張博誌、陳煜、謝明里、黃世聰、黃信介、許毓昭、李威昌

林口長庚紀念醫院外科部 男性學及婦女泌尿科

Po-Chih Chang, Yu Chen, Ming-Li Hsieh, Shih-Tsung Huang, Hsin-Chieh Huang, Yu-Chao Hsu, Wei-Chang Lee

Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou medical center, Taoyuan, Taiwan

 

The management of urethral stone had many options. Electrohydraulic lithotripsy is one of the most common operations for urehtral stone. However, the urethral fistula formation after the urethral lithotripsy was relative rare. 

We reported a case of a Fournier’s gangrene resulting from an infection after the endoscopic urethrolithotripsy. This 79-year-old male patient without any systemic disease suffered from progressive urgency and dysuria for months. He presented with acute urine retention from a urethral stone to a local medical doctor and electro-hydraulic lithotripsy was done there. However, erythematous change and swelling over suprapubic area was noted postoperatively and intermittent febrile episodes accompanied for 3 days. Computed tomography showed some grouping tiny air bubbles around penis shaft, Fournier’s gangrene was highly suspected. Therefore, he was transferred to our hospital for surgical debridement. During the operation, abscess formation extended from penile base to suprascrotal and suprapubic area with many stone fragments in the subcutaneous tissue. A urethrocutaneous fistula was identified. After several surgical debridement and tunica albuginea repairment, the infection was under control and skin defect was covered with local flap.

Most urethral stones can be managed endoscopically. The possible complication of urethral injury during the operation should be always kept in mind.