Penile gangrene in a chronic dialysis patient

Nephrol Dial Transplant (2005) 20: 1503–1504 doi:10.1093/ndt/gfh789

Advance Access publication 22 March 2005

Images in Nephrology

(Section Editor: G. H. Neild)

Penile gangrene in a chronic dialysis patient

Hung-Wei Liao

, Ke-Hsun Lin

, Tso-Hsiao Chen

, Chia-Chen Wang

and Yuh-Mou Sue

Department of1_{Nephrology and}2_{Urology, Taipei Medical University-Wan Fang Hospital,}

Taipei, ROC and3Department of Dermatology, Cardinal Tien Hospital, Taipei, Taiwan, ROC

Keywords: diabetes mellitus; dialysis; gangrene; penile disease

Case

A 65-year-old man presented with right arm pain after falling over. He had end-stage renal disease secondary to type II diabetes mellitus and had required haemodialysis for 1 year. Plain-film radiographs of the right arm showed a right humeral neck fracture. Urine retention due to benign prostate hypertrophy was noted after admission and relieved by a Foley catheter. However, necrotic distal glans penis and purulent discharge from the urethral orifice developed 4 days later and progressed (Figure 1). The culture results of the purulent discharge showed Proteus mirabilisand Pseudomonas aeruginosa. A non-contrast computed tomographic (CT) scan of the pelvis demon-strated calcification of the bilateral penile artery (Figure 2). His serum calcium and phosphate were 8.5 mg/dl and 7.7 mg/dl, respectively. Partial penile resection was performed to stem the progression of gangrene. Unfortunately, he died of overwhelming sepsis 5 days after the operation.

Comments

Penile gangrene is a rare but severe complication of end-stage renal disease, characterized by calcifica-tion of small- and medium-sized vessels and leading to mortality in 64% of cases [1]. Most cases are asso-ciated with diabetes mellitus, hyperparathyroidism and calciphylaxis, which would interfere with flow to the distal region and cause skin necrosis. In this

case, calcium phosphate production was up to 65 mg2/dl2 and vascular calcification was also con-firmed by CT image. Meanwhile, Foley catheter retention might have further decreased blood flow to the penile artery and subsequently facilitated distal penile gangrene. Although surgical intervention is reported to provide a better quality of life [2], neither

Correspondence and offprint requests to: Yuh-Mou Sue, MD, Department of Nephrology, SF, No. 111. Sec 3, Xing Long Road, Taipei City, 116, Taiwan, ROC. Email: sueym@mail.ncku.edu.tw

Fig. 1. Distal penile gangrene with ulceration of urethral orifice.

Fig. 2. Non-contrast CT scan showing bilateral penile artery calcification (arrow).

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partial nor total penectomy can decrease mortal-ity [1]. Because of the high co-morbidmortal-ity and mor-tality of penile gangrene, we should be alert to its occurrence.

Conflict of interest statement. None declared.

References

1. Karpman E, Das S, Kurzaock EA. Penile calciphylaxis: analysis of risk factors and mortality. J Urol 2003; 169: 2206–2209 2. Weiner DM, Lowe FC. Surgical management of ischemic

penile gangrene in diabetics with end stage atherosclerosis. J Urol1996; 155: 926–929

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