Penile calciphylaxis—a complicated case managed with circumcision and glansectomy

Abstract

Penile calciphylaxis is a serious manifestation of calcifying uremic arteriolopathy, with only a small number of cases reported in the literature. It is rare, characterized by calcification within the walls of small vessels, resulting in ischaemic changes to the skin, and is mainly seen in patients with end-stage renal failure (ESRF). Management of penile calciphylaxis is difficult, with both conservative and surgical approaches advocated for. Due to their comorbidity profile, patients with penile calciphylaxis can present multiple management challenges. We present a case of penile calciphylaxis in a patient with ESRF who was initially managed conservatively, and then underwent circumcision and glansectomy due to a necrotic glans penis and non-resolving penile pain. The patient was spared a partial penectomy and went on to make a full recovery.

Penile Calciphylaxis: A Successfully Treated Case

“…Penile calciphylaxis is a multifactorial and rare presentation of systemic calciphylaxis associated with high mortality [ 1 - 3 ]. The high mortality rate is predominantly from superimposed sepsis [ 1 , 2 ].…”

“…Penile calciphylaxis is a multifactorial and rare presentation of systemic calciphylaxis associated with high mortality [ 1 - 3 ]. The high mortality rate is predominantly from superimposed sepsis [ 1 , 2 ]. Multiple studies have been done to identify the possible causes of calciphylaxis, but they are limited by sample size.…”

“…Penile calciphylaxis, a form of calcific uremic arteriolopathy, poses a potential life-threatening risk and is observed in around 6% of individuals with end-stage renal disease (ESRD) undergoing hemodialysis [ 1 ]. The clear etiopathogenesis of calciphylaxis is not fully understood, but it is postulated to be characterized by the accumulation of calcium in the microvessels of adipose tissue and skin, which may lead to ischemia and necrosis, causing painful ulcerations.…”

“…The clear etiopathogenesis of calciphylaxis is not fully understood, but it is postulated to be characterized by the accumulation of calcium in the microvessels of adipose tissue and skin, which may lead to ischemia and necrosis, causing painful ulcerations. It could potentially be complicated by sepsis and mortality [ 1 - 3 ].…”

“…ESRD stands out as a significant contributor to the risk of penile calciphylaxis. Additional factors that elevate this risk encompass diabetes mellitus, obesity, hyperphosphatemia, hyperparathyroidism, specific medications, hypercoagulable states, and belonging to Caucasian ethnicity [ 1 , 2 ]. The mortality rate is notably elevated in individuals with penile calciphylaxis due to their susceptibility to infections and the development of dry gangrene [ 2 , 3 ].…”