1/9. Penile calciphylaxis: analysis of risk factors and mortality.PURPOSE: Penile calciphylaxis is a rare condition resulting in infection and gangrene. Most cases are associated with systemic calciphylaxis. The pathophysiology, diagnosis and management of penile calciphylaxis as a distinct entity have received little attention. We reviewed the literature to increase understanding of this disease. MATERIALS AND methods: A retrospective review of the literature was performed after treating a case of penile calciphylaxis. Patient characteristics, presentation, serum chemistry studies, management and outcomes are reported. RESULTS: A total of 34 cases of penile calciphylaxis were identified in the literature including our patient. Average patient age was 58 years. All patients had end stage renal disease, and diabetes mellitus was a co-morbidity in 76%. Additional areas of gangrene beyond the genitalia were found in two-thirds of patients. Average calcium phosphate product was 78.5 mg.2/dl.2 (range 20.6 to 52.5) and mean parathormone level was 553 pg./ml. (10 to 65). parathyroidectomy was performed in 8 patients. All patients were treated with either local debridement/wound care or partial/total penectomy. survival was better in patients who underwent parathyroidectomy (75%) than in those treated with local debridement or penectomy alone (28%). The overall mortality associated with this disease was 64% with a mean time to death of 2.5 months. CONCLUSIONS: Penile calciphylaxis is a result of medial calcification and fibrosis of blood vessels. The co-morbidity and mortality associated with this disease are extremely high. Secondary hyperparathyroidism and an increased calcium phosphate are characteristic and require aggressive medical management. Surgical management of penile lesions and parathormone is controversial. Our review suggests that parathyroidectomy may improve survival and that survival is independent of the type of local treatment for the penile lesions.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/9. The so-called Hoffman's lymphangitis of the penis: is it a lymphangitis or a phlebitis?Hoffman's plastic lymphangitis of the penis is a benign, uncommon entity whose aetiology is still unknown. Microscopically there is a fibrous thickening of the involved lymph vessels but the primary localization of the lesion--lymphatic or venous--is still debated. Anatomo-clinical and histological findings suggest a primary involvement of the lymphatic system of the penis, probably related to a prolonged period of sexual excitement.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/9. Localized gangrene of the scrotum and penis: a complication of heroin injection into the femoral vessels.Long-term intravenous heroin abusers have problems of vascular access. After the accessible sites are sclerosed, the neck, axillae and groins are then used frequently. We report on 3 heroin abusers who presented with localized gangrene of the genitalia after injection into the femoral vessels. We postulate that the pathophysiology of this entity is related to arterial embolization of particulate matter into the microcirculation of the genitalia, which causes arterial thrombosis leading to localized gangrene. Of the 3 patients 2 were treated with local excision, debridement and primary closure. A fourth addict who injected heroin directly into the scrotum and perineum, presented with Fournier's gangrene, a completely different, more lethal entity.- - - - - - - - - - ranking = 5keywords = vessel (Clic here for more details about this article) |
4/9. vascular calcification presenting as necrosis of penis in patient with chronic renal failure.An unusual presentation of metastatic calcification as gangrene of the penis is reported in a patient with chronic renal failure on maintenance hemodialysis. Calcification of the vessels of the penis was documented radiographically and pathologically. Recognition of the possible occurrence of this complication becomes of great importance in younger patients on dialysis or with kidney transplants.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/9. Impotence in the bull: (3) rupture of the corpus cavernosum penis proximal to the sigmoid flexure.Penile haematomas, lying outside the tunica albuginea, were found in six bulls of various breeds, aged one-and-a-half to nine-and-three-quarter years. In five cases the haematomas definitely arose from rupture of the dorsal or crural canal and tunica albuginea of the corpus cavernosum penis (ccp) within the proximal 12 cm of the penile body. In the sixth bull, lesions of the tunica albuginea and distortion of the penis just proximal to the proximal bend of the sigmoid flexure may have represented the site of rupture. There was no evidence of rupture at the distal bend of the sigmoid flexure or of rupture of the dorsal penile vessels in any of these specimens. In all six specimens, the dorsal canals of the ccp were occluded by translucent fibrous tissue distal to the sites of rupture; this was considered to be the factor immediately predisposing to proximal rupture of the ccp. Clinically, a small haematoma in the perineal region is difficult or impossible to palpate externally. However, when the haematoma of proximal origin is large, differentiation from rupture at the distal bend of the sigmoid flexure may be based tentatively on a careful clinical examination. In cases of proximal rupture the haematoma lies caudal and dorsal to the scrotum and no abnormality of the distal bend may be palpable. In cases of distal rupture, the haematoma usually lies cranial to the scrotum and involves the distal bend of the flexure. Severe disruption of the vascular structure is found in cases of proximal rupture of the ccp; therefore the prognosis is grave.