(014) A Rare Case of Penile Skin Necrosis in Granulomatosis with Polyangiitis: Surgical Management and Functional Outcomes

Introduction Granulomatosis with polyangiitis (GPA) is a rare necrotizing vasculitis affecting small- and medium-sized vessels, primarily involving the respiratory tract and kidneys. Genitourinary manifestations are uncommon, and penile involvement is extremely rare, occurring in approximately 1% of male patients. Male urogenital involvement has been anecdotally reporter in the literature, with some 20 cases of GPA patients presenting with genital skin involvement having been reported in the literature, and an estimated prevalence of 1% among the male patients with a GPA diagnosis. Painless genital skin ulceration was the presenting symptom in almost all of the cases, either at disease onset and during flares. Genital ulcers were usually recurrent and, in some cases, accompanied by local oedema and/or regional lymphadenopathy. Objective The our aim is underscoring the pivotal role of a multidisciplinary management strategy that integrates both medical and surgical interventions Methods Clinical assessment included history, physical examination of genital lesions, and CT imaging of the abdomen and pelvis to evaluate edema, corpora cavernosa integrity, and lymphadenopathy. A bedside penile skin biopsy confirmed necrotizing vasculitis, and wound swabs were cultured for infection. Treatment included targeted antibiotics, corticosteroid immunosuppression, and surgical management: escharotomy, repeated bedside curettage, and coverage with a split-thickness skin graft using tie-over dressing. Hyperbaric oxygen therapy (HBOT) was delivered in 16 weekly sessions to enhance tissue oxygenation and healing. Results The aesthetic result appeared satisfactory from the surgical perspective. Regarding the functional outcome the patient reports a curvature of approximately 110° during erection, which results in an inability to engage in penetrative intercourse. Consequently, the use of a Vacuum Pump has been recommended for the next two months as part of the management plan. Conclusions A multidisciplinary management approach integrating medical and surgical expertise should always be implemented to treat any GPA-associated genital involvement. Surgical management of large penile skin defects using skin grafts should be attempted in an effort to minimize the hospital stay and to optimize the aesthetic and functional outcomes, but the patient should always be thoroughly informed about an higher likelihood of complications such as possible graft infection or graft failure. Patients should always be informed that the second-intention healing process for large genital skin defects due to GPA may require long periods of time and long hospital stays and may associated with severe functional issues despite optimal medical management. HBOT is feasible on selected cases of GPA genital involvement, and seemed to provide a favorable effect on the healing process of the penile skin defect in this case. Further studies are needed to better characterize the genital skin manifestations of GPA and to develop evidence-based guidelines for their management. Disclosure No