Published online Sep 26, 2023. doi: 10.12998/wjcc.v11.i27.6498
Peer-review started: May 3, 2023
First decision: July 17, 2023
Revised: August 15, 2023
Accepted: August 29, 2023
Article in press: August 29, 2023
Published online: September 26, 2023
Thermo-expandable urethral stent (Memokath 028) implantation is an alternative treatment for older patients with lower urinary tract symptoms and benign prostatic obstruction. Following prostatic urethral stent implantation, minor complications such as urinary tract infection, irritative symptoms, gross hematuria, and urethral pain have been observed; however, there are no reports of life-threatening events. Herein, we report a critical case of Fournier’s gangrene that occurred 7 years after prostatic stenting.
An 81-years-old man with benign prostatic hyperplasia (volume, 126 ccs; as measured by transrectal ultrasound) had undergone insertion of a thermo-expandable urethral stent (Memokath 028) as he was unfit for surgery under general anesthesia. However, the patient had undergone a suprapubic cystostomy for recurrent acute urinary retention 4 years after the insertion of prostatic stent (Memokath 028). We had planned to remove the Memokath 028; however, the patient was lost to follow-up. The patient presented to the emergency department 3 years after the suprapubic cystostomy with necrotic changes from the right scrotum to the right inguinal area. In digital rectal examination, tenderness and heat of prostate was identified. Also, the black skin color change with foul-smelling from right scrotum to right inguinal area was identified. In computed tomography finding, subcutaneous emphysema was identified to same area. He was diagnosed with Fournier’s gangrene based on the physical examination and computed tomography findings. In emergency room, Fournier’s gangrene severity index value is seven points. Therefore, he underwent emergent extended surgical debridement and removal of the Memokath 028. Broad-spectrum intravenous antibiotics were administered and additional necrotic tissue debridement was performed. However, the patient died 14 days after surgery due to multiorgan failure.
If Memokath 028 for benign prostatic hyperplasia is not working in older patients, its rapid removal may help prevent severe complications.
Core Tip: Herein, we report a life-threatening complication occurring several years after Memokath 028 implantation in an older and frail patient with benign prostatic hyperplasia for the first time. Memokath 028 is a permanent stent, but the long-term indwelling of Memokath 028 which is not working can be caused to acute bacterial prostatitis and epididymitis because of urinary tract infection. Eventually, our report reveals that Fournier’s gangrene associated with genitourinary organ infection such as acute bacterial prostatitis and epididymitis may occur in elderly unless the stent is removed. This report provides a good example of the management of patients with permanent or temporary prostatic stents for benign prostatic hyperplasia.