Acute ischaemia of the glans penis post-circumcision managed with pentoxifylline, topical nitroglycerin and epidural

Abstract

Acute ischaemia of the glans penis is a rare and serious complication following circumcision. We report the case of a teenage boy with glanular ischaemia shortly after circumcision with dorsal penile nerve block. This was successfully treated with total 11 days of topical 2% nitroglycerin ointment, 14 days of oral pentoxifylline 400 mg three times a day and 3 days of epidural (0.2% ropivocaine). There was marked clinical improvement at 4 days with a few patches of cyanosis remaining. Surgical intervention was not required, and the patient was discharged with follow-up review. At 12 days, there was complete resolution of ischaemia and the glans penis appeared normal. We suggest that oral, topical and epidural regimen of vasodilators and anti-sympathomimetic agents can be used in combination for acute ischaemia of the glans penis.