Management of penile post-circumcision ischemia by pentoxifylline infusion and hyperbaric oxygen therapy.

BACKGROUND: Post-circumcision penile ischemia is a devastating complication. We will present our experience in managing children with various forms of penile ischemia. MATERIALS AND METHODS: This cohort prospective observational and interventional study was performed on all male children with post-circumcision penile ischemia between April 2017 and October 2021. A designed and approved protocol includes a combination of early pentoxifylline infusion, hyperbaric oxygen inhalation, early catheterization, and appropriate surgical debridement were applied for patients with deep ischemia 11/23, mainly the necrotic skin and subcutaneous tissues. Data of patient age, anesthesia method, monopolar diathermy usage, early presentation and positive wound culture were collected and analyzed statistically. RESULTS: During the study period 3,382 children were circumcised for non-medical reasons; 23 children were diagnosed with penile ischemia (0.7%), among other complications (9%). Most of the penile ischemia is associated with the use of monopolar diathermy (74%). The use of compressive wound dressing to control post-circumcision bleeding and infections is also responsible for ischemia in 52.2% and 43.5% of the cases. Inexperienced physicians were commonly responsible for ischemia (73.9%). Patients managed at first 24 h had better outcomes than those who were presented later (p = 0.001). CONCLUSION: In children with post-circumcision penile ischemia, a combination of hyperbaric oxygen therapy and pentoxifylline is especially effective for patients with skin and facial necrosis, this management reduces penile tissue loss.

Management of Disastrous Complications of Penile Implant Surgery.

RATIONALE: Penile Prosthesis Implantation (PPI) is the definitive treatment for Erectile Dysfunction not responsive to conservative management strategies. Furthermore, it is a staple of surgical treatment of severe Peyronie's Disease (PD) and phallic reconstruction. Expert implantologists occasionally face disastrous complications of penile implant surgery which can prove to be very challenging. In this article we present a selected number of case reports which exemplify this kind of situations and discuss management strategies while also commenting on plausible aetiologies. PATIENTS' CONCERNS: The first case describes a PPI performed in end-stage fibrotic corpora after multiple instances of implantation/explant. The second and third cases show two diametrically opposed approaches to the management of glans necrosis after PPI in post-radical cystectomy patients. The fourth case describes the history of a diabetic patient suffering from glandular, corporal and urethral necrosis after a complicated PPI procedure. The fifth case reports the surgical treatment of a case of recurring PD due to severe scarring and shrinking of a vascular Dacron patch applied in a previous operation. DIAGNOSIS: Complication diagnosis in all patient was mainly clinical, intra- and postoperative, with Penile Color Doppler Ultrasonography performed when needed in order to demonstrate penile blood flow. INTERVENTIONS: The patients underwent complex surgical procedures that addressed each specific complication. Complex penile implants with fibrosis-related complications, penile prosthesis explant with and without surgical debridement of necrotic areas, penile prosthesis explant with necrotic penile shaft and urethral amputation with perineostomy, and complex corporoplasty with scar tissue excision and patch application with PPI were performed in the five patients. OUTCOMES: Penile anatomy and erectile function with PPI was achieved in 4 out of 5 patients. 1 of 5 patient is scheduled to undergo a total phallic reconstruction procedure at the time of this writing. LESSONS: Management of disastrous complications of penile implant surgery can be very challenging even in expert hands. In-and-out knowledge of possible PPI and PD complications is required to achieve an acceptable outcome. Bettocchi C, Osmonov D, van Renterghem K, et al. Management of Disastrous Complications of Penile Implant Surgery. J Sex Med 2021;18:1145-1157.

Glans ischaemia after circumcision in adult males: A two-patient case series and a narrative review of the literature.

