M. Stein et al., PENILE GANGRENE ASSOCIATED WITH CHRONIC-RENAL-FAILURE - REPORT OF 7 CASES AND REVIEW OF THE LITERATURE, The Journal of urology, 152(6), 1994, pp. 2014-2016
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.