Management of Penile Post-circumcision Ischemia by Pentoxifylline Infusion and Hyperbaric Oxygen Therapy

Abstract

Background: Post-circumcision penile ischemia is a devastating complication. We will present our experience in managing children with various forms of penile ischemia.Material and methods: This cohort prospective observational study was performed on all male children with post-circumcision penile ischemia between April 2017 and October 2021. A designed and approved protocol includes a combination of early pentoxifylline infusion, hyperbaric oxygen inhalation, early catheterization, and appropriate surgical debridement were applied for all cases. Data of patient age, anesthesia method, monopolar diathermy use, early presentation and positive wound culture were collected and analyzed statistically.Results: During the study period a 3,382 child were circumcised for non-medical reason; 23 children were diagnosed with penile ischemia (0.7%), among other complications (9%) Most of the penile ischemia is associated with use of monopolar diathermy (74%), compressive wound dressing to control post-circumcision bleeding and infections are responsible for ischemia in 52.2% and 43.5% of cases. Inexperienced physicians were commonly responsible for ischemia (73.9%). Patients managed at first 24 hours had better outcomes than those who were presented later (p = 0.001).Conclusion: In children with post-circumcision penile ischemia, a combination of hyperbaric oxygen therapy and pentoxifylline is effective, and reduces penile tissue loss.