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Glans necrosis following penile procedures: a systematic review of etiology, frequency, and management

International Journal of Impotence Research (2025)Cite this article

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Abstract

This systematic review aimed to evaluate the current evidence on the etiology, frequency, and management of glans necrosis (GN). A comprehensive search was conducted in Medline (via PubMed), Web of Science, and Embase (via Scopus) for studies on GN as a penile procedure complication. This study involved articles in English published between May 1967 and January 2025. Articles reporting GN following penile procedures were included, whereas those describing GN due to metabolic causes or non-surgical interventions were excluded. Nine of 321 identified articles met the inclusion criteria, enrolling 34 GN cases among 2582 patients. The etiologies were penile prosthesis implantation (n = 24), grafting procedures for Peyronie’s disease (n = 2), penile brachytherapy for penile cancer (n = 4), and penile paraffinoma removal (n = 4). None of the studies reported conservative management. Surgical interventions included prosthesis removal (n = 6), prosthesis replacement combined with glans resurfacing (n = 1), debridement (n = 17), glans reconstruction (n = 1), scrotal skin free grafting (n = 4), and partial penectomy (n = 4). Therefore, although GN is rare, its consequences can be severe. Immediate surgical intervention is warranted for effective management.

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Fig. 1: Illustration of the blood supply to glans and penis.
Fig. 2: Illustration of the neurovascular bundle in a cadaveric specimen.
Fig. 3: Illustrations of glans ischemia and necrosis.
Fig. 4: Flow chart of the study according to the PRISMA guidelines.
Fig. 5: “Risk of bias” assessment for each included study according to the Risk of Bias in Non-Randomized Studies – of Interventions, Version 2 tool.
Fig. 6: Illustrations of glansectomy performed due to glans necrosis.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Department of Urology, University Medical Center Schleswig-Holsten Campus Lübeck, Lübeck, Germany

    Berk Hazir, Axel Stuart Merseburger, Marie Christine Roesch & Daniar Osmonov

  2. Department of Urology, Etlik City Hospital, Ministry of Health, Ankara, Türkiye

    Berk Hazir

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  1. Berk Hazir
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  2. Axel Stuart Merseburger
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  3. Marie Christine Roesch
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  4. Daniar Osmonov
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Contributions

Study concept and design: BH, ASM, and DO. Analysis and interpretation of data: BH, MCR, and DO. Drafting of the manuscript: HBH, and DO. Statistical analysis: BH, and MCR. Supervision: ASM, MCR, and DO. All authors reviewed the manuscript.

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Correspondence to Berk Hazir.

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Competing interests

DO, a co-author of this study, serves as the Section Editor for the “Surgical Considerations in Prosthetic Urology” special section in the International Journal of Impotence Research (IJIR). All other authors declare no competing interests.

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Hazir, B., Merseburger, A.S., Roesch, M.C. et al. Glans necrosis following penile procedures: a systematic review of etiology, frequency, and management. Int J Impot Res (2025). https://doi.org/10.1038/s41443-025-01151-1

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