Case Report: Penile necrosis associated to paraphimosis with calciphylaxis due to terminal chronic kidney disease

Abstract

Background: Penile necrosis is a rare condition that may present in patients with diabetes mellitus or chronic kidney disease (CKD). The recommended treatment is controversial. We report a case of penile necrosis in a diabetic patient caused by episode of paraphimosis associated with uremic arteriopathy treated with partial amputation. Clinical Case: A 53-year-old male with a background of arterial hypertension, diabetes mellitus and CKD in hemodialysis. The patient presented with paraphimosis and glans necrosis. An emergency circumcision was carried out. A doppler ultrasound found fluid collection in the left corpus cavernosum, parietal vascular calcifications and vascular insufficiency in the corpus cavernosum that suggested necrosis. A partial amputation of the penis was carried out. After three years of follow-up, the outcome has remained favorable. Conclusions: Penile necrosis is a rare but serious complication of terminal CKD. In these patients, systemic calciphylaxis is usually observed. The main take-away lesson is that a multidisciplinary approach is necessary.

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

“…In previously reported cases [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] ] ( Table 1 ), all patients including the present case had chronic kidney disease (78% were reported on dialysis) and diabetes mellitus which could be a predisposing factor [ 16 ]. Seven reported cases, including our patient’s case, had a high blood pressure and two of them had a long history with smoking [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] ]. In our case, other risk factors were found such as obesity and anticoagulant treatment that may worsen pre-existing atherosclerosis.…”

“…In our case, the histopathological diagnosis of calciphylaxis shows diabetic microangiopathy that is accompanied by vascular calcification of both the tunica intima and media of blood vessels with intimal fibroblastic proliferation. In other cases [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] ], the histopathological diagnosis was performed in 6 patients including our case and 8 patients who received at least one radiological assessment. In our case, the patient received an arteriography that showed multiple vascular calcifications at the level of the internal iliac artery and its branches.…”

Penile calciphylaxis—a complicated case managed with circumcision and glansectomy

“…Calciphylaxis is a rare condition caused by calcification of small vessels, resulting in occlusion, ulceration and necrosis of overlying subcutis and skin [ 2 ]. It mainly effects patients on dialysis for ESRF, with a prevalence of 1–4% [ 3 , 4 ].…”

“…Calcifying uremic arteriolopathy (CUR) is a rare condition characterized by calcification within the walls of small vessels, resulting in ischaemic changes to the skin [ 1 ]. It is very commonly seen in patients with end-stage renal failure (ESRF), especially those on dialysis [ 2 , 3 ]. Penile calciphylaxis is an unusual presentation, with various management options employed based on the literature.…”

The “Wet Collar” Sign: A Case of Paraphimosis on CT

“…Paraphimosis is a urologic emergency and prompt detection and treatment must occur in order to avoid morbidity, which can ultimately include necrosis of penile tissues and the necessity for operative management [ 1 - 2 ]. It is diagnosed by physical examination and imaging has not had a role in evaluation.…”