Urological Emergency Research Articles

Replantation following complete penile amputation: Summary of perioperative experience and treatment strategies.

To date, there are only case reports of penile amputation, a rare urological emergency with a low-treatment successful rate, and there are still no advanced, detailed surgical or perioperative treatment plans. Effective treatments for these rare diseases are urgently needed. The researchers summarized the perioperative experience of 20 patients who underwent replantation after complete penile amputation at several hospitals over the past 5 years and shared experience in detail. Only 1 of the 20 surgeries failed, and both urinary and erectile functions were successfully restored in other cases, indicating that the surgical methods and perioperative treatments summarized by researchers are feasible and highly successful for replantation following complete penile amputation. Researchers have summarized the method and perioperative plan for replantation following penile amputation based on a summary of 20 cases, thereby providing guidance for urologists and andrologists.

73-year-old patient with urological emergency

73-year-old patient with urological emergency

Editorial Comment on "Learning by clinical reasoning versus interactive lecture: an analytical and experimental study of teaching urological emergencies"

Editorial Comment on "Learning by clinical reasoning versus interactive lecture: an analytical and experimental study of teaching urological emergencies"

A needs assessment for simulation-based training in emergency urological skills in Ethiopia.

Urologic emergencies are common and complications from their management are high. Simulation-based education (SBE) is a highly effective training method, allowing trainees to learn both technical and nontechnical skills in a safe environment. Training in the management of urological emergencies is limited in many healthcare settings, so we performed a needs assessment for a urological emergencies SBE course in Ethiopia. This study presents data from a descriptive cross-sectional, survey-based survey of consultants and residents in the Ethiopian surgical community. The survey was disseminated using online Google Forms, through social media (WhatsApp), and to colleagues in the College of Surgeons of East, Central and Southern Africa (COSECSA) via email and social media. One hundred-seven results were received; two were discarded due to incomplete data. Fifty three of the respondents were general surgeons and 38 of the respondents were urologists. Sixty nine respondents strongly agreed that simulation-based training was important for first-year surgical residents, whereas twenty-five respondents agreed and nine respondents strongly disagreed; one respondent disagreed and one was neutral. Eighty seven respondents suggested a 3-day training course, whereas 17 respondents suggested a two-day course. More than 80 of the respondents rated training in the management of acute urinary retention, acute scrotum, urethral, and suprapubic catheterization as extreme or very important and 79 respondents wanted education about urologic trauma and Fournier's gangrene. Surgical and urology residents in Ethiopia have expressed a need for, and a strong interest in, simulation-based urological emergency training.

Learning by Clinical Reasoning Versus Interactive Lecture: An Analytical and Experimental Study of Teaching Urological Emergencies

To scrutinize the progression of clinical reasoning and theoretical knowledge by comparing the impact of Clinical Reasoning-Based Learning (CRBL) sessions with interactive lectures (IL). In this experimental study conducted from November 15, 2021, to May 7, 2022, we focused on second-year students in the second cycle of medical studies. Four specific urologic emergency scenarios (nephritic colic, macroscopic hematuria, acute scrotal pain, and urinary incontinence in men) were selected for interactive teaching sessions. Four groups were studied. One urology item was taught via CRBL, the rest via IL. Each item was taught once with CRBL and thrice with IL. After instruction, learners took a 10-point evaluative test with multiple-choice questions and clinical scenarios. Four groups of 14 learners attended our department, for a total number of 56 participants. Each student attended 4 learning sessions (1 CRBL session and 3 ILs) with a number of tests completed at 4 for each. The total number of tests taken was 224. The scoring of each test was out of 10 with theoretical scores between 0 and 10. The overall median score was 7/10. We noted better ratings after the CRBL sessions (n=56) with a median of 8/10 [4-10] compared to the IL sessions (n=168) whose median was 6 [3-10] with a significant difference between the 2 learning methods (P<.001). The CRBL sessions were significantly better than the ILs at developing the clinical reasoning and theoretical knowledge in urology of our medical students.

