A Twelve-Year Experience in the Management of Calciphylaxis Resulting in Penile Gangrene

Objective: To analyze the mode of presentation of patients with calciphylaxis induced penile gangrene and the outcome of management of the disease Design: Prospective study (1998 - 2010) Setting: Urology Unit, Mubarak Hospital, Kuwait Subjects: Patients presenting with penile gangrene secondary to calciphylaxis were analyzed. Intervention(s): Patients with moderate to severe penile gangrene had penile amputation Main Outcome Measure(s): Etiological factors, mode of presentation, patient characteristics and the outcome of management Results: Eleven patients were managed in the 12-year period All patients (100%) had end stage renal failure (ESRF) and nine patients (81 8%) were on chronic dialysis at presentation Poorly controlled diabetes mellitus was a co-morbidity in 10 patients (90.9%). Areas of gangrene were limited to the glans penis in nine patients (81 8%) and extending to the scrotum in two patients (19 2%) All patients had generalized calcified blood vessels on plain X-ray of the abdomen and pelvis Eight patients (72 7%) required partial or total amputation of the penis. Three patients were successfully managed by debridement while one of them was too ill for surgical intervention Seven patients (63 6%) were dead within three months of the diagnosis of penile gangrene Conclusion: Penile gangrene due to calciphylaxis is a rare disease seen mostly in patients with ESRF on chronic dialysis. Poorly controlled diabetes is a risk factor for the onset of penile gangrene The disease has a high mortality in older patients with other co-morbid medical diseases. Immediate penile amputation may result in a satisfactory outcome in less than 50% of all patients.