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

Spanish Translation:

Paciente masculino, de 50 años de edad, con antecedentes de diabetes mellitus tipo 2, controlado parcialmente con metformina y linagliptina, el cual acude a servicio de urgencias porque desde hace varios días notó un aumento de volumen en la región de los testículos que se extendía hasta el pene, imposibilitado la micción de forma regular. Ante este cuadro se indican laboratorios que muestran: Glucemia: 310 mg/dl, Hemoglobina: 9.0 g/dl, Leucocitos: 32 x 10⁹/L, Creatinina: 3 MG/dl. El ultrasonido de partes blandas muestra colección de aproximadamente 10 cm en región perineal, con edema del tejido celular subcutáneo adyacente. 

Somos llamados para interconsulta del caso y decidimos llevar a quirófano una vez listo el paciente, además se comienza con tratamiento antimicrobiamos empírico con reajuste renal. 

Al realizar el lavado quirúrgico se observa abundante pus, fétido y espeso en toda la región perineal, testicular y del pene, se retira todo el tejido necrótico y se coloca sonda uretrovesical. 

En las curas posteriores nos percatamos que la infección había provocado la sección de la uretra por lo que se decide enviar a un hospital de alta especialidad para la resolución del caso