Surgical outcomes in penile fractures: A single center experience in China

IntroductionPenile fracture is an uncommon urological emergency resulting from tunica albuginea rupture during penile erection. It is a rare condition requiring urgent surgery. Despite immediate surgical repair, the patients' erectile functions may still be impacted by penile fracture. This study aims to investigate the efficacy of surgical repair in penile fractures and its impact on erectile function. MethodsOur cohort was composed of patients diagnosed with penile fractures and received surgical repair from September 2014 to August 2022 in Peking University First Hospital. Penile color Doppler ultrasound confirmed the diagnosis. Surgical exploration was conducted, and postoperative complications were evaluated during follow-up. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5) score. Univariate analysis was conducted employing the chi-square test, t-test, and Mann-Whitney U test to identify factors that may impact postoperative erectile function. Furthermore, multivariate analysis was conducted using logistic regression and linear regression to determine the independent risk factors influencing postoperative erectile function. ResultsA total of 58 patients were enrolled in our study. The majority of injuries (69.0 %, 40/58) resulted from vigorous sexual intercourse. Most of the patients (69.0 %, 40/58) presented within 24 h. Sixteen patients (27.6 %) presented with concomitant urethral injury. The median size of the tunical tear was 1.5 (IQR, 1.0–2.0) cm. Presentation delay correlated significantly with the difference in IIEF-5 score before and after surgery, with corresponding p values of 0.028. Urethral injury correlated significantly with postoperative erectile dysfunction (ED), postoperative IIEF-5 score, and the difference in IIEF-5 score before and after surgery, with corresponding p values of 0.002, 0.004, and 0.002, respectively. ConclusionsTo conclude, surgical repair of penile fracture provides good functional results with few morbidities and urethral injury may adversely affect postoperative erectile function after penile fracture repair.

Corporal aspiration and sympathomimetic injection for priapism: “Preprocedure preparation” and “procedural considerations”

Priapism is a prolonged and persistent erection that lasts more than 4 hours and is unrelated to sexual stimulation. Although uncommon, it requires expeditious treatment to prevent erectile function compromise. Corporal aspiration is the first-line treatment for patients with ischemic priapism. This article focuses on contemporary corporal aspiration techniques for the management of priapism. After obtaining informed consent and administering local anesthesia, corporal aspiration was initiated by inserting 2 large-bore butterfly needles into the penile shaft. Aspiration is then performed using 10-mL syringes to decompress the corporeal pressure, flush out clots, and restore the pH balance of the penis. Diluted phenylephrine (100–1000 μg/mL) is injected in 1 mL aliquots every 5 to 10 minutes until complete detumescence is achieved. The results show that the overall resolution rate using corporal aspiration followed by phenylephrine injection is 65% to 72%. Ninety percent of men experience detumescence success if aspiration and phenylephrine injection are performed within 12 hours. Conversely, 85% of patients with priapism may require penile shunt surgery if the priapism exceeds 24 hours, and in the majority of these patients, health care providers will consider placing a penile prosthesis if the priapism exceeds 36 hours. Corporal aspiration is the first-line treatment for priapism. When properly performed expeditiously, patients experience a high rate of detumescence. Ischemic priapism is a true urological emergency that requires prompt diagnosis and treatment. The advantages of using corporal aspiration as a first-line treatment include pain relief and the prompt restoration of circulation.

Audit of the Acute Management of Renal Colic in District Hospitals Within a National Health Service Trust.

Renal colic is a prevalent acute urological emergency caused by urinary stones and commonly manifests as severe loin pain. This audit assesses the management of acute renal colic at a National Health Service (NHS) Trust in the West Midlands, England, comparing practices against theNational Institute for Clinical Excellence (NICE) and the British Association of Urological Surgeons (BAUS) guidelines. This retrospective audit reviewed 417 patients with suspected renal colic over a month. Data collected included patients' demographics, time to complete CT scan, laboratory investigations requested and management modalities. Patients assessed were either admitted through the Emergency Department, Surgical Assessment Unit, or previously admitted for other conditions on the wards. The audit benchmarked against NICE and BAUS guidelines, focusing on diagnostic timeliness and management, including essential blood investigations. Data analysis performed using SPSS (IBM Corp., Armonk, NY, USA) included descriptive statistics and Chi-square tests, with significance set at p < 0.05. A total of 417 patients met the inclusion criteria. The average age of patients was 47.4 years with slightly higher male population (51.1%). The diagnostic rate for renal or ureteric stones using computed tomography of the kidneys, ureters, and bladder (CT-KUB) was 41.2%. The positive detection rate was significantly higher in males (54%) compared to females (27.5%) while females have more alternate diagnosis than males (13.7% vs 6.1%). The average completion time of CT-KUB was nine hours with 7.7% of patients having their CT-KUB beyond the 24-hour benchmark. Most patients (48%) were managed conservatively with analgesia, 32% received tamsulosin as medical expulsive therapy and others had interventions like ureteric stent insertion (9.3%), nephrostomy (6.4%) or primary ureteroscopy (4.1%). The audit of renal colic management at our centre revealed a 41.2% diagnostic rate for renal or ureteric stones via CT-KUB, with a significantly higher rate in males than females. Diagnostic delays were minimal, with only 7.7% of scans exceeding 24 hours. Conservative management was common, however non-steroidal anti-inflammatory drugs (NSAIDs) were underutilized despite guideline recommendations. There was a notable gender disparity in diagnostic and alternate findings rates. The results showed the need for adherence to pain management protocols and highlight the effectiveness of existing renal colic protocol, while also pointing to potential areas for improvement in treatment uniformity and guideline adherence.

