Penile calciphylaxis: Rare necrotic lesions in chronic renal failure patients

Purpose: Calciphylaxis is a rare devastating condition of cutaneous necrosis resulting from calcification of small blood vessels in patients with end stage renal failure and secondary hyperparathyroidism. We describe 5 patients with penile calciphylaxis at a single institution. Materials and Methods: From 1992 to 1996, 5 patients had penile calciphylaxis. The charts of these patients were reviewed to determine the nature of the lesions, association with hyperparathyroidism and treatment outcomes. Results: All 5 patients had chronic renal failure, secondary hyperparathyroidism and painful necrotic lesions at multiple sites. Radiographs showed stippled calcification of small vessels, which was confirmed histologically. Three patients had undergone parathyroidectomy with a significant decrease in mean calcium x phosphorus ion products from 86.01 to 45.37 mg.(2)/dl.(2) (p < 0.001), and in 1 calciphylaxis resolved postoperatively. The penile lesions were treated with debridement and aggressive wound care. Conclusions: The increase in the number of patients with chronic renal failure on dialysis may make penile calciphylaxis more prevalent in the future. Lowering of serum calcium and phosphorus levels, and debridement of these necrotic lesions help to diminish this aggressively destructive process.