Fournier's gangrene with prostatic and bladder trigone colliquation: a suggested treatment algorithm

• Published in: BMJ case reports Vol. 15; no. 9; p. e251448
• Main Authors: Asimakopoulos, Anastasios D, Colalillo, Gaia, Miano, Roberto, Germani, Stefano
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 26-09-2022; BMJ Publishing Group
• Subjects: Abscesses; Algorithms; Bladder; Case reports; Case Reports: Learning from unexpected outcome (positive or negative); Catheters; Debridement; Emergency medical care; Fournier Gangrene - surgery; Gangrene; Humans; Male; Necrosis; Ostomy; Penis; Perineum; Prostate; Urinary Bladder - surgery; Urine; Wound care; Urinary tract infections; Urological surgery; Prostate; Urology
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2022-251448

Fournier's gangrene (FG) is an infectious necrotising fasciitis of the perineum and genital regions with a high mortality rate. We report the case of a man in his 70s with FG who presented with bladder trigone and prostate colliquation. Bulbar and penile urethra were also injured with multiple fenestrations. Bilateral percutaneous nephrostomy positioning followed by the placement of occluding ureteral catheters preceded the surgical debridement of the necrotic tissues and protective colostomy. There followed periodic sessions of surgical debridement and VAC therapy. The persistent perineal urinary leak required the crafting of a suprapubic surgical cystostomy with bladder neck obliteration through double-layer raphy. The cystostomy maintained the healing tissues free from the constant and damaging urine action. This report describes the successful multistep approach of an FG with deep involvement and colliquation of the bladder neck and prostate reaching the Denonvilliers fascia that ensured the correct healing of tissues.