FROM ISCHAEMIA TO HEALING: SUCCESSFUL MULTIMODAL MANAGEMENT OF PENILE CALCIPHYLAXIS IN KIDNEY FAILURE

 

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FROM ISCHAEMIA TO HEALING: SUCCESSFUL MULTIMODAL MANAGEMENT OF PENILE CALCIPHYLAXIS IN KIDNEY FAILURE

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Ken
Chau
Archee Singh archee.singh@health.qld.gov.au Metro North Kidney Health Services Nephrology Brisbane Australia -
Kirsten Hepburn kirsten.hepburn@health.qld.gov.au Metro North Kidney Health Services Nephrology Brisbane Australia -
Ken Chau ken.Chau@health.qld.gov.au Metro North Kidney Health Services Nephrology Brisbane Australia *
Martin Wolley martin.wolley@health.qld.gov.au Metro North Kidney Health Services Nephrology Brisbane Australia -
Emma Murgatroyd emma.murgatroyd@health.qld.gov.au RBWH Internal Medicine Brisbane Australia -
Shaun Chandler shaun.chandler@health.qld.gov.au Metro North Kidney Health Services Nephrology Brisbane Australia -
Jay Roberts jay.roberts@health.qld.gov.au RBWH Urology Brisbane Australia -
Samantha Peden samantha.peden@health.qld.gov.au RBWH Vascular Surgery Brisbane Australia -
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Calciphylaxis is a rare, life-threatening disorder characterised by vascular calcification and skin necrosis, predominantly affecting patients with Kidney Failure. Penile calciphylaxis is especially uncommon and presents unique management challenges owing to the region’s complex vascular anatomy and significant impact on quality of life.

A 62-year-old man with Kidney Failure due to diabetic nephropathy, previously managed with peritoneal dialysis, developed severe penile pain and a necrotic lesion at the urethral meatus during hospitalization for diabetic foot ulcers. A biopsy of the lesion, performed during amputation, revealed stromal calcium deposition without vascular luminal calcification, supporting a diagnosis of calciphylaxis

Laboratory investigations revealed mild hypercalcaemia (corrected calcium 2.53 mmol/L) and hyperphosphataemia (3.69 mmol/L). Doppler ultrasonography demonstrated extensive calcification of the cavernosal arteries with absent flow, while the dorsal arteries and corpus spongiosum remained patent. The patient was transitioned from peritoneal to haemodialysis via a tunnelled catheter and received six months of intravenous sodium thiosulphate. Due to persistent pain and progression of the lesion, a partial penectomy was performed for symptom control. Postoperatively, the patient experienced complete pain resolution and discontinued analgesia. Notably, he has remained recurrence-free for more than three years.

This case underscores the diagnostic challenges and need for multidisciplinary management in penile calciphylaxis. A combination of medical therapy with sodium thiosulphate and timely surgical intervention can provide sustained symptom control and functional improvement.


Kewords