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NDT Advance Access originally published online on August 22, 2005
Nephrology Dialysis Transplantation 2005 20(12):2864; doi:10.1093/ndt/gfi090
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Evaluation and treatment of penile gangrene in a chronic dialysis patient

Email: mylai{at}vghtpe.gov.tw

Sir,

With great interest, we have read the article by Liao et al. [1] entitled ‘Penile gangrene in a chronic dialysis patient’ in a recent issue of Nephrology Dialysis Transplantation. They reported a case of penile gangrene in a 66-year-old man with diabetic nephropathy in end-stage renal disease (ESRD) on regular haemodialysis for 1 year. The patient received partial penile resection to stem the progression of gangrene, but he died of overwhelming sepsis 5 days after the operation. The authors attributed the penile gangrene to calcification of the bilateral penile artery (documented by non-contrast computed tomography), associated with high serum calcium phosphate production (65 mg2/dl2), and Foley catheter retention, which might have further decreased blood flow to the penile artery and subsequently facilitated distal penile gangrene. However, the status of secondary hyperparathyroidism (i.e. serum parathyroid hormone level) and the definite pathological diagnosis were not clarified. In our opinion, the probability of calciphylaxis (calcific uraemic arteriolopathy) associated with diabetes, ESRD and secondary hyperparathyroidism is high. A pathological review to identify the evidence of calciphylaxis (e.g. medial calcification and intimal hyperplasia of medium and small arteries) is crucial. Further, emergent parathyroidectomy should be considered because the study of Karpman et al. [2] has revealed that the survival was better in patients who underwent parathyroidectomy (75%) than those treated with local debridement or penectomy alone (28%). In addition, recent studies have supported a role of hyperbaric oxygen therapy in the treatment of some patients with calciphylaxis, particularly as in the absence of uncontrolled secondary hyperparathyroidism there are few therapeutic options [3,4].

Conflict of interest statement. None declared.

Ming-Yu Lai1,2, Yao-Ping Lin1,2, Chih-Ching Lin1,2 and Wu-Chang Yang1,2

1 Division of Nephrology Taipei Veterans General Hospital2 School of Medicine National Yang-Ming University Taipei Taiwan

References

  1. Liao HW, Lin KH, Chen TH, Wang CC, Sue YM. Penile gangrene in a chronic dialysis patient. Nephrol Dial Transplant 2005; 20: 1503–1504[Free Full Text]
  2. Karpman E, Das S, Kurzaock EA. Penile calciphylaxis: analysis of risk factors and mortality. J Urol 2003; 169: 2206–2209[CrossRef][Medline]
  3. Podymow T, Wherrett C, Burns KD. Hyperbaric oxygen in the treatment of calciphylaxis: a case series. Nephrol Dial Transplant 2001; 16: 2176–80[Abstract/Free Full Text]
  4. Basile C, Montanaro A, Masi M, Pati G, De Maio P, Gismondi A. Hyperbaric oxygen therapy for calcific uremic arteriolopathy: a case series. J Nephrol 2002; 15: 676–680[Medline]

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This Article
Right arrow Extract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
20/12/2864    most recent
gfi090v1
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Right arrow Articles by Lai, M.-Y.
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