Diagnosis, treatment and prognosis of Fournier’s gangrene in Africa: a scoping review protocol

Abstract Fournier’s gangrene is a rare necrotizing soft-tissue infection affecting the perineal, perianal and genital regions. It constitutes a genuine medical, surgical and urological emergency. Despite a better understanding of the etiology and pathophysiology of Fournier’s gangrene, mortality rates reported in the literature remain high. Still very common in Africa, it seems to occur mainly during hot, dry months and particularly affects people of low socio-economic status. This explains why the diagnosis is often made at a late stage. To our knowledge, there is no literature evaluating the epidemiology, clinical presentation, management and prognosis of Fournier’s gangrene in Africa, necessitating a review of the scope. This literature review protocol describes how the authors intend to study the available data on the presentation, management and prognosis of Fournier’s gangrene in Africa. Databases such as PubMed/Medline, Embase, Google Scholar and African Journal Online will be searched for articles published on Fournier’s gangrene in Africa and covering clinical, therapeutic and prognostic outcomes. The sociodemographic profile of all included studies will be examined. Results will include epidemiological, clinico-biological, severity score, management and prognostic data. Based on the analyzed results, the various parameters linked to the specific objectives of the African and non-African studies will be discussed and compared. This discussion will focus on clinical presentation, management and prognosis. This scoping review will be the first to address this research question, which has yet to be reported serially by African authors.

Piroxicam and paracetamol in the prevention of early recurrent pain and emergency department readmission after renal colic: Randomized placebo-controlled trial.

Renal colic (RC) is a common urologic emergency often leading to significant pain and recurrent hospital visits. This study aimed to compare the efficacy and safety of piroxicam versus paracetamol in preventing pain recurrence and hospital readmission in patients treated for RC and discharged from the emergency department (ED). A prospective, randomized, single-blind trial was conducted in four EDs. Eligible adults with RC were randomized to receive oral piroxicam, paracetamol, or placebo for 5 days post-ED discharge. Primary outcomes included pain recurrence and ED readmission within 7 days. Secondary outcomes included time to recurrence and treatment-related side effects. Of 1383 enrolled patients, no significant differences were observed among the groups regarding baseline characteristics. Pain recurrence rates within 7 days were 29% (95% confidence interval [CI] 24.9%-33.2%) for piroxicam, 30.3% (95% CI 26.1%-34.5%) for paracetamol, and 30.8% (95% CI 26.6%-35.0%) for placebo, with no significant between-group differences (p = 0.84). Among patients experiencing recurrence, the majority encounter it within the initial 2 days following their discharge (86% in the piroxicam group, 84.1% in the paracetamol group, and 86% in the placebo group, respectively). ED readmission rates were similar across groups: 20.8% (95% CI 17.1%-24.5%) in the piroxicam group, 23.8% (95% CI 19.9%-27.7%) in the paracetamol group, and 22.9% (95% CI 19.1%-26.8%) in the placebo group (p = 0.52). The piroxicam group reported significantly higher adverse effects compared to others. Piroxicam and paracetamol did not demonstrate efficacy in preventing pain recurrence or ED readmission within the first week following RC treatment.

Left Testicular Torsion in an Undescended Left Testis in a 5-Year-Old Boy: A Case Report

