A 50-year-old male patient with a history of type 2 diabetes mellitus, partially controlled with metformin and linagliptin, presents to the emergency department after noticing for several days an increase in volume of the scrotal region extending to the penis, which made normal urination impossible.

Laboratory tests showed:

Blood glucose: 310 mg/dL
Hemoglobin: 9.0 g/dL
White blood cell count: 32 × 10⁹/L
Creatinine: 3 mg/dL

Soft-tissue ultrasound revealed a fluid collection of approximately 10 cm in the perineal region, with edema of the adjacent subcutaneous tissue.

We were consulted on the case and decided to take the patient to the operating room once stabilized, while initiating empirical antimicrobial therapy adjusted for renal function.

During surgical debridement and irrigation, abundant foul-smelling, thick pus was found throughout the perineal, scrotal, and penile regions. All necrotic tissue was removed, and a urethrovesical catheter was placed.

In subsequent wound care, we noted that the infection had caused complete transection of the urethra, so it was decided to transfer the patient to a tertiary-care hospital for definitive management.

What is the best course of action in this type of case — to repair the urethra, or to perform a penectomy with urethral reconstruction?

Yoniel Peralta Campo MD is a General Surgeon in Mexico