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Medicine (Baltimore). 2018 Nov;97(46):e13249. doi: 10.1097/MD.0000000000013249.

Urethral defect due to periurethral abscess treated with a tunica vaginalis flap: A case report.

Author information

1
Department of Urology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung.
2
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Abstract

RATIONALE:

Periurethral abscess is a life-threatening disease, and the occurrence of a urethral defect with periurethral abscess is a rare finding. In this case, the patient had a lengthy urethral defect from the bulbous urethra to the membranous urethra accompanied by periurethral abscess that developed within a short time. Herein, we report a case of a pedicle-sparing tunica vaginalis flap utilized in urethral reconstruction which degenerated due to fibrotic changes and soft tissue defects in the urethral bed.

PATIENT CONCERNS:

The patient was a 36-year-old man with fever and lower urinary tract symptoms who had been treated with antibiotics and anti-inflammatory drugs for urinary tract infections 3 days before admission. Purulent necrosis was formed by the urethral abscess, and a long-length urethral defect was formed in the bulbous urethra.

DIAGNOSIS:

Based on the initial computed tomography and laboratory findings, empirical antibiotics were administered to treat a lower urinary tract infection. On the 7th day of hospitalization, ultrasonography was performed due to the sudden swelling of the scrotum, and the patient was diagnosed with a periurethral abscess that was 10 × 3 cm in size.

INTERVENTION:

Initial urinary diversion, wide debridement, and a large amount of abscess drainage were performed. Necrosis of the urethral ventral part caused a urethral defect that was 5 cm in size. After treatment with antibiotics, long-term disinfection and intermittent debridement were conducted and urethral reconstruction was performed using a tunica vaginalis flap with preserved vascular structure.

OUTCOMES:

No complications occurred until 6 months after urethral reconstruction.

LESSONS:

Urethral reconstruction using a tunica vaginalis flap is a good method for selected patients. Pedicle-sparing tunica vaginalis is an advantