Case report: isolated glans penis gangrene

• Main Authors: Syazwan, Abu, Lee, Chin Yiun, Mohamed, S. O., Salauddin, Syahril Anuar, Ab. Rashid, Islah Munjih, Kamarulzaman, Mohd Nazli, Ghazali, Hamid
• Format: Article
• Language: English
• Published: Wiley 2017
• Subjects: RD Surgery
• Online Access: http://irep.iium.edu.my/61098/1/BJUI%202017%204.pdf; http://irep.iium.edu.my/61098/; http://onlinelibrary.wiley.com/doi/10.1111/bju.14029/full?wol1URL=/doi/10.1111/bju.14029/full&regionCode=MY&identityKey=0f3c5747-04b9-426c-87d8-8df578c77246

Introduction Glans penis gangrene is a rare condition that carries special challenges in managing the problem. It is usually associated with vascular insufficiency and amputation is required to prevent spread of infection from the necrotic tissue. While most penile gangrene presented on top of Fournier's gangrene, this particular case presented with isolated glans penis gangrene. Case Report A 60 year-old man, known case of diabetes mellitus, presented with lethargy and poor oral intake for past 1 month. He denied having any prior urinary symptoms, external device applications or trauma. He was treated as having hyperosmolar hyperglycemic state. At catheterization there was blackish discoloration over the glans penis with erythema of surrounding penile shaft. Foley catheter was successfully inserted. His blood investigations were suggestive of infection and acute renal injury secondary to dehydration. Urine analysis was clear of infection. Parenteral Ampicillin and Metronidazole was given empirically. The glans penis was amputated and penile shaft debrided. It was noted no active bleeder upon debriding the corpora until we reached the base of penis. Adjacent tissue of penile urethra was necrotic until base of penis. The remaining healthy penile stump was 1 cm from the base of penis and successfully reconstructed. Post operatively, he recovered well and the catheter was removed after 2 weeks. The patient was able to urinate in a standing position with good urinary flow. Histopathological report showed ischemic necrosis of the glans and along the corpus cavernosa. Discussion Most penile gangrene occurs on top of a Fournier's gangrene setting, and may extend to the penis along the Buck fascia thus compromising vascularity via local infection. In isolated penile gangrene, thromboembolism to end arterial organ is the main culprit. Underlying disease such as diabetes mellitus, smoking and atherosclerosis may precipitate thromboembolic events that eventually affect end-arteries of digits and penis. Amputation may be required to prevent extension of infection, particularly when wet gangrene component is evident. Preserving the penile stump can be done in this case, as the necrosis had not extended to the base of penis. Severe cases require total amputations and perineal urethrostomy or suprapubic cystostomy urinary diversions.