Ischemic gangrene of the penis: Experience of the Urology Department, Hassan II University Hospital, Fez (about 5 cases)

Penile gangrene is a rare clinical entity, most often reflecting advanced peripheral arterial disease and posing significant therapeutic challenges. It predominantly occurs in patients with diabetes mellitus, established arteriopathy, or chronic renal failure. Owing to the lack of standardized management guidelines, four therapeutic approaches are generally described: conservative management, circumcision, penectomy, and parathyroidectomy.
This retrospective study was conducted over a 10-year period (2015–2025) in the urology department of CHU Hassan II and included five cases of penile gangrene. The parameters analyzed comprised patient age, risk factors, clinical presentation, paraclinical findings, and therapeutic modalities.
The patients’ ages ranged from 58 to 78 years, with a median age of 65 years. Clinically, all patients (100%) presented with penile black discoloration associated with erectile dysfunction, with an International Index of Erectile Function (IIEF) score ranging from 5 to 12. Penile pain was reported in two patients (40%), while one patient (20%) presented with acute urinary retention. Physical examination findings were otherwise unremarkable. Common risk factors identified across all cases included advanced age, chronic renal insufficiency, diabetes mellitus, and a history of smoking.
Surgical management consisted of partial penectomy in four patients (80%), whereas one patient (20%) refused surgical intervention. Postoperative outcomes were generally favorable, with three patients (60%) discharged between postoperative days 4 and 8. However, one patient (20%) developed necrosis of the glans and distal extremities, leading to death within six days due to hemodynamic instability.
Ischemic penile gangrene remains a rare but severe condition, frequently associated with advanced peripheral vascular disease. Diabetes mellitus and end-stage renal failure constitute the principal etiological factors. Two main therapeutic strategies can be considered: conservative management and radical surgical treatment, primarily based on penectomy. The prognosis is generally poor, with a high mortality rate, largely dependent on the patient’s general condition and associated comorbidities.