Necrotizing Penile Shaft Infection after Compression Ring Use: A Photographic Case Report
Amanda R. Swanton, MD/PhD, Kevin J. Krughoff, MD, Gina N. Tundo, MD, Martin S. Gross, MD.
Dartmouth-Hitchcock Medical Center, Lebanon, NH
Introduction: Penile necrotizing soft tissue infection is an emergent issue rarely encountered in urology. Necrotizing fasciitis of the scrotum and/or perineum is more common, but generally spares the penile shaft. We documented our experience with a rare distribution of necrotizing soft tissue infection limited to the penile shaft. We captured photographic progression of the evolution of the infection as well as the outcome following surgical management.
Materials & Methods: This is a photographic case report of a 48 year old male who presented in septic shock with complaint of worsening penile swelling and pain following a sexual encounter involving use of a penile compression ring two days prior. He was admitted to the intensive care unit for resuscitation. Labs were notable for WBC 16, creatinine 5, lactate 5. Past medical history included a remote history of treated syphilis infection and urethral stricture repair. On exam, he was noted to have significant penile edema with a circumferential area of necrotic-appearing tissue with exudate (Figure 1a) and maculopapular rash involving the groin, lower torso, and bilateral lower extremities.
Results: The patient was started on broad spectrum antibiotics. MRI imaging showed cellulitis of the penile shaft, but no involvement of the corpora cavernosa or corpus spongiosum. He was taken to the operating room for debridement, which included the penile shaft skin and dartos fascia (Figure 1b). Great care was taken to avoid the neurovascular bundles, and Buck’s fascia was left intact. Wound cultures obtained during surgery were positive for Group A beta-hemolytic Streptococcus, and he was transitioned to penicillin G with gradual resolution of his maculopapular rash. On hospital day 8, he underwent split thickness skin grafting of the penile shaft with intraoperative induction of an erection to assist with graft placement (Figure 1c). He was discharged on hospital day 14 with daily xeroform gauze dressing changes.
Conclusions: We have documented a rare case of a necrotizing soft tissue infection and toxic shock syndrome following use of a penile compression ring. This was managed with penile shaft wound debridement and skin grafting. Images demonstrate the complete clinical course including preadmission baseline/early infection, serial examinations performed in the hospital, diagnostic imaging, and operative management.
Figure 1. Image of patient presenting with necrotizing infection of the penile shaft (a) requiring debridement (b) and subsequent skin grafting (c).
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