Deadly case of 'penile gangrene' linked to improperly applied catheter

A man developed an "unusual" case of gangrene, or tissue death, after an improperly applied external catheter cut off blood flow to his penis and led to a serious bacterial infection. Unfortunately, despite aggressive treatment, the man ultimately died of septic shock, a condition in which a person's blood pressure drops dangerously low and organs shut down. 

Prior to developing gangrene, the 64-year-old man had lost some control of his bladder due to a stroke that interrupted the blood flow to part of his brain, according to a report of the case, published Jan. 31 in the Journal of Medical Case Reports. After being treated for the stroke, he was prescribed blood thinners to prevent the formation of blood clots, and given a condom catheter, a device that fits over the penis like a condom and siphons urine into an attached bag. He was then discharged from the hospital.

Ten days later, the man returned to the hospital with fever, pain and brownish-black discoloration of his penis. Doctors found that the end of the patient's penis was "engorged" and "gangrenous," meaning there was a significant amount of dead tissue. In addition, his blood contained a notably high concentration of white blood cells — infection-fighting immune cells — so he was given broad-spectrum antibiotics. 

Later tests revealed that he was infected with Klebsiella pneumoniae, a type of bacteria that can sometimes infect patients in health care settings and poses the highest risk to those with weakened immune systems, according to the Centers for Disease Control and Prevention. (In addition to a history of stroke, the man had type 2 diabetes, which can compromise immune function, the case report authors noted.)

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To treat the man's gangrene, doctors first cleared all the dead tissue from the affected area; this involved a penectomy and urethrectomy, to remove the penis and the duct that carries urine from the bladder out of the body. A new, internal catheter was placed after the procedure.

"Although source control was achieved with aggressive debridement" — meaning tissue removal — "careful wound care, and wide-spectrum antibiotherapy, the patient died due to septic shock," the doctors wrote.

Tissue-killing infections of the genital area are known as "Fournier's gangrene," since the condition was first described in the late 1800s by dermatologist and venereal specialist J.A. Fournier, the case report states. 

"The time between diagnosis and treatment greatly affects morbidity and mortality, and it can quickly progress to sepsis. This is why it remains a life-threatening disease," the authors wrote. Historically, successful treatments of the condition have involved prompt antibiotic treatment and removal of dead tissues, followed by reconstructive surgeries. The doctors followed these examples, "but in our case, the septic complication was fatal," they wrote. 

"Healthcare professionals should be aware that improperly applied condom catheters can lead to penile gangrene, a rare but serious condition," the authors concluded. "Prevention is the key, by maintaining strict hygiene and frequent monitoring of the device."