Management of ischemic penile gangrene: prompt partial penectomy and other treatment options

Penile gangrene is a rare but troublesome problem with high mortality rates. The etiologies could be infectious, traumatic, or vasculogenic. The treatment algorithm is controversial because of limited case numbers.

To describe our experiences in treating the patients with ischemic penile gangrene, to review the related literatures, and to try to summarize a practical algorithm for penile gangrene.

We retrospectively reviewed the medical records of five patients with penile gangrene treated between 1996 and 2006. Data obtained include the patients' ages initial presentation, detailed histories, comorbidity, renal status, other vascular diseases, coagulation profile, treatment course, histology presentations, and prognosis were obtained.

Comparison of the patients' ages, presentations, underlying diseases, the duration of conservative treatments, surgical options, resected penile length, and prognosis.

All of the five patients underwent partial penectomy. One patient underwent immediate surgery while the other four had delayed partial penectomy because of progressive distal penile gangrenous change. There was no postoperative wound infection noted in any of the five patients and all had survived after 1 year follow-up. Three of them could void independently with a neourethra meatus. Two of them kept suprapubic cystostomy as a result of bladder outlet obstruction caused by an enlarged prostate and bed-ridden status.

Penile dry gangrene is an irreversible process. Early partial penectomy and correction of the underlying disease can prevent wound liquefaction, preserve more penile length, and improve quality of life.