Delayed glans necrosis after circumcision: role of testosterone in salvaging glans

Glans necrosis is a rare complication after circumcision and may occur secondary to cautery . The treatment of choice for glanular necrosis has not yet been established. The authors describe two cases of severe glanular ischemic necrosis that occurred after circumcision. The patients were successfully managed with 10% testosterone cream for 4 wk. After completing the treatment course, the glans looked acceptable in size but the urethra sloughed partially and became hypospadic in one case. The authors hypothesize that the testosterone impact on endothelial cells and vascular endothelial growth factor expression may increase the penile blood supply and induce adequate revascularization of the glans; the effect that has been previously shown in experimental in vitro studies.