Management of neglected urethral stone and Fournier's gangrene as its complication: A case report

TL;DR

This case report describes the emergency treatment of a rare complication involving a neglected urethral stone leading to Fournier's gangrene, emphasizing the importance of immediate intervention.

Contribution

The paper highlights the management approach for a rare and complex case of penile Fournier's gangrene caused by a neglected urethral stone.

Findings

Fournier's gangrene in the penile region is rare and requires urgent treatment.

Combining necrotomy debridement and open cystostomy improved outcomes in this complex case.

Empirical antibiotics and simultaneous procedures are critical for managing such cases.

Abstract

Fournier's gangrene (FG) is a rare necrotizing fasciitis, and it's a urological emergency. Another disease that can cause FG is urethral stones. This case report is prepared to discuss the management of neglected urethral stones and Fournier's Gangrene, as well as its complications.

A 49-year-old male presented to the emergency room (ER) referred from the public health centre with a swollen and infected scrotum 2 weeks ago. It was worsened 1 day before hospital admission, accompanied by the discharge of pus from the scrotum. The patient also complained presence of intermittent fever, nausea, and vomiting. There was a history of straining when urinating. Physical examination showed a lump at the penis and crepitation at the scrotum. Radiological examination of the kidney ureter and bladder (KUB) x-ray and urethrography showed the presence of gangrenous gas at the scrotum. In this case, we perform open cystostomy, debridement necrotomy, and removal of urethral stone.

Management of neglected urethral stones and Fournier's Gangrene cases needs to be done immediately to prevent poor outcomes. Necrotomy debridement management is performed immediately as a source of infection. Open cystostomy as a urinary diversion is performed so that urine does not pass through the urethra and the healing process of the urethra can be maximized.

Controlling the source of infection and urinary diversion is important in cases where neglected urethral stones and Fournier's gangrene are found.

•Fournier’s gangrene on the penile region is rare•Empirical antibiotics should be given to avoid mortality•Simultaneous proscedures are needed for complex cases of penile FG followed by urethral stone.

Fournier’s gangrene on the penile region is rare

Empirical antibiotics should be given to avoid mortality

Simultaneous proscedures are needed for complex cases of penile FG followed by urethral stone.

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