Labanaris et al.: Dry Gangrene of the Penis
TheScientificWorldJOURNAL (2008) 8, 896–900
nicotine, alcohol abuse, peripheral arterial disease, or diabetes mellitus. Clinical examination revealed a patient in distress and in pain; the penis showed dry gangrene of the distal one-third, including the glans and penile shaft skin extending about 1.5 cm proximal to the coronary sulcus (Fig. 1). The necrosis was sharply demarcated and although a putrid odor was present, no signs of infection were identified. The penile shaft was slightly swollen, but not tender on palpation. On sonography, the bladder, although previously emptied as reported by the patient, contained about 200 ml residual urine. Both testicles were normal.
FIGURE 1. Preoperative view exhibiting dry gangrene of the glans with involvement of the distal shaft.
Urinalysis exhibited 500 leucocytes with positive nitrates. The urine culture exhibited a growth of Escherichia coli and Enterococcus, both of which were sensible to Ampenicillin. The laboratory values showed only an elevated white blood count of 13/nl.
The patient was given antibiotic prophylaxis and then a partial penectomy was planned. At first, a urethrocystoscopy was performed in order to estimate the length of urethral involvement, then a partial penectomy took place. Only macroscopic tissue necrosis was dissected up to the length of urethral involvement in order to save as much living tissue as possible. Intraoperative findings exhibited ischemic necrosis of the glans and partial necrosis of the proximal spongiosal and cavernosal corporal tissues (Figs. 2 and 3). Histopathogical evaluation indicated dry gangrene of the distal penis. The postoperative convalescence was uneventful, and the cosmetic and functional results 3 months later were impressive.
Dry gangrene of the penis is a consequence of vascular compromise. The progressive vaso-occlusive changes that result in penile gangrene are usually caused by diabetes mellitus, a buildup of calcium deposits owing to end-stage renal disease, or penile strangulation due to constricting devices[1,2,3,4,5,6]. Strangulation objects can be metallic or nonmetallic, and are used for sexual stimulation, in an attempt to improve sexual interest and to maintain a longer erection. The use of such devices varies and depends on