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Главная arrow Новости arrow PENILE GANGRENE: CLINICAL CASE ANALYSIS
PENILE GANGRENE: CLINICAL CASE ANALYSIS Версия для печати Отправить на e-mail
19.11.2007

PENILE GANGRENE: CLINICAL CASE ANALYSIS

Stroy O.O., Ivashko V.A., Shuliak A.V., Mytsyk J.O., Shatynska I.S.
Danylo Halytsky Lviv National Medical University
named after Danylo Halytskyi (Department of Urology )

Penile gangrene (PG) is rare, but extremely complicated disease which is predisposed to fast progression and spreading creating the life-threatening condition for the patient. Penile gangrene may be caused by paraphimosis or compression with ring-shaped objects which leads to the impairment of the blood supply and infectious complications. The highest incidence of the penis gangrene occurs in severely immune compromised patients and patients with diabetes mellitus [1, 2].
The article describes a clinical case observed in 2004 in urology department of the Lviv municipal clinical hospital of the emergency aid. Diagnostic algorithm and treatment tactics were assessed retrospectively.

Patient, 32 years old, was admitted to the department with complaints on the intensive penis ache, penis hyperemia and edema, fever, body temperature was about 400C, perspiration, malaise. Urination was not complicated. In patients history- penis bite during sexual relationships 2 days beforehand (Fig. 1).

Penile gangrene following bite

Fig. 1. Penile gangrene following bite.

During inspection – hyperemic painful penis, extensive edema and pigmentation in the injury area which were rapidly spreading.
Recognizing rapid progression of the penis tissues necrosis it was settled to perform surgical treatment with excision of the necrotized tissues immediately.
On the beginning of the surgical treatment (2 hours following admittance) edema and pigmentation of the penis tissues have spread on the whole organ which is characteristic for the acute penile gangrene according to the different author’s data [3, 4, 5] (Fig .2, 3).

Fig. 2. Spreading of the necrotic process on the whole organ.

Spreading of the necrotic process on the whole organ

Fig. 3. Spreading of the necrotic process on the whole organ.

All necrotized tissues were excised. The absence of the necrotic process spreading directly on the penis corpus was revealed during the operation, which consequently stipulated the selective excision of the skin layers over the organ (Fig . 4).

Fig. 4. Penis necrotized tissues excision.

Penis necrotized tissues excision

2 contra-apertures were created in the pubic area through which a draining tubes with outputs around penis basis were introduced (Fig. 5). After final wound area dressing the operation was completed.

Fig. 5. Drainage tubes introducing throughout the contra-apertures.

Drainage tubes introducing throughout the contra-apertures

The patient was prescribed an intensive anti-inflammatory therapy by following regimen:

  1. Immediately on admission – Zanocyn, which is effective against multiresistant microorganisms; it is administered I.V. 200 mg t.i.d., for 5-6 days;
  2. Next step is Klabaks 500 mg I.V. b.i.d. for 5-6 days;
  3. Cyfran 500 mg P.O. b.i.d. for 10 days;

Desintoxication therapy was performed at all times. Before the surgery and intraoperatively 100 ml of metronidazoleis added I.V. to Zanocyn.

Postoperative period was without significant complications and extensive purulent wound discharge. The signs of intoxication were diminishing progressively until the complete cessation on the 8th day. The drainage tubes were extracted on the 6th day after operation.

Fig. 6. 3rd day after surgical intervention.

3rd day after surgical intervention

The penis wound area was covered with granulation tissue on the 20th day after surgical operation; the hyperemia and edema were insignificant. The patient was discharged on the 22nd day for outpatient follow-up.

A reconstructive plastic surgery was recommended to the patient from which he refused.

Conclusions:

  1. Penile gangrene is the disease which is followed by severe intoxication and predisposed to fast progression;
  2. Immediate surgical intervention with excision of the necrotizing tissues allows to prevent the scrotal, perineal and anterior abdominal wall spreading of the necrotic process;
  3. In some cases the necrotic process involves only superficial tissues which preconditions organ-sparing operation and consequently increases patients life quality.

References.

  1. Benchekroun A, Lachkar A, Bjijou Y, et al: [Gangrene of the external genital organs. Apropos of 55 cases]. J Urol (Paris) 1997; 103(1-2): 27-31
  2. Donovan JF, Kaplan WE. The therapy of genital trauma by dog bite. J Urol 1989;141(5):1163-1165
  3. Marekovic Z, Derezic D, Krhen I, Kastelan Z. Urogenital war injuries. Mil Med 1997;162(5):346-348
  4. Archbold JA, Barros d’sa AA, Morrison E. Genito-urinary tract injuries of civil hostilities. Br J Surg 1981;68(9):625-631
  5. Bertini JE Jr, Corriere JN Jr. The etiology and management of genital injuries. J Trauma 1988;28(8):1278-1281
  6. Nicolaisen GS, Melamud A, Williams RD, McAninch JW. Rupture of the corpus cavernosum: surgical management. J Urol 1983;130(5):917-919
 
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