Necrosis de pene: Revisión de 18 casos en el Hospital de Especialidades Centro Médico Nacional Siglo XXI

Abstract

OBJECTIVES: To report the experience in the management of penile necrosis at our hospital. METHODS: We performed a review of the medical records with the diagnosis of penile necrosis at the Department of the Urology of the Hospital de Especialidades Centro Médico nacional Siglo XXI from January 1995 to March 2005. RESULTS: 18 cases of penile necrosis were found, with ages from 28 to 78 years (mean age 58.1 yr.). Diabetes mellitus and end stage renal disease were the most frequent associated diseases, with 10 and 11 cases respectively. Reasons for consultation were penile scars in 5 cases, purulent exudation, inflammation of the glans penis and prepuce in 3, ischemic priapism in 2, Fournier's syndrome in 2, urethral bleeding in one, penile necrosis secondary to extrinsic compression in one, and periurethral abscess in another. Thirteen out of the 18 cases underwent partial or complete penectomy, and three of them died. Five patients were managed conservatively with antibiotics, one of them died. The pathology report showed ischemic necrosis in 3 cases, arterial and venous thrombosis, ischemic necrosis and dystrophic arterial and venous calcifications in 10 cases. CONCLUSIONS: Occlusive vascular changes are a conditioning factor in most patients with penile necrosis. This is more evident in patients with end stage renal disease, diabetes mellitus and hypertension. Clinical features of penile necrosis include scars, mummification, self-amputation, and superinfection, so that an early diagnosis and proper treatment are decisive for the evolution of this disease.