1
|
Wipattanakitcharoen A, Takkavatakarn K, Susantitaphong P. Risk factors, treatment modalities, and clinical outcomes of penile calciphylaxis: systematic review. World J Urol 2023; 41:2959-2966. [PMID: 37782324 DOI: 10.1007/s00345-023-04611-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/01/2023] [Indexed: 10/03/2023] Open
Abstract
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.
Collapse
Affiliation(s)
| | - Kullaya Takkavatakarn
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Paweena Susantitaphong
- Research Unit for Metabolic Bone Disease in CKD patients, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| |
Collapse
|
2
|
Lum K, Gardner J, Dao H. A case of nonuremic calciphylaxis of the penis responding to sodium thiosulfate therapy. JAAD Case Rep 2023; 38:4-7. [PMID: 37456516 PMCID: PMC10338229 DOI: 10.1016/j.jdcr.2023.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Affiliation(s)
- Kalisa Lum
- Loma Linda University School of Medicine, Loma Linda, California
| | - Jeffrey Gardner
- Department of Dermatology, Loma Linda University, California
| | - Harry Dao
- Department of Dermatology, Loma Linda University, California
| |
Collapse
|
3
|
Jarrett O, Heydari H, Elder Z, Casadesus D. Penile calciphylaxis in a patient with concurrent haemodialysis and Coumadin treatment. BMJ Case Rep 2023; 16:e254925. [PMID: 37130645 PMCID: PMC10163535 DOI: 10.1136/bcr-2023-254925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
A man in his 30s, with a medical history of end-stage renal disease on haemodialysis three times a week after kidney transplant rejection, anaemia of inflammatory disease, hypertension, atrial fibrillation, hyperlipidaemia, subtotal parathyroidectomy and aortic valve replacement on Coumadin treatment, presented to our institution with glans penis pain. Examination of the penis revealed a painful black eschar with ulceration on the glans penis with surrounding erythema. CT scan of the abdomen and pelvis and penile Doppler ultrasound revealed calcifications of the abdominal, pelvic and penile blood vessels. He was diagnosed with penile calciphylaxis, a very rare manifestation of calciphylaxis characterised by penile blood vessel calcification leading to occlusion, ischaemia and necrosis. Treatment with low calcium dialysate and sodium thiosulfate was initiated with haemodialysis. Five days after the treatment started, the patient's symptoms improved.
Collapse
Affiliation(s)
- Omar Jarrett
- Hospital Medicine, Jackson Memorial Hospital, Miami, Florida, USA
- Internal Medicine, St George's University, Great River, New York, USA
| | - Hamed Heydari
- Hospital Medicine, Jackson Memorial Hospital, Miami, Florida, USA
- Internal Medicine, American University of the Caribbean School of Medicine BV, Plantation, Florida, USA
| | - Zachary Elder
- Hospital Medicine, Jackson Memorial Hospital, Miami, Florida, USA
- Internal Medicine, American University of the Caribbean School of Medicine BV, Plantation, Florida, USA
| | - Damian Casadesus
- Hospital Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| |
Collapse
|
4
|
Bkiri S, Tlemsani Z, Khdach Y, Nmili Y, Bennani K, Abbad F, Ghadouane M. Penile calciphylaxis in a patient with end-stage renal disease and chronic hemodialysis: a case report. Pan Afr Med J 2022; 43:136. [PMID: 36762167 PMCID: PMC9898768 DOI: 10.11604/pamj.2022.43.136.37673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
Penile calciphylaxis is a rare and highly morbid condition mainly affecting diabetic patients with chronic renal failure (CRF). It is characterized by ischemic skin ulceration and necrosis secondary to dystrophic calcification of the subcutaneous penile tissue and penile arterioles. We report a 52-year-old male with a 6-year history of diabetes mellitus and CRF on hemodialysis, who presented with a painful penile necrotic lesion in the last three weeks. He firstly treated with medical treatment, which was failed. Then underwent total penectomy. The histopathology result confirmed the diagnosis of penile calciphylaxis. Unfortunately, he passed away due to septic shock and multisystem organ failure ten days after surgery. In conclusion, the diagnosis of penile calciphylaxis must be evoked in the presence of any minimal necrotic penile lesion in a patient with CRF; this will initiate quick medical and/or minimally invasive surgical treatment to improve the patient's prognosis and avoid serious complications.
Collapse
Affiliation(s)
- Saad Bkiri
- Urology Department, Cheikh Zaid International Hospital, Abulcasis International University, Rabat, Morocco,,Corresponding author: Saad Bkiri, Urology Department, Cheikh Zaid International Hospital, Abulcasis International University, Rabat, Morocco.
