Case Presentation: Penile Gangrene
A 64-year-old man from Tunisia, with a known history of hypertension and type 2 diabetes initially presented with a stroke. The doctors managed the patient and discharged him with anticoagulants and a condom catheter for urine collection.
Ten days after the initial presentation he returned with fever, pain, and dark discolouration on his penis caused by the tape used to secure the catheter. The doctors performed a physical examination which showed the patient was febrile. Moreover, they found a constricting band around the base of his penis, with a swollen and gangrenous distal. They diagnosed him with penile gangrene, secondary to an infection caused by the tape that secured the catheter to the penis.
The patient had no sensation and no pulse distal to the constricting band. The doctors found no other infection in the genital and perineal region and the prostate gland was normal on examination. Lab results revealed, elevated white blood cells, C-reactive protein, and blood sugar, while blood urea and creatinine levels were normal. The doctors sent a sample of the purulent discharge from the penis for culture and blood, urine, and pus culture.
The doctors gave the patient antibiotics (tazobactam and amikacin) and fluid treatment. They performed an emergency procedure to remove the necrotic tissue, drain the pus, and take a culture sample. The doctors found that the corpora cavernosa and urethra were necrotic, so they performed a penectomy, urethrectomy, and tissue removal. This was followed by the placement of a cystostomy catheter. The culture results showed Klebsiella pneumoniae. However, despite efforts to control the infection through aggressive removal of necrotic tissue, proper wound care, and antibiotics; the patient died from septic shock.
Condom Catheter: What is it?
A condom catheter is a type of urinary catheter used by doctors for managing incontinence in male patients. It consists of a flexible, rubber sheath that fits over the penis and is secured with tape. The catheter tube allows continuous drainage of urine into a collection bag. The condom catheter is a non-invasive alternative to traditional indwelling catheters and is commonly used for short-term or intermittent catheterization.
It differs from the foley’s catheter in many ways including the insertion, foley’s is inserted into the bladder whereas the condom catheter is connected to the penis. The Foley has a balloon at the end to help secure its place in the bladder, whereas the condom catheter doesn’t. Additionally, the condom catheter is considered more comfortable and is usually used for short periods of time. Foley’s, however, is used when catheterization is required indefinitely.
Penile/ Fournier’s Gangrene: An Overview
Fournier’s gangrene is a rare and fatal bacterial infection of the genital and perianal regions. It is a medical emergency and requires prompt surgical intervention and antibiotics.
Fournier’s Gangrene is caused by the combination of several types of bacteria, typically including anaerobic organisms. It is most commonly seen in men over 50 years old. It is caused due to underlying co-morbidities such as diabetes, obesity, and weakened immune systems. Symptoms include pain, swelling, redness, and a foul-smelling discharge in the affected area. Early recognition and treatment are crucial for preventing severe tissue damage and death. Treatment typically involves aggressive surgical debridement, antibiotics, and supportive care.
Investigations include assessment of the affected area for signs of infection, such as redness, swelling, and tenderness; blood tests and cultures to determine white blood cell count and to check for evidence of systemic infections. Moreover, imaging such as CT scans or ultrasound is done, to evaluate the extent of tissue damage and guide surgical planning. Finally, a tissue biopsy is needed to confirm the diagnosis and identify the type of bacteria causing the infection.