Hyperbaric Oxygen Therapy Improving Penile Calciphylaxis

Abstract

Calciphylaxis is a rare and poorly understood disease that almost exclusively occurs in endstage renal disease (ESRD). It is characterized by the calcification of medium and small dermal arterioles with resultant gangrenous necrosis. Patients develop exquisitely painful skin ulceration and necrosis, typically in the lower extremities. Treatments are severely limited, and mortality is high, as few treatment options provide a survival benefit. Improvement in a few calciphylaxis cases affecting the extremities or abdomen have been reported using hyperbaric oxygen therapy (HBOT), however, very few have had a favorable response when it affected penile tissue. We present a case of a patient with ESRD on hemodialysis and subtotal parathyroidectomy who had biopsy-proven penile calciphylaxis with refractory pain who ultimately underwent successful HBOT.

Penile calciphylaxis in a patient with concurrent haemodialysis and Coumadin treatment

“…Hyperbaric oxygen is an experimental treatment for PC with promising results. It was used successfully in one patient previously described, but in our case, it was not necessary 18…”

“…The treatment of PC includes conservative measures such as calcium binders and sodium thiosulfate, topical wound care, hyperbaric oxygen, antibiotics to prevent bacterial proliferation, as well as surgical treatment like parathyroidectomy, penile debridement, revascularisation, partial penectomy with or without reconstruction, and total penectomy 9 12–20…”

Penile Focal Erythematous Macules and Patches: Answer

“…Successful anecdotal use of hyperbaric oxygen therapy in cases refractory to wound care management has been considered as a possible treatment modality. 7 In addition, palliative therapy and analgesia administration has been implemented for management, given the immense pain the patients experience. In the case of penile calciphylaxis, ultrasound-guided dorsal penile nerve block with phenol has been suggested for pain management.…”

A Rare Presentation of Penile Calciphylaxis Requiring Partial Penectomy

“…Calciphylaxis is a life-threatening disease characterized by skin necrosis and ulceration secondary to peripheral vascular disease due to the deposition of calcium in the medial layer of small blood vessels. It’s estimated that 1-4% of patients affected have end-stage kidney disease [ 1 , 2 ]. However, penile calciphylaxis has been reported in only a few cases in the literature.…”

“…The abdomen and buttocks can also be affected. However, penile calciphylaxis is a rare phenomenon reported in only a few cases in the literature [ 1 , 2 ].…”