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Number №1, 2021 - page 140-143

Ischemia of the glans penis after circumcision and blockade of the spinal nerve of the penis, a clinical case DOI: 10.29188/2222-8543-2021-14-1-140-143

For citation: Valiev R.Yu., Vrublevskiy S.G.,Vrublevskiy A.S., Vrublevskaya E.N., Oganisyan A.A. Ischemia of the glans penis after circumcision and blockade of the spinal nerve of the penis, a clinical case. Experimental and Clinical Urology 2021;14(1):140-143, https://doi.org/10.29188/2222-8543-2021-14-1-140-143
R.Yu. Valiev, S.G. Vrublevskiy, A.S. Vrublevskiy, E.N. Vrublevskaya, A.A. Oganisyan
Information about authors:
  • Valiev R.Yu. – pediatric surgeon, V.F. Vojno-Yasеnetsky Scientific and Practical Center for Specialized Care for Children; Moscow, Russia; https://orcid.org/0000-0003-1805-9169
  • Vrublevskiy S.G. – Dr. Sc., Professor, V.F. Vojno-Yasеnetsky Scientific and Practical Center for Specialized Care for Children; Moscow, Russia; https://orcid.org/0000-0002-6967-4180
  • Vrublevskiy А.S.– PhD, children's urologist-andrologist of the Surgical department №1 of V.F. Vojno-Yasеnetsky Scientific and Practical Center for Specialized Care for Children; Moscow, Russia; https://orcid.org/0000-0001-8550-8636
  • Vrublevskaya E.N. – Dr. Sc., Head of the Surgical department №1 of V.F. VojnoYasеnetsky Scientific and Practical Center for Specialized Care for Children; Moscow, Russia; https://orcid.org/0000-0001-7312-5945
  • Oganisyan А.А. – pediatric surgeon, V.F. Vojno-Yasеnetsky Scientific and Practical Center for Specialized Care for Children; Moscow, Russia; https://orcid.org/0000-0002-5495-4315
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Introduction. Circumcisio is a fairly simple, often performed surgical procedure in childhood, which is fraught with a small number of complications (1-5-5%). One of the most rare and dangerous is necrosis of the glans penis. The low incidence of complications determines the lack of a single standardized approach to the treatment of this pathology.

The clinical case. In this article, we present a case of glans ischemia after circumcisio with pineal block, corrected with the help of therapy aimed at improving the rheological properties of the blood. A review of the literature and various treatment methods described by other authors was conducted. The exact etiology of ischemia and necrosis of the head in most cases remains unclear. However, numerous possible causes have been described, including spasm of the veins / arteries in the glans penis, thrombosis, hematoma at the injection site, burn during electrocoagulation, perforation of a vein or artery leading to endothelial damage and delayed necrosis.

Results. After a course of conservative therapy, local signs of ischemia associated with surgery were stopped without side effects.

Discussion.The standard of choice of treatment method for ischemia and necrosis of the glans penis after circumcisio has not yet been established. We have not found an analysis of such clinical cases in children in the domestic literature. A number of foreign colleagues have reported several therapies that have been used with successful results. The ultimate goal of all of these studies was vasodilation to increase arterial inflow and improve venous outflow, which allowed for revascularization of ischemic tissues.

Conclusions. Despite the fact that ischemia or necrosis of the glans penis after circumcision is extremely rare, surgeons, urologists need to be wary if patients complain of acute pain or darkening of the color of the glans penis after circumcision of the foreskin

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glans penis ischemia; pineal block; circumcisio; children.

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