| | - Zakaria Tlemsani
- Urology Department, Cheikh Zaid International Hospital, Abulcasis International University, Rabat, Morocco
| | - Youness Khdach
- Urology Department, Cheikh Zaid International Hospital, Abulcasis International University, Rabat, Morocco
| | - Youssef Nmili
- Nephrology Department, Cheikh Zaid International Hospital, Abulcasis International University, Rabat, Morocco
| | - Karim Bennani
- Urology Department, Cheikh Zaid International Hospital, Abulcasis International University, Rabat, Morocco
| | - Fayçal Abbad
- Histopathology Department, Cheikh Zaid international Hospital, Abulcasis International University, Rabat, Morocco
| | - Mohammed Ghadouane
- Urology Department, Cheikh Zaid International Hospital, Abulcasis International University, Rabat, Morocco
| |
Collapse
|
5
|
Strand N, Maloney J, Wu S, Kraus M, Schneider R, Gomez D, Char S. Perioperative Management of Calciphylaxis: Literature Review and Treatment Recommendations. Orthop Rev (Pavia) 2022; 14:37573. [DOI: 10.52965/001c.37573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Calciphylaxis is a serious and rare medical condition that leads to substantial clinical manifestations including pain, creating perioperative and treatment challenges. No standard treatment protocol exists nor are comprehensive guidelines available for perioperative management of patients with calciphylaxis. In this review, we evaluate existing literature (January 2000 to May 2021) with the aim to offer guidance for treating patients with this challenging disease through the perioperative period. Although no therapies are currently considered standard for treating calciphylaxis, multiple interventions are available for improving symptoms. Preoperative and intraoperative management involves monitoring and optimizing patient comorbid conditions and any possible electrolyte imbalances. Postoperative management can be challenging when potential calciphylaxis triggers are indicated, such as warfarin and corticosteroids. In addition, poor wound healing and difficult pain control are common. Therefore, a multifactorial approach to controlling postoperative pain is recommended that includes the use of nerve blocks, renal-sparing opioids, benzodiazepines, and/or ketamine. We present preoperative, intraoperative, and postoperative recommendations for treating calciphylaxis with levels of evidence when appropriate.
Collapse
|
6
|
Alshoubi A, Matougelwerfelli A. A Rare Presentation of Penile Calciphylaxis Requiring Partial Penectomy. Cureus 2022; 14:e28211. [PMID: 36158391 PMCID: PMC9484786 DOI: 10.7759/cureus.28211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2022] [Indexed: 11/05/2022] Open
Abstract
Calciphylaxis is a rare disease and carries high morbidity and mortality rates. It’s characterized by microvascular calcification and occlusion, which leads to a life-threatening disease characterized by skin necrosis and ulceration. Calciphylaxis is classified as uremic, which occurs in patients with end-stage renal disease and who are non-uremic. Non-uremic calciphylaxis is an even rarer disease that occurs in patients without end-stage renal disease and has a high mortality rate secondary to sepsis. The most common risk factors are diabetes mellitus, hyperparathyroidism, malignant neoplasm, warfarin-based anticoagulation, alcoholic liver disease, and autoimmune disorders. The management includes wound debridement, pain management, and sepsis control. We report a case of penile calciphylaxis in a 36-year-old male with a 15-year history of type II diabetes mellitus and chronic kidney disease. He presented with penile ulceration, which rapidly progressed to necrosis. He also had skin necrosis, characteristic of penile calciphylaxis. The patient has perished of multiorgan failure secondary to severe septic shock.
Collapse
|
7
|
Nisar US, Cheville JC, Sturgis CD. Images - Penile pain in the setting of end-stage renal disease: An unusual anatomic location for calciphylaxis. Can Urol Assoc J 2022; 16:E304-E305. [PMID: 34941493 PMCID: PMC9119602 DOI: 10.5489/cuaj.7618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
In this report, we present a case of penile calciphylaxis, an extremely rare and serious condition occurring in association with dysregulation of systemic calcium metabolism in the setting of chronic renal impairment. Calciphylaxis can occur at various body sites and is associated with diffuse vascular calcifications in small and medium-sized arteries of the involved tissues. Penile calciphylaxis has a grim prognosis. Calciphylaxis is an important etiologic differential diagnosis for penile necrosis and penile pain in patient’s being treated with dialysis for end-stage kidney disease. Diagnosis of penile calciphylaxis is possible via clinical and radiological evaluations. Medical management may alleviate symptoms; however surgical interventions may be necessary, and histological studies may allow for definitive classification.
Collapse
|
8
|
Zaayman M, Silfvast-Kaiser A, Rodriguez E, DeCrescenzo AJ, Menter A. Penile calciphylaxis with extragenital gangrene. Proc AMIA Symp 2021; 34:416-418. [PMID: 33953484 DOI: 10.1080/08998280.2020.1868280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Penile calciphylaxis is a rare cause of penile gangrene and is typically associated with multiple comorbidities, most commonly diabetes mellitus and hyperparathyroidism. It demonstrates a high mortality rate of 64% and is seen almost exclusively in patients with end-stage renal disease on hemodialysis. Underreporting of this disease likely occurs, contributing to a paucity of data and lack of formal therapeutic guidelines and approved treatments. Conflicting guidance exists regarding effective treatment strategies, with most formal literature existing in the form of case reports. Herein, we describe a 44-year-old man with end-stage renal disease on hemodialysis who presented with a 2-month history of nonhealing wounds on his penis and lower extremities.
Collapse
Affiliation(s)
- Marcus Zaayman
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas
| | | | - Edgar Rodriguez
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas
| | | | - Alan Menter
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas.,Division of Dermatology, Texas A&M University College of Medicine, Dallas, Texas
| |
Collapse
|
9
|
Penile calciphylaxis diagnosis and treatment challenges a case report. Int J Surg Case Rep 2020; 77:187-190. [PMID: 33166817 PMCID: PMC7652709 DOI: 10.1016/j.ijscr.2020.10.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 11/24/2022] Open
Abstract
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.
Collapse
|