Systematic review of penile glans necrosis

Penile glans necrosis is a rare, debilitating condition with significant cosmetic and functional consequences. Despite its clinical importance, no standardized treatment protocol exists owing to a lack of robust evidence and variability in management practices.

This systematic review aims to evaluate therapeutic interventions for penile glans ischemia and necrosis, identify gaps in current knowledge, and propose a framework for future clinical practice.

In accordance with the PRISMA 2020 statement, a systematic search of PubMed was performed from March 2024 to May 2025 using predefined search terms related to penile glans ischemia and necrosis. The inclusion criteria focused on cases of ischemia caused by reduced blood flow, excluding those linked to infections, calciphylaxis, priapism, or immediate surgical interventions. Outcomes were classified by lesion extent and type (grades I-III, A-B), and statistical analyses explored associations between treatment modalities and outcomes. Risk of bias was assessed with the JBI and Risk Of Bias In Non-randomized Studies-of Interventions tools.

Data from 48 studies encompassing 79 patients were analyzed. Circumcision (n = 55) and prostatic artery embolization (n = 13) were the most common etiologies. Treatments varied widely, including hyperbaric oxygen therapy (44.94%), antibiotics (43.82%), surgical interventions (43.82%), and pentoxifylline (40.45%). While grade A ischemia was significantly associated with better outcomes (P < .001, odds ratio = 182.77), no single treatment modality demonstrated statistically superior efficacy when compared pairwise. Antibiotic therapy and surgical interventions were associated with worse outcomes, likely reflecting their use in more severe cases. Publication bias and heterogeneity in case descriptions posed challenges to definitive conclusions.

Early recognition of ischemia significantly improves outcomes, highlighting the importance of prompt diagnosis and intervention, and the combination of pentoxifylline, hyperbaric oxygen therapy, anticoagulation, and topical agents may offer synergistic benefits. The findings of this review underscore the critical need for evidence-based protocols, standardized classification systems, consistent therapeutic strategies, and robust clinical trials; future research should focus on prospective studies with standardized methodologies to optimize care and improve functional and aesthetic outcomes for affected patients.