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

Abstract

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.

Acute glans ischemia after circumcision successfully treated with low-molecular-weight heparin and topical dihydrotestosterone

“…Serious complications (e.g., ischemia and necrosis of the glans penis) are rare, but well described in the literature. [ 4 – 7 ] The etiology of ischemia of the glans after circumcision remains however unclear. We believe that in our case ischemia might be due to the tight bandage on the base of glans with a consequent venous obstruction.…”

Glans Ischemia after Circumcision in a 16-Year-Old Boy: Full Recovery after Angiography with Local Spasmolysis, Systemic Vasodilatation, and Anticoagulation

“… 10 Other authors also report on ischemia of the glans penis following DPNB for circumcision. 6 7 11 As an alternative for DPNB, topical anesthetics have been evaluated but did not provide sufficient perioperative analgesia. 12 Kaplanian et al suggested to limit the volume of local anesthetic solution to an amount of 0.2 mL/kg (up to maximum of 10 mL).…”

“…Several therapeutic approaches have been described including pentoxifylline, hyperbaric therapy, iloprost, enoxaparin, anticoagulation, local testosterone, and peridural anesthesia. 2 3 4 5 6 7 8 …”

“…Two case reports on a 3- and 10-year-old boy combined the therapy of caudal block with PTX and described good outcomes. 4 6 However, indication and dosage of PTX in children remain controversial. 3 4 6 8 11 Hence, in our patient we used the selective phosphodiesterase inhibitor (PDE 5) sildenafil as a vasodilative agent with success and did not appreciate side effects.…”

“… 1 In contrast, ischemia or even necrosis of the glans is a rare complication; in the past 15 years, nine pediatric cases have been reported in the literature. 2 3 4 5 6 7 8 We report the case of a boy with ischemia of the glans penis after circumcision at an outside hospital.…”