Ischemic Gangrene of the Glans following Penile Prosthesis Implantation

Abstract

The development of ischemic gangrene of the penis following implantation of prosthesis is unusual, and very few cases are available in the literature. As a result, no established treatment protocol is available. We report our experience within a case of gangrene of the glans following implantation of a three-component prosthesis. We present a 53-year-old male, smoker with diabetes and hypercholesterolemia, who underwent surgery for the insertion of a penile prosthesis with 3 components to correct his erectile dysfunction and severe Peyronie's disease. The procedure was carried out without incidents. During the postoperative period, the patient began to complain from penile and perineal pain. He developed avascular necrosis of the glans. The necrosed area was excised. Four weeks later, he developed fever and perineal pain arriving to the emergency room with the prosthesis extruding through the glans. He had emergency surgery to remove the prosthesis plus surgical lavage and was prescribed broad-spectrum antibiotic therapy. Four weeks later, the penis was completely revascularized and reepithelialized. Ischemic gangrene following penile prosthesis implantation takes place in patients with poor peripheral vascularisation. Diabetes mellitus has been the common denominator to all of the reported cases.

Dry Gangrene of the Glans Penis Following Surgical Correction of Peyronie’s Disease

“…The common feature of these cases was the presence of diabetes. Poor glycaemic control has been reported to play a role in the development of ischemia as well as superinfection (6). A rare medical condition called "calciphylaxis" is characterized by a progressive cutaneous necrosis and ischemia of the lower extremities and penis that occurs as a result of small arterial occlusions at sites of calcification regions.…”

Necrosis del glande posterior a la colocación de un implante protésico peneano

“…Si bien existe consenso en que las infecciones protésicas ocurren frecuentemente en pacientes con diabetes mal controlada, Minervini y su grupo señalan que no existe correlación entre las concentraciones elevadas de hemoglobina glucosilada e infección, incluso con mayor incidencia de necrosis. 8 Por el momento no existe un consenso o protocolo de tratamiento para esta alteración; 9 sin embargo, se sugiere una conducta conservadora en pacientes con necrosis, que no manifiestan signos clínicos o infección. 7 Weiner y su equipo de trabajo sugieren que la intervención quirúrgica temprana puede prevenir la evolución a necrosis húmeda.…”

Glans ischemia following inflatable penile prosthesis surgery

“…surgery. To date, less than twenty-one cases have been reported in the literature (1)(2)(3)(4). Its rarity, combined with likely underreporting, has led to a paradigm of non-guideline based management.…”