Purpose: Testicular torsion is a urological emergency characterized by the twisting of the spermatic cord structures, and subsequent loss of blood supply to the ipsilateral testis leading to testicular ischemia and infarction. This condition, if not promptly treated, can result in permanent testicular damage. Within 6 hours from onset of testicular pain, testicular exploration is recommended.While testicular torsion is common in normally descended testes, its occurrence in an undescended testis is rare and poses unique diagnostic and management challenges. Methodology: A 5-year-old male presented with a 6-hour history of severe left groin pain. Clinical examination revealed an empty left Hemiscrotum and a tender left groin swelling. Doppler ultrasound confirmed the absence of the left testis in the scrotum, locating it in the left groin with markedly reduced blood supply, suggestive of testicular torsion. Laboratory investigations, including a complete blood count, were within normal limits. Urgent surgical intervention involved detorsion and bilateral orchidopexy, leading to complete resolution of symptoms and an uneventful recovery. Findings: This case highlights the diagnostic difficulties associated with testicular torsion in an undescended testis. The rarity of this condition necessitates heightened clinical suspicion in patients with cryptorchidism presenting with acute abdominal or groin pain. Relevant literature and case reports emphasize the importance of early diagnosis and treatment to salvage the affected testis. Doppler ultrasonography is the diagnostic modality of choice, though clinical suspicion should guide management due to the possibility of false negatives. Surgical intervention remains the definitive treatment, with timely detorsion and orchidopexy being crucial for favorable outcomes. Unique Contribution to Theory, Practice and Policy: Testicular torsion in an undescended testis requires prompt recognition and multidisciplinary management to prevent long-term complications such as infertility. Clinicians should maintain a high index of suspicion for this condition in pediatric patients presenting with inguinal swelling and ipsilateral empty hemiscrotum. Early surgical intervention is essential for the preservation of testicular function and favorable patient outcomes.

Penile Replantation: A Review of Microsurgical Techniques, Patient Outcomes, and Solutions to Complex Reconstructive Challenges

Introduction: Penile amputation is a rare urological emergency with varying etiologies, ranging from psychiatric disorders to traumatic injuries, and requires precise microsurgical replantation techniques to restore function and appearance. The popularization of microsurgery has greatly improved outcomes by enabling accurate vascular and nerve reattachments, which are crucial for erectile function and sensation. This comprehensive study reviews advancements in microsurgical penile replantation, perioperative, and postoperative care, focusing on the nuances of surgical interventions and potential complications such as ischemia and necrosis. Methods: The PubMed, EMBASE, and Cochrane databases, were queried for studies published between 2015 and 2023 that discussed preoperative conditions, surgical techniques, and postoperative outcomes in penile replantation cases. Resulting studies that reported preoperative and postoperative outcomes of at least one case of penile replantation after amputation were included. Case parameters of interest were then extracted and categorized to determine the most common complications as well as solutions utilized in penile replantation. Results: Our findings from 46 cases across 37 studies revealed a common occurrence of postoperative necrosis (56.5%) and highlighted the importance of timely vascular reconnection and innovative surgical strategies to manage complications. Three cases were complicated by scrotal hematomas and 23 cases reported at least one psychiatric comorbidity. Some innovative solutions mentioned include hyperbaric oxygen therapy, laser angiography, leech therapy, PDE inhibitors, and penile splints. Conclusion: The outcomes suggest a critical need for standardized protocols and further research into optimizing techniques and therapies to enhance the success rates as well as quality of life post-replantation. This review aims to guide future practices and encourage collaborative efforts to refine the complex microsurgical procedures involved in penile replantation.

Giant Urinary Bladder Stone in Association with Acute Kidney Injury: A Rare Urological Emergency

Giant Urinary Bladder Stone in Association with Acute Kidney Injury: A Rare Urological Emergency

Targeting heme in sickle cell disease: new perspectives on priapism treatment.

Men with sickle cell disease (SCD) frequently experience priapism, defined as prolonged, painful erections occurring without sexual arousal or desire. This urological emergency can lead to penile fibrosis and permanent erectile dysfunction if not treated adequately. Due to its complex pathophysiology, there is currently no effective preventative treatment for this condition. Recent studies have highlighted the dysfunction of the nitric oxide (NO) and cyclic guanosine monophosphate (cGMP) pathway in erectile tissues as a critical mechanism in developing priapism in SCD. Additionally, further research indicates that intravascular hemolysis promotes increased smooth muscle relaxation in the corpus cavernosum and that excess heme may significantly contribute to priapism in SCD. Pharmacological treatments should ideally target the pathophysiological basis of the disease. Agents that reduce excess free heme in the plasma have emerged as potential therapeutic candidates. This review explores the molecular mechanisms underlying the excess of heme in SCD and its contribution to developing priapism. We discuss pharmacological approaches targeting the excess free heme in the plasma, highlighting it as a potential therapeutic target for future interventions in managing priapism.

