Penile gangrene associated with chronic renal failure: report of 7 cases and review of the literature.

Distal penile gangrene associated with renal failure is a rare entity with only 3 cases reported in the literature. Certain physiological abnormalities are commonly found in association with this condition, including secondary hyperparathyroidism, diabetes and peripheral vascular disease. We report our experience with 7 patients who presented with this condition. All patients had end stage renal disease with 5 on hemodialysis, 1 on peritoneal dialysis and 1 with a functioning cadaveric renal transplant. Six patients had diabetes mellitus and all had derangements of the calcium and phosphate metabolism, with the calcium-phosphorus product being greater than 70. Five patients were treated expectantly with resolution of gangrene in 2 and stable disease in 3. Three of the 5 patients managed expectantly and both patients treated with penectomy died of unrelated causes within 3 months. We conclude that there is no advantage to aggressive surgical treatment of penile gangrene associated with renal failure, since the outcome is the same. The overall mortality for this group is high due to associated co-morbid disease regardless of the type of treatment. Furthermore, subtotal parathyroidectomy is not indicated, since spontaneous improvement and mortality rates reported in our series were similar to those of previously reported cases. Expectant management of affected patients affords the best treatment.