Surgical Management of Penile Calciphylaxis Without Penectomy

TL;DR

This paper presents a rare case of penile calciphylaxis managed conservatively with wound care and antibiotics instead of surgery.

Contribution

The novelty lies in the successful non-surgical management of penile calciphylaxis, a condition typically requiring amputation.

Findings

Penile calciphylaxis was managed without penectomy using wound debridement and antibiotics.

The patient had a history of end-stage renal disease, diabetes, and hypertension, common risk factors for calciphylaxis.

Conservative treatment was accepted by the patient and avoided major surgery.

Abstract

Calciphylaxis, a rare and life-threatening condition, involves the calcification and occlusion of microvasculature, leading to tissue ischemia and necrosis. The pathophysiology of calciphylaxis remains complex, but it is often associated with derangements in calcium and phosphate metabolism, ultimately resulting in the deposition of calcium within small blood vessels. This process leads to compromised blood flow, tissue hypoxia, and subsequent skin necrosis and ulceration, often with catastrophic consequences. While calciphylaxis typically occurs in individuals with end-stage renal disease (uremic calciphylaxis), it can also afflict those without renal impairment (non-uremic calciphylaxis). Several risk factors predispose individuals to this condition, including diabetes mellitus, hyperparathyroidism, malignancies, warfarin-based anticoagulation, alcoholic liver disease, and autoimmune disorders. Understanding the etiology, risk factors, and clinical manifestations of calciphylaxis is critical for timely diagnosis and management to mitigate its devastating effects. Management includes sepsis control, wound debridement, and analgesic support.

We report a case of penile calciphylaxis in a 58-year old male with a past medical history significant for end stage renal disease on hemodialysis, diabetes mellitus, and hypertension. The patient presented with a painful lesion on the glans penis which rapidly progressed to necrosis and gangrene with wet features. The patient refused partial penectomy and wanted conservative management with local wound debridement and antibiotics.

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