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/9. Sclerosing lymphangitis of the penis: a lymphangiofibrosis thrombotica occlusiva.Three patients with so-called non-venereal sclerosing lymphangitis of the penis are presented. light and electron microscopy of one case revealed a lymphatic collecting vessel with a fibrin thrombus in the process of recanalization and vessel wall fibrosis due to hyperplasia of smooth muscle cells and fibroblasts. The term 'lymphangiofibrosis thrombotica occlusiva' is proposed. Lymph stasis is suggested as a provoking factor for the dilatation and clinically striking firm thickening of the affected collecting vessel. No microorganisms were recognized. Within the fibrin thrombus, sprouts of endothelial cells showed intracellular vacuoles, probably indicating the first identifiable step in lymph capillary lumen formation. Signs of collagen remodelling were encountered in the thickened vessel wall.- - - - - - - - - - ranking = 4keywords = vessel (Clic here for more details about this article) |
7/9. calciphylaxis in three patients with end-stage renal disease.BACKGROUND: calciphylaxis is a rare and life-threatening condition of progressive cutaneous necrosis secondary to small- and medium-sized vessel calcification seen almost exclusively in patients with end-stage renal disease and hyperparathyroidism. Two patients had bullous lesions preceding their ulcerative lesions, an unusual presentation of this entity. One patient also had penile involvement that, to our knowledge, has not been described previously. OBSERVATIONS: Three patients, all of whom were being maintained on hemodialysis, developed painful, progressive leg ulcerations. Two patients had elevated parathormone levels, and the third patient did not. All patients had only very modest increases in their calcium x phosphate product. CONCLUSIONS: calciphylaxis should be included in the differential diagnosis of panniculitis and vasculitis. It is important to diagnose promptly, as early treatment may prevent progression.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/9. Penile calciphylaxis.calciphylaxis is a condition of cutaneous necrosis secondary to small- and medium-sized vessel calcification that may progress rapidly and is often fatal. patients with end-stage renal disease and hyperparathyroidism are almost exclusively at risk. Only 1 case of penile involvement has been previously described. At our institution, a 56-year-old man with end-stage renal disease presented with penile calciphylaxis. The patient received a series of treatments including circumcision, partial penectomy, amputation of necrotic phalanges, and a subtotal parathyroidectomy after which the patient's parathyroid hormone level normalized and the disease progression abated.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/9. Congenital lymphoedema of the genitalia.Isolated congenital lymphoedema of the external genitalia in boys is extremely rare. It can have major physical and emotional consequences for the children. Three male patients with primary lymphoedema of the penis and scrotum are described. The first case presented with lymphoedema of the prepuce and the phallic skin that persisted after the age of 1 year. Circumcision and excision of the subcutaneous tissues of the phallic skin were successful in producing the appearance of a normal circumcised penis. The second case presented with oedema of both phallic and scrotal skin. At age 1 year only a pastous thickening of the prepuce remained, scrotal and phallic skin normalised spontaneously. Routine circumcision was successful with a 5-year follow up. The third case presented with persistent oedema of both the scrotum and the phallus. He suffered leakage of lymph requiring incontinence pads, with complicating skin infections recurring every 4-6 weeks at age 8 years. After complete peeling of the scrotal and phallic skin from subcutaneous tissue some leakage persisted, infections subsided. The cause of this disorder remains unknown, although hypoplasia of the lymphatic vessels is reported in most cases. In the literature, several congenital malformations have been associated with primary lymphoedema. These were not noted in our patients. Rarely, the lymphoedema regresses spontaneously. The treatment of persistent lymphoedema is surgical and consists of meticulous excision of all subcutaneous layers of the affected skin, combined with reconstruction of the penis and/or scrotum. CONCLUSION: Primary lymphoedema of the male external genitalia is an extremely rare malformation of the lymphatic vessels of unknown origin. If persistent, surgical treatment is necessary.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |