Severe ischemia of the glans penis following circumcision: A successful treatment via pentoxifylline

Abstract

Severe ischemia or necrosis of glans penis is rare. We report the case of an 11-year-old boy with severe glanular ischemia occurring 24 h after circumcision. This was successfully treated with pentoxifylline injection for 5 days, and while the black color of the glans penis changed to brownish at 48 h, appearances were close to normal at 5 days. The patient did not require any surgical intervention, and was discharged without sequelae. We suggest that pentoxifylline might be considered as a treatment of choice for severe ischemia of glans penis.

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

“…Although generally seen in patients with diabetes and end-stage renal disease, other reported causes of penile gangrene involves trauma, vessel narrowing procedures, circumcision, vasculitis (3), acute occlusion of arteries, foreign bodies, Fournier gangrene, spider bites and topical treatment with 1% gentian violet (2). Also urine extravasation, priapism, narrow bands or pressure from clothing, Wegener's …”

“…Pentoxifylline is a peripheric vasodilator substance that is reported to be beneficial in preventing ischemic tissue damage. It has been proposed that the preventive effect of pentoxifylline on ischemia-reperfusion injury is mediated via stimulation of prostaglandin synthesis and increase in cyclic 3',5'-adenosine monophosphate after inhibition of the enzyme phosphodiesterase (2). It inhibits the free oxygen radicals as a result of inhibition of xanthine oxydase (8).…”

“…Additionally, penile prosthesis implantation, circumcision, acute arterial obstruction, Fournier gangrene, spider bite, foreign bodies and trauma are among the other factors that may cause ischemic gangrene (2). Regardless of its etiology, penile necrosis is a very critical condition that may lead to very serious complications, such as loss of penis, and it should be treated urgently.…”

Acute Ischemia of the Glans Penis after Circumcision Treated with Hyperbaric Therapy and Pentoxifylline: Case Report and Revision of the Literature

“…PTX, by inhibiting erythrocyte, platelet, monocytes and lymphocytes PDEs, increases erythrocyte flexibility, decreases platelet adhesion and aggregation to vessel walls, and reduces the endotoxic effect of cytokine inhibiting its production. PTX also decreases the viscosity of blood by reducing plasma fibrinogen and increasing fibrinolytic activity [1][2][3][4][5][6][7][8]. Moreover, the combination of HBO with PTX seems to have a synergistic effect as demonstrated in vitro on skin flaps in rats [9].…”

“…Ischemia or even necrosis of the glans penis is a very rare event and can be related to trauma, diabetes mellitus, vasculitis, acute arterial occlusion, foreign bodies with strangulation, Fournier's gangrene, spider bite, topical treatment with 1% gentian violet [1,2] and surgical complication.…”