Proanthocyanidin alleviates testicular torsion/detorsion-induced ischemia/reperfusion injury in rats

Testicular torsion is an urological emergency and can lead to ischemia damage and testicular loss if not diagnosed in time. Proanthocyanidin is reported to have anti-inflammatory and antioxidant properties. The current study aimed to examine the possible effects of proanthocyanidin (P) on the testis in torsion/detorsion (T/D)-induced testicular ischemia/reperfusion (I/R) injury in rats. Forty rats were divided into four groups (n=10 for each): sham-operated (sham), I/R, I/R + P100 (100 mg/kg, 30 min before torsion), and I/R + P200 (200 mg/kg, 30 min before torsion). Testicular T/D was performed on the left testicle by 3 hours of torsion at 720° clockwise, followed by 3 hours of detorsion. In the I/R group, an increase in malondialdehyde (MDA) levels and a decrease in glutathione (GSH), vitamin C (Vit C), glutathione peroxidase (GPx), glucose-6-phosphate dehydrogenase (G6PD) values were determined compared to the sham group (p<0.001). Moreover, an increase in the expression of cleaved caspase-3 and Bcl2-associated X protein (Bax), a decrease in the expression of B-cell lymphoma 2 (Bcl-2) and proliferating cell nuclear antigen (PCNA) were detected in the I/R group (p<0.001). Histopathologically, it was determined that the Johnsen and Cosentino scores of the testicles were irregular in the I/R group (p<0.001). Proanthocyanidin treatment caused a decrease in MDA, cleaved caspase-3 and Bax levels and an increase in GSH, Vit C, GPx, G6PD, Bcl-2 and PCNA values. Additionally, Johnsen and Cosentino rearranged the scores. The present findings revealed the protective and curative effects of proanthocyanidin in organ damage due to testicular torsion/detorsion-induced ischemia/reperfusion with their antioxidative and antiapoptotic properties.

The New York Section EMPIRE Collaborative: Piloting a Multi-Institutional, Simulation-Based Surgical Skills Boot Camp for Junior Urology Residents.

Since the integration of the intern year into urology residencies, programs are mandated to introduce fundamental skills to junior residents. Our goal was to assess the impact of one such program: the 2023 New York Section of the AUA (NYS-AUA) EMPIRE (Educational Multi-institutional Program for Instructing REsidents) Boot Camp. Junior urology residents from all 10 NYS-AUA institutions attended a free EMPIRE Boot Camp on June 9, 2023. The seminar covered procedural skills including urethral catheterization, cystoscopy, renal and bladder ultrasound, transrectal prostate ultrasound with biopsy, and an introduction to robotics/laparoscopy. Sessions focused on urologic emergencies and postoperative scenarios. Participants completed questionnaires before, immediately after, and 6 months post course, assessing comfort with procedures and overall program quality using a 5-point Likert scale and free text responses. t Tests compared pre and immediate/6-month post scores. Forty junior residents, along with faculty and resident instructors from all 10 NYS-AUA programs, participated. Of the 40 trainees, 35 (87.5%) completed pre- and immediate post-boot camp surveys, while 23 (57.5%) responded to the 6-month follow-up survey. Ratings showed significant improvement in comfort with basic urologic technical skills for 13 out of 14 domains (93%) immediately after the course and at the 6-month mark. Attendees reported notably higher comfort levels in managing obstructive pyelonephritis (P = .003) and postoperative complications (P = .001) following didactic sessions. A skills-based, free collaborative urology boot camp for junior residents is feasible and can be effective. Trainees reported improved comfort performing certain technical skills and managing urologic emergencies both immediately after the course and at 6 months of follow-up.

Cystoscopic extraction of a wired earphone from male urinary bladder

Abstract A foreign body in the urinary bladder is an uncommon urological emergency, resulting from scenarios such as iatrogenic injuries, self-insertion for pleasure, sexual abuse, assault, and migration from the adjacent sites. Self-inserted urinary bladder foreign bodies for sexual enjoyment pose a substantial issue for clinicians due to their difficulty in the diagnosis and therapy. Most patients were admitted late owing to embarrassment, resulting in severe short-and long-term consequences. This case study describes the intriguing presentation of a 57-year-old male who came to the surgery outpatient department 17 days after experiencing burning when urinating along with blood and dysuria. Wire-like radiodensities in the soft tissues of the pelvis were seen on an X-ray; their morphology was described as that of an earphone wire. The wired earphone foreign body was removed using a cystoscopy procedure. The patient’s hospital stay was minimal, and he was discharged with antibiotics and analgesics.

Early Diagnosis and Treatment Outcomes of Fournier Gangrene in a Tertiary Center.

