PENILE GANGRENE ASSOCIATED WITH CHRONIC-RENAL-FAILURE - REPORT OF 7 CASES AND REVIEW OF THE LITERATURE

Distal penile gangrene associated with renal failure is a rare entity with only 3 cases reported in the literature. Certain physiological ab normalities are commonly found in association with this condition, inc luding secondary hyperparathyroidism, diabetes and peripheral vascular disease. We report our experience with 7 patients who presented with this condition. All patients had end stage renal disease with 5 on hem odialysis, 1 on peritoneal dialysis and 1 with a functioning cadaveric renal transplant. Six patients had diabetes mellitus and all had dera ngements of the calcium and phosphate metabolism, with the calcium-pho sphorus product being greater than 70. Five patients were treated expe ctantly with resolution of gangrene in 2 and stable disease in 3. Thre e of the 5 patients managed expectantly and both patients treated with penectomy died of unrelated causes within 3 months. We conclude that there is no advantage to aggressive surgical treatment of penile gangr ene associated with renal failure, since the outcome is the same. The overall mortality for this group is high due to associated co-morbid d isease regardless of the type of treatment. Furthermore, subtotal para thyroidectomy is not indicated, since spontaneous improvement and mort ality rates reported in our series were similar to those of previously reported cases. Expectant management of affected patients affords the best treatment.