|
#1
●
05-15-2024, 04:47 PM
|
|
Necrotizing Penis
>>Fifty-eight-year old patient, complaining of penile pain and edema, associated with foul smell for about 2 weeks. He used topic treatment with ointments, with no improvement to the condition. He has chronic renal disease, undergoing hemodialysis for over 4 years, hypertension and type 2 diabetes. Five years ago he had an ischemic stroke event, shows intermittent claudication for short distances and, now and then, chest pain events. He has secondary hyperparathyroidism, regularly using cinacalcet, isosorbide, NPH insulin, gabapentin and captopril. He smokes and drinks. >>At the first examination wet necrosis and hyperemia were found all over the penis (Fig. 1). Debridement of the penile skin was first performed, but evolved to necrosis of the entire penile shaft in 5 days, when he underwent total penectomy (Fig. 2) with confection of perineal urethrostomy (Fig. 3). He was treated with ceftriaxone and metronidazole and improved gradually, and eventually was discharged 5 weeks later. He is currently monitored in different clinical treatment groups, and is clinically controlled. The anatomopathological exam revealed presence of an ischemic necrosis, with Monckeberg atherosclerosis and acute inflammatory infiltrate. |