INTRODUCTION: Glans necrosis after circumcision is an exceedingly rare complication among adult males, with only a handful of cases being reported in the literature. MATERIALS AND METHODS: We present here two cases of glans ischaemia observations after circumcision in both a 19-year-old and a 26-year-old patient; both were managed with oral medications in the outpatient setting, with complete restitutio-ad-integrum. A narrative review of the literature was also performed to better describe the possible predisposing factors; the treatment/management options; and the typical outcomes among the adult males experiencing with this complication. RESULTS: Penile dorsal anaesthetic blocks, monopolar cautery usage and compressive wound dressing are all reported to play a role as co-factors for glans ischaemia after circumcision, hence their adoption should be mindful. There is no consensus on the management of ischaemia of the glans after male circumcision. CONCLUSIONS: The favourable outcomes being reported for most of the literature cases of glans ischaemia after circumcision among adults despite the adoption of diverse empirical therapeutic strategies suggest that the role of the proactive management may be questionable.

Novel treatment for glance necrosis due to priapism; presentation and review of literature.

INTRODUCTION: Glans necrosis in association with priapism is very rare and its appropriate treatment is not known. There is a secondary cause in most cases. CASE DESCRIPTION: We treated a 65-year-old man with priapism and glans necrosis using a closed shunt (Winter), continuous penile irrigation with normal saline, and heparin for 48 h and waited for the necrotic area to resolve spontaneously. The treatment outcome was much better compared to previous cases in whom open surgery, irrigation with pure normal saline, and/or resection of the necrotic area were performed. CONCLUSION: In cases with priapism and glans ischemia, we recommend treating the condition with continuous covernose irrigation with heparinized saline and avoiding open surgery.

Penile Glans Necrosis Associated With Antiphospholipid Syndrome: A Rare Complication.

Penile glans necrosis is a rare clinical condition caused by trauma, diabetes mellitus, adverse effect of vasoconstrictive solutions, and circumcision. Antiphospholipid syndrome (APS) is categorized as an autoimmune disease with the presence of antiphospholipid antibodies that results in an increased risk of vascular thrombosis and obstetrical complications. In this article, we report a rare case of a 20-year-old boy with penile glans necrosis due to penile vascular thrombosis following catastrophic antiphospholipid syndrome (CAPS) which we successfully treated at People's Hospital 115.

Penile implant surgery-managing complications.

Penile prosthesis surgery represents the end-stage treatment for erectile dysfunction. It is conventionally used only in cases of erectile dysfunction refractory to pharmacological treatments or vacuum constriction devices. Contemporary literature suggests that penile prothesis surgery is associated with a high satisfaction rate and a low complication profile. However, it must be appreciated that the complications of surgery can have devastating consequences on a patient's quality of life and satisfaction and include infection, prosthesis malfunction, penile corporal perforation and penile length loss. Several factors - such as appropriate patient selection, methodical preoperative assessment and patient optimization, specific intraoperative protocols and postoperative recommendations - can reduce the risk of surgical complications. This narrative review discusses the diagnosis and management of both intraoperative and postoperative complications of penile prosthesis surgery.

Glans ischemia following inflatable penile prosthesis surgery.

We present a case report of acute glans ischemia in a patient with significant vascular comorbidities following insertion of an inflatable penile prosthesis for erectile dysfunction. In this report, we pictorially display the physical exam findings that led to prompt diagnosis and discuss the importance of early device explantation (within 24 hours) to prevent glandular tissue loss.

Penile reconstruction using scrotal flap after usage of monopolar electrocautery in a 2-month-old Syrian child: a case report.

Circumcision is regarded as one of the most common procedures in pediatrics. We present a case of a newborn, who has undergone circumcision using monopolar electrocautery. He admitted to the hospital with glans necrosis and was treated with antibiotics and surgical debridement. Four months later, phalloplasty was performed for the newborn using scrotal flap. The result is satisfactory, and the penis is esthetically acceptable with effective urination. Our case suggests the use of scrotal flap for penile reconstruction due to feasibility of procedure and anatomic privilege. It would also support usage of bipolar electrocautery for circumcision to avoid possible unwanted complications of monopolar electrocautery.