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

Abstract

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.

Severe Acute Ischemia of Glans Penis after Achieving Treatment with Only Hyperbaric Oxygen Therapy: A Rare Case Report and Systematic Literature Review

“…Hyperbaric oxygen therapy (HBOT) has been used with success in patients undergoing urological reconstructive surgery due to the fact that it improves graft integration. HBOT presents clinical benefits by accelerating tissue regeneration by increasing oxygen levels and improving angiogenesis and tissue reperfusion [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. Pablo Garrido-Abad et al described acute ischemia of the penis in a 3-year-old boy after circumcision.…”

“…They also recorded the normal function of the organ after ischemic resolution and at follow-up visits. We highlight that the presented literature played a crucial role in the clinical management of the 17-year-old patient who presented with glans ischemia following circumcision for congenital phimosis and was treated in our clinical service [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ].…”

“…In cases of GI to prevent septic complications, taking into consideration that studies note the susceptibility of urinary infection (Gram-negative bacteria) and urological wound infection (Gram-positive/negative bacteria), these pathogens are well covered with the combination of amoxicillin/clavulanic acid, showing a low resistance to E. coli and Staphylococcus aureus haemolyticus [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. We note that the overuse of antibiotics may result in microbiota alterations and even complications in cases of Clostridioides difficile colitis [ 12 , 15 , 16 , 17 ].…”