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Fournier’s gangrene with prostatic and bladder trigone colliquation: a suggested treatment algorithm
  1. Anastasios D. Asimakopoulos1,
  2. Gaia Colalillo2,
  3. Roberto Miano2 and
  4. Stefano Germani1
  1. 1Unit of Urology, Fondazione PTV Policlinico Tor Vergata, Rome, Italy
  2. 2Unit of Urology, Department of surgical sciences, University Tor Vergata, Rome, Italy
  1. Correspondence to Dr Gaia Colalillo; gaia_colalillo{at}hotmail.it

Abstract

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.

  • Prostate
  • Urology
  • Urological surgery
  • Wound care
  • Urinary tract infections

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Footnotes

  • Contributors GC and AA provided provided substantial contribution to the conception and design of the work as well as analysis and interpretation of data and drafting of the manuscript. GC, AA, SG and RM have revised the work critically for important intellectual content and provided final approval of the version to be published. They agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SG has been also involved in the patient’s care. All authors contributed to the article and approved the submitted version. AA and SG were the surgeons in charge of the case, and they were involved in management of the patient.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.