陰莖切除術對陰莖鈣化防禦症患者生存率影響的系統性回顧

楊迪媛^1,2, 陳鈺昕^1,2, 林文榮^1,2, 邱文祥^1,2,3

¹馬偕紀念醫院泌尿科, ²馬偕醫學院, ³國立陽明大學醫學院

Ti-yuan Yang^1,2 , Yu-hsin Chen^1,2, Wun-Rong Lin^1,2, Allen W. Chiu^1,2,3

¹Department of Urology, Mackay Memorial Hospital,

²Department of Medicine, Mackay Medical College,

³School of Medicine, National Yang-Ming University, Taipei, Taiwan

 

Penile calciphylaxis is a rare cause of penile gangrene. Calciphylaxis is a serious disorder of smaller arteries, arterioles and capillaries seen in 1% to 4% of patients with end-stage renal disease on hemodialysis. The systemic calciphylaxis population has a reported penile calciphylaxis prevalence of 6%. The benefit of penectomy is still debated. This study reviewed the literature to understand the influence of penectomy on survival rate of patients with penile calciphylaxis.

 

PubMed electronic searches were performed by using the term of “penile calciphylaxis” for English language articles from 1995 to 2017. We describe a case of a 43-year-old man known to have dia1betes mellitus, end-stage renal disease on haemodialysis, ischemic heart disease and systemic calciphylaxis. He underwent total penectomy for progressive gangrenous penile lesions and died 7 weeks later due to multiple organ failure.

 

A total of 50 cases of penile calciphylaxis were identified in literature review including our patient. The average age was 54 years (range 32 to 76). All patients had end stage renal disease, 41 patients receiving hemodialysis, 7 patients receiving peritoneal dialysis and 2 patients was in the pre-dialysis stage. Forty-one patients had diabetes mellitus. Average calcium level was 9.1 mg/dl, average phosphate level was 8.1 mg/dl and average calcium phosphate product was 72.6 mg²/dl². Average parathyroid hormone was 439.9 pg/ml. Extragenital gangrene was noted in 32 patients. The 3 months mortality rate was 60.7 % and 23.5 % in patients with extragenital gangrene and without extragenital gangrene (P=0.03). Twenty-one patients received partial or total penectomy. The 3 months mortality rate was 42.9% and 50% in patients underwent partial or total penectomy and patients who received local debridement and wound care, respectively (P=0.77). Sodium thiosulfate was used in 3 patients, one expired within 1 months. Two patients treated with hyperbaric oxygen therapy, both of them expired within 1 months. The overall 3 months mortality rate was 46.7% and the 1 year mortality rate was 53.3% in this study.

 

Penile calciphylaxis is a rare condition of penile gangrene resulting from calcification of small blood vessels with high mortality rate. Our review reveals that extragenital gangrene is a predictor of poor survival. Partial or total penectomy has no significant influence on survival rate of patients with penile calciphylaxis compared with those received conservative treatment.