Penile calciphylaxis: surgical management in the setting of Fournier's gangrene-a case report and literature review.

Abstract

Background: Penile calciphylaxis is a rare and severe manifestation of calciphylaxis. It refers to calcification of the small subcutaneous vessel network in the otherwise highly vascularized penis. Given how rare the condition is, there are no clear guidelines for treatment yet. The role of biopsy or surgery remains controversial due to concerns about exacerbating the condition in the context of poor wound healing. We had a rare case of penile calciphylaxis with superimposed infection. Through our case as well as through review of additional reports, we aim to further the discussion of treatment for penile calciphylaxis and provide an example of successful surgical resection.

Case description: We report a case of penile calciphylaxis complicated by Fournier's gangrene following a partial penectomy. He presented with penile drainage and a foul odor three months after undergoing a partial penectomy at another institution for the treatment of penile calciphylaxis. The patient underwent total penectomy with penoscrotal urethrostomy and was treated with antibiotics. At follow-up, the patient demonstrated good wound healing and recovery.

Conclusions: A review of 19 operative case reports on penile calciphylaxis highlights varied management strategies for this highly morbid condition. Current evidence suggests that treatment should be tailored to disease severity. In severe cases with infection, aggressive surgical intervention may be necessary to achieve source control and improve outcomes.