Fournier gangrene is an uncommon urological emergency caused by microbial agents, resulting in necrosis of the genitalia and perineum. This study aims to evaluate the outcomes of early diagnosis and management of Fournier gangrene at KAMC in Riyadh, Saudi Arabia. A retrospective cohort study was conducted at KAMC, Saudi Arabia. The study population included all adult patients diagnosed with Fournier gangrene between 2015 and 2022. Data analysis was performed using RStudio (RStudio, Boston, MA). Frequencies and percentages were used to present categorical data, while medians and interquartile ranges were used to express numerical variables. The study included 41 patients with Fournier gangrene, the majority (95.12%) being male with a median age of 60 years. The most prevalent comorbidity was diabetes mellitus (85.37%). Ten patients presented to the hospital with sepsis, two of whom were in shock. Within 90 days of admission, two of them had expired. This resulted in a 20% mortality rate among septic patients. The mean FGSI in patients who had died during hospital stays was approximately two times the mean in surviving patients (8.17 and 4.32, respectively). The most utilized imaging study was a CT scan (70.7%). Most patients had undergone multiple debridements (87.7%). The median number of debridements per patient was three, and the interval between each debridement was three days. The most frequent tissue culture finding was mixed organisms, followed by Escherichia coli. Regarding empiric antibiotics, tazocin was the most used, accounting for 22.0%. The most frequently performed adjunctive procedure was the placement of a suprapubic catheter, accounting for 41.5%. Roughly 43.90% required a blood transfusion. Within 90 days of admission, six patients had died, which makes the mortality rate 14.6%. Four of them had died within 30 days of admission (9.76%). Fournier gangrene is a surgical emergency that requires prompt attention and resuscitation, antibiotic therapy, and surgical debridement. The study identified the demographic factors of patients who presented with the disease and provided the incidence, mortality rate, and outcomes of the disease. It also identified specifics of the pharmacological and surgical management and hospital courses.

Psychiatric Fantasies and Urological Realities: A Singular Case of Self-Inserted Intra-Urethral Foreign Body

This case report describes a rare urological emergency involving a 26-year-old schizophrenic patient who presented with acute urinary retention and bleeding after self-inserting a 65 cm metal cable into his urethra. Following sedation, a bladder ultrasound confirmed urinary retention but no foreign bodies in the bladder. Manual removal attempts were unsuccessful, and the patient was taken to the operating room without further imaging. Surgical removal was achieved by making an incision and opening the spongy body to extract the cable. Prophylactic antibiotics were administered, and the urethra was closed over a silicone catheter. Despite recommendations for longer catheter retention, the patient's psychiatric condition required early removal. Postoperative recovery was uneventful, with good outcomes at six months and one year, as confirmed by flexible endoscope evaluations. The patient was referred to psychiatric services for ongoing care. This case highlights the necessity of a multidisciplinary approach in managing urological emergencies, especially when complicated by psychiatric disorders.

Gangrena de Fournier en portador de catéter doble jota

Case report: A 30-year-old male patient, with a history of endoscopic ureterolithotomy plus placement of a double J catheter for 5 years. The clinical examination showed edema, redness, and heat that extended to the base and shaft of his penis. Laboratory tests, soft tissue ultrasound and Urotac were performed, showing a 30-cc collection at the base of the penis with debris inside, and gas area in the soft tissues in front of the pubic area and at the base of the penis. Surgery was performed with the intention of draining the abscess and taking a sample for culture, testing positive for Escherichia coli. The diagnosis was Fournier's gangrene. In-hospital management was performed, including broad spectrum coverage with Piperacillin / Tazobactam. Relevance: Fournier's gangrene is a progressive necrotizing, soft tissues infection, affecting the external genitals and/or perineum. It generally occurs in older men and is considered a urological emergency due to its rapid progression and high lethality; even under the administration of broad-spectrum antibiotics and extensive surgical debridement, it could be fatal. Among its predisposing factors are diabetes mellitus, kidney failure, obesity, alcoholism, hallucinogens, steroids, smoking, cancers, and HIV. Clinical implications: Main implications of this case are related to a better control, and surveillance to patients with double J catheter. It is recommended the removal of these devices within the appropriate period of time, in order to decrease the risk of complications such as Fournier’s gangrene due to its inadequate utilization. Conclusion: Fournier's gangrene could be associated with the use of double J catheter, which is a medical device frequently used in the urology area. Therefore, this device should be removed from all patients at the indicated times, reducing the probability of suffering from this infection.