Partial Penectomy due to Penile Calciphylaxis

Partial penectomy is the surgical standard of care for invasive tumors of the mid to distal penis, but is utilized in cases of distal penile calciphylaxis due to pain. Partial Penectomy is advantageous compared to a total penectomy, as the patient is able to urinate in the standing position.

A 51-year-old man on dialysis for end stage renal disease presented to the emergency department with pain that was increasing in severity for over a month at the glans of the penis.  On examination, the glans of the penis was firm with gangrenous necrosis extending distal to the corona, and the urethral meatus was not identified due to the extensive scarring.  A clinical diagnosis of penile calciphylaxis was determined and a Partial Penectomy was subsequently performed.  Calciphylaxis is a rare life-threatening systemic disease in patients with end stage renal disease due to medial calcification and fibrosis of blood vessels leading to infection and gangrene.  The prognosis for penile calciphylaxis tends to be poor with an overall mortality of 64% with a mean time to death of 2.5 months.

Partial Penectomy or Glansectomy with Glansorrhaphy
Pain and psychological manifestations due to penile calciphylaxis.
Proximal gangrene extension in which at least 3cm of shaft can not be spared by partial penectomy. Can not obtain negative surgical margins. All other contraindications associated with anesthesia.
Clinical Diagnosis.
Glans, corona, coronal sulcus, shaft, corpus spongiosum, corpora cavernosa, corpus cavernosum, urethra
Advantages - allows the patient to continue to stand to pee and minimizes psychological issues with a total penectomy. Disadvantages - If performed for penile cancer could lead to higher recurrence rates if negative margins are not truly established.
Infection, bleeding, pain, recurrence, anesthesia, distal urethral strictures
Tezuka M, Mizusawa H, Tsukada M, Mimura Y, Shimizu T, Kobayashi A, Takahashi Y, Maejima T. Severe necrosis of the glans penis associated with calciphylaxis treated by partial penectomy. IJU Case Rep. 2020 May 26;3(4):133-136. doi: 10.1002/iju5.12166. PMID: 33392472; PMCID: PMC7770588. Karpman E, Das S, Kurzrock EA. Penile calciphylaxis: analysis of risk factors and mortality. J Urol. 2003 Jun;169(6):2206-9. doi: 10.1097/01.ju.0000064334.85656.a1. PMID: 12771751. Nigwekar SU. Calciphylaxis. Curr Opin Nephrol Hypertens. 2017 Jul;26(4):276-281. doi: 10.1097/MNH.0000000000000328. PMID: 28375870; PMCID: PMC5907931.

Review Partial Penectomy due to Penile Calciphylaxis.

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