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Also known as
Penile glandular necrosis, Ischemic gangrene of the glans, Acute ischemia of the glans penis, Dry gangrene of the penis, Penile tip necrosis, Glans penis ischemia
Definition
Glans necrosis refers to the tissue death of the glans penis, a rare but catastrophic complication that occurs due to disruption of the glans blood circulation (dorsal arteries and terminal branches of the spongiosal arteries)1. This condition can develop following penile surgeries such as circumcision, penile prosthesis implantation, or penile lengthening procedures2. It can also occur secondary to medical conditions including diabetes mellitus, severe atherosclerotic cardiovascular disease, and antiphospholipid syndrome3. The necrotic process typically presents with a discolored appearance of the glans, absent or diminished capillary refill, and blister formation4. Without prompt intervention, glans necrosis can lead to permanent tissue loss, urethral complications, and significant functional and psychological impact5.
Clinical Context
Glans necrosis is primarily encountered in urological practice following surgical interventions or in patients with significant vascular comorbidities1. Patient selection criteria for surgical management include assessment of vascular risk factors such as diabetes mellitus, smoking status, and history of cardiovascular disease2. In cases of penile prosthesis implantation, patients with preoperative risk factors should avoid high-risk adjunctive surgical maneuvers3. Diagnosis is primarily clinical, with Doppler ultrasound providing valuable assessment of the degree of ischemia4. Treatment approaches vary based on severity and include immediate prosthesis removal (if applicable), pharmacological interventions (pentoxifylline, enoxaparin, corticosteroids), hyperbaric oxygen therapy, and surgical debridement with reconstruction5. Early intervention is critical, as delayed treatment often results in complete glans loss. Conservative management has shown success in select cases, particularly with pentoxifylline and topical testosterone applications2. Reconstructive surgery may require multiple stages but can restore both urinary and erectile function in many patients1.