negative Pressure Wound Therapy (NPWT).

DISCUSSION

The majority of the patient's treatment was done at a local community hospital with remote coordination with the Hyperbaric Medicine Center where the patient was temporarily transferred to for HBOT. Multiple treatment modalities were employed in this case of Fournier's gangrene, including intravenous antibiotic therapy, necrosectomy, chronic wound care with septic dressings and tissue debridement, HBOT and NPWT. Interdisciplinary cooperation between different medical specialists was crucial in treatment.

CONCLUSION

The presented case shows that despite the large scale of difficulty and the complexity of treatment, it is possible to effectively manage Fournier's Gangrene in a local community hospital through interdisciplinary cooperation with specialized quaternary care centers. HBOT and NPWT proved to be useful treatment modalities.

Penile calciphylaxis-a complicated case managed with circumcision and glansectomy

Penile calciphylaxis is a serious manifestation of calcifying uremic arteriolopathy, with only a small number of cases reported in the literature. It is rare, characterized by calcification within the walls of small vessels, resulting in ischaemic changes to the skin, and is mainly seen in patients with end-stage renal failure (ESRF). Management of penile calciphylaxis is difficult, with both conservative and surgical approaches advocated for. Due to their comorbidity profile, patients with penile calciphylaxis can present multiple management challenges. We present a case of penile calciphylaxis in a patient with ESRF who was initially managed conservatively, and then underwent circumcision and glansectomy due to a necrotic glans penis and non-resolving penile pain. The patient was spared a partial penectomy and went on to make a full recovery.

Management of chronic urinary retention in glanular penile calciphylaxis

Urinary retention in penile calciphylaxis is a rare phenomenon due to its association with end-stage renal failure.

A 48 year-old male was noted to have a lesion with necrotic appearances overlying his urethral meatus with increasing bladder volumes. He is on haemodialysis for end-stage renal failure and was being treated for infected calciphylaxis ulcers on his thigh.

The current literature provides little guidance on managing urinary retention in this cohort of patients.

We recommend that ultrasound-guided aspiration of the bladder should be performed in patients with glanular penile calciphylaxis who develop urinary retention as it offers a high safety profile.

Penile calciphylaxis diagnosis and treatment challenges a case report

•

Rarity of this presentation.

•

Controversies on treatment.

•

Controversies about diagnosis.

Introduction

Painful tip penile ischemic lesion that varies from ulceration to dry gangrene which is calcified in a patient with ESRD on chronic dialysis is a seriously complicated disease due to microvascular disease of subcutaneous and adipose tissue.

Case presentation

72 gentleman who is on chronic dialysis for the last 8 years because of ESRD, In which he developed many vascular disease and amputation done for him presented with spreading black painful areas at the tip of the glans for which conservative treatment took place for about month.

Discussion

The diagnosis and management of this rare disease still unclear. Diagnosis mostly clinical, treatment conservative versus surgical.

Conclusion

Controversies of for penile Calciphylaxis diagnosis and treatment for its rarity, high mortality rate, and as its part of systematic disease treatment till know individualized according to patient status and extent of the necrotic area.