The Pattern of Penile Gangrene in Sokoto, Nigeria

Objective: To examine the presentation and outcome of management of penile gangrene. Patients and Methods: The health records of all patients admitted for penile gangrene in Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria between January 1994 and December 2003 were reviewed Results: The patient group consisted of 16 patients aged between 6 and 62 years (mean: 42.5 years), of whom 7 (44%) presented in an advanced stage of gangrene. The main etiological factors were urethral stricture in 8 (50%) patients, associated with diabetes mellitus in 2 (13%), impacted urethral calculus in 3 (19%), circumcision in 2 (13%), priapism in sickle cell disease in 2 (13%) and trauma in 1 (6%). All patients were initially treated by suprapubic catheterization, broad-spectrum antibiotics, intravenous fluids and wound debridement. Surgical treatment included total penectomy in 3 (19%), phalloplasty in 3 (19%), neomeatoplasty in 5 (31%) and urethroplasty in 5 (31%) patients. Following treatment, 8 (50%) patients had a functional entire penis, while 5 (31%) had a functional penile stump and 3 (19%) no penis. Erectile dysfunction was found in 3 (19%) patients. Conclusion: Penile gangrene has a unique pattern of causes and presentation. The main cause in our series was urethral stricture. The risk of penile loss is high. Early presentation, aggressive antibiotic therapy and urinary diversion can prevent or minimize penile loss. Some patients with partial penile loss require surgical reconstruction of the urethra and penis.