Keywords
priapism
penile necrosis
total penectomy
Categories
How to Cite
Abstract
Fournier’s gangrene (FG) is a necrotizing fasciitis of the perineal and genital areas, characterized by severe complications and a high level of mortality. The occurrence of concurrent priapism is extremely rare and carries a very poor prognosis. Here, we report a case of a 74-year-old male patient with no medical history who presented with FG of the scrotum and penis associated with simultaneous priapism. He was given intravenous antibiotic therapy, cavernous aspiration, and surgical debridement. In the following days, the penis became completely necrotic. A total penectomy was performed with a perineal urethrostomy following complete wound closure. There are only a few documented cases in the medical literature of simultaneous Fournier’s gangrene and priapism. As a result, there is no established protocol for managing this rare occurrence. When gangrene extends to the penis, cavernous aspiration is not recommended as it tends to exacerbate penile necrosis in the majority of cases. However, early administration of broad-spectrum antibiotic therapy, surgical debridement, and urinary diversion are necessary to prevent necrosis and sepsis.
References
Chernyadyev SA, Ufimtseva MA, Vishnevskaya IF, Bochkarev YM, Ushakov AA, Beresneva TA, et al. Fournier’s Gangrene: Literature Review and Clinical Cases. Urol Int. 2018;101(1):91-97. https://doi.org/10.1159/000490108
Sorensen MD, Krieger JN. Fournier’s Gangrene: Epidemiology and Outcomes in the General US Population. Urol Int. 2016;97(3):249-259. https://doi.org/10.1159/000445695
Singh V, Sinha RJ, Sankhwar SN. Penile gangrene: a devastating and lethal entity. Saudi J Kidney Dis Transplant Off Publ Saudi Cent Organ Transplant Saudi Arab. 2011;22(2):359-361.
Korkut M, Içöz G, Dayangaç M, Akgün E, Yeniay L, Erdoğan O, et al. Outcome analysis in patients with Fournier’s gangrene: report of 45 cases. Dis Colon Rectum. 2003 May;46(5):649-52. https://doi.org/10.1007/s10350-004-6626-x
Charbonneau H, Pène F. A crackling priapism related to Fournier’s gangrene in a patient on chronic peritoneal dialysis. J Infect. 2010;61(3):274-275. https://doi.org/10.1016/j.jinf.2010.06.011
Kuchinka J, Matykiewicz J, Wawrzycka I, Kot M, Karcz W, Głuszek S. Fournier’s gangrene - challenge for surgeon. Pol Przegl Chir. 2019;92(5):1-5. https://doi.org/10.5604/01.3001.0013.5894
Morpurgo E, Galandiuk S. Fournier’s gangrene. Surg Clin North Am. 2002 Dec;82(6):1213-24. https://doi.org/10.1016/s0039-6109(02)00058-0
Dey S, Bhutia KL, Baruah AK, Kharga B, Mohanta PK, Singh VK. Neonatal Fournier’s gangrene. Arch Iran Med. 2010;13(4):360-362.
Cakmak A, Genç V, Akyol C, Kayaoğlu HA, Hazinedaroğlu SM. Fournier’s gangrene: is it scrotal gangrene? Adv Ther. 2008;25(10):1065-1074. https://doi.org/10.1007/s12325-008-0103-1
Morua AG, Lopez JAA, Garcia JDG, Montelongo RM, Guerra LSG. Fournier’s gangrene: our experience in 5 years, bibliographic review and assessment of the Fournier’s gangrene severity index. Arch Esp Urol. 2009;62(7):532-540.
Tahmaz L, Erdemir F, Kibar Y, Cosar A, Yalcýn O. Fournier’s gangrene: report of thirty-three cases and a review of the literature. Int J Urol. 2006 Jul;13(7):960-7. https://doi.org/10.1111/j.1442-2042.2006.01448.x
Koukouras D, Kallidonis P, Panagopoulos C, Al-Aown A, Athanasopoulos A, Rigopoulos C, et al. Fournier’s gangrene, a urologic and surgical emergency: presentation of a multi-institutional experience with 45 cases. https://doi.org/10.1159/000321691
Villanueva-Sáenz E, Martínez Hernández-Magro P, Valdés Ovalle M, Montes Vega J, Alvarez-Tostado F JF. Experience in management of Fournier’s gangrene. Tech Coloproctology. 2002;6(1):5-10; discussion 11-13. https://doi.org/10.1007/s101510200001
Hosseini SJ, Rahmani M, Razzaghi M, Barghi M, Hosseini Moghaddam SMM. Fournier gangrene: a series of 12 patients. Urol J. 2006;3(3):165-170.
Schaeffer A. Infections of the Urinary Tract. In: Walsh P, Retik A, Vaughan E, Wein A, eds. Campbell’s Urology, Eighth Edition. Saunders; 2002:515-602.
Gupta N, Zinn KM, Bansal I, Weinstein R. Fournier’s gangrene: ultrasound or computed tomography? Med Ultrason. 2014;16(4):389-390.
Singh A, Ahmed K, Aydin A, Khan MS, Dasgupta P. Fournier’s gangrene. A clinical review. Arch Ital Urol Androl Organo Uff Soc Ital Ecogr Urol E Nefrol. 2016;88(3):157-164. https://doi.org/10.4081/aiua.2016.3.157
Hejase MJ, Simonin JE, Bihrle R, Coogan CL. Genital Fournier’s gangrene: experience with 38 patients. Urology. 1996;47(5):734-739. https://doi.org/10.1016/s0090-4295(96)80017-3
Thwaini A, Khan A, Malik A, et al. Fournier’s gangrene and its emergency management. Postgrad Med J. 2006;82(970):516-519. https://doi.org/10.1136/pgmj.2005.042069
Jones RB, Hirschmann JV, Brown GS, Tremann JA. Fournier’s syndrome: necrotizing subcutaneous infection of the male genitalia. J Urol. 1979;122(3):279-282. https://doi.org/10.1016/s0022-5347(17)56367-3
Kindwall EP. Uses of hyperbaric oxygen therapy in the 1990s. Cleve Clin J Med. 1992;59(5):517-528. https://doi.org/10.3949/ccjm.59.5.517
Capelli-Schellpfeffer M, Gerber GS. The use of hyperbaric oxygen in urology. J Urol. 1999;162(3 Pt 1):647-654. https://doi.org/10.1097/00005392-199909010-00002
Gillitzer R, Franzaring L, Hampel C, Pahernik S, Bittinger F, Thüroff JW. Complete gangrene of penis in patient with arterial vascular disease. Urology. 2004;64(6):1231.e4-6. https://doi.org/10.1016/j.urology.2004.06.004
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2024 Bakkali Issaoui Z et al.
