PMC7533627_01
Preoperative appearance of penile necrosis.
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On clinical examination, there were necrotic ulcer and blackish discoloration of the glans (Fig. 1).
(a) Immediate post-op of the partial penectomy and (b) a trans-surgery of partial penectomy.
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Due to a severe penile pain, the patient was programmed for partial penectomy (Fig. 2a) after taking his permission as well as that of his family. In the trans-surgery, the absence of vascular flow was observed in the penile arteries and in the deep dorsal vein (Fig. 2b).The following management was based on a daily wound care, debridement for the next 2 weeks and an antibiotic-based treatment for a second episode of urinary tract infection.
(a) Wound infection with wet gangrene and (b) post-operatory total penectomy.
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In the first postoperative days, the patient's state shows recovery, but from the 14th day of this intervention, the surgical wound remained open with little serohematic secretion, as well as infected tissues shows poor progression that led to Fournier's gangrene (Fig. 3a). Then, a total penectomy was performed through removing a part of his left scrotum (Fig. 3b).
(a) Microphotography showing important calcium deposits in vessels lumen with intimal fibroblastic proliferation (HE; 100X) and (b) microphotography at higher magnification showing the marked calcium deposits with an advanced diabetic microangiopathy (HE; 200X).
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The histopathological analysis found an advanced diabetic microangiopathy accompanied by significant calcium deposits in vessels lumen with intimal fibroblastic proliferation (Fig. 4a and b).