Penile Necrosis Following Urinary Instrumentation in Patients with Uremic Calcific Arteriolopathy: A Series of Seven Clinical Cases

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Introduction: Uremic calcific arteriolopathy (UCA) is a devastating complication in patients with chronic kidney disease (CKD), characterized by medial vascular calcification, ischemia, and tissue necrosis. Penile involvement is rare but carries a high mortality rate. We present seven cases of penile necrosis in patients with CKD, where urinary catheterization triggered the onset of necrosis, suggesting a potential risk factor. Case Description: This case series includes seven patients between 40 and 60 years of age, all patients had advanced chronic kidney disease and were undergoing renal replacement therapy at the time of presentation-four were on hemodialysis and three on peritoneal dialysis. All cases had a medical history of both type 2 diabetes mellitus and hypertension and occurred after urinary catheterization or manipulation. This was the precipitating event in every case. These comorbidities, along with vascular calcification, likely contributed to poor tissue perfusion and increased susceptibility to necrosis, aligning with a clinical picture suggestive of calciphylaxis. Despite intervention and antimicrobial therapy, five of the seven patients died, reflecting a high mortality. Discussion: Penile necrosis is an uncommon but lethal manifestation of UCA, particularly in patients with CKD, diabetes, and hypertension. While risk factors such as hypercalcemia, hyperphosphatemia, and hypoalbuminemia are well established, our cases suggest that urinary catheter placement may act as a local precipitating factor in an already compromised vascular bed. This highlights the importance of carefully assessing the risk-benefit ratio of urinary catheterization in patients with high risk and UCA.

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