Monckeberg's calciphylaxis with necrosis of the glans penis: a case presentation.
ABSTRACT Monckeberg's calcific sclerosis of the media of the small-sized and medium-sized arteries is a well described and potentially life-threatening condition seen almost exclusively in patients with end-stage renal disease (ESRD) and with hyperparathyroidism. Penile gangrene resulting from this entity is associated with a mortality as high as 64%. A 65-year-old man with ESRD on dialysis for 6 years was referred to Harborview Medical Center with severe penile pain and partial necrosis of his glans penis, which progressed despite medical management. The patient had previously undergone amputations on all four extremities. After intraoperative biopsies of the proximal corpora cavernosa and spongiosum demonstrated viable tissue, he underwent partial penectomy. Pathologic evaluation revealed calciphylaxis within the media of the penile vessels. Two months later the patient had persistent wound-healing issues with intractable pain and thus underwent a complete penectomy with ultimate resolution of his severe pain.
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ABSTRACT: We presented a case of a 63-year-old man with type 2 diabetes mellitus and end-stage renal disease on hemodialysis. Precontrast CT images showed atrophy of kidneys bilaterally and calcification of the abdominal aorta, small branches of bilateral renal arteries and small arteries of the pelvis, including the internal pudendal artery and penile artery. Postcontrast CT scans revealed a nonenhancing glans penis with a clear margin relative to normal tissue. The CT findings were compatible with gangrenous penis and were confirmed by surgery and histology. Findings of CT images can help urologists to decide the cutting margin in planning surgery.Computerized Medical Imaging and Graphics 04/2007; 31(2):103-5. · 1.66 Impact Factor
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ABSTRACT: Penile ischemia, a rare complication of diabetic end-stage renal disease, is usually treated by penectomy once conservative measures fail. We present a patient with diabetes mellitus and end-stage renal disease with penile ischemia that was successfully treated with an arteriovenous interposition bypass graft between the common femoral artery and the deep dorsal vein of the penis. Retrograde flow into the corpus spongiosum resulted in immediate pain relief and healing of the ischemic lesions.Urology 02/2005; 65(1):174. · 2.42 Impact Factor
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ABSTRACT: We determined whether early surgical intervention for ischemic penile gangrene in diabetics can be successful and limit morbidity. A retrospective review was done of 7 diabetic patients with ischemic penile gangrene. Three patients underwent early distal penectomy without complications. All 4 patients initially observed suffered liquefaction and progression from dry to wet gangrene, and 2 underwent surgery (subtotal penectomy in 1 and distal penectomy in 1 who required reoperations for wound complications). With appropriate patient selection, surgical intervention can be successful and provide a better quality of life for those without terminal disease. Delaying intervention will usually require more extensive surgery and increase the risk of wound complications. However, observation is indicated for moribund hospitalized patients.The Journal of Urology 04/1996; 155(3):926-9. · 3.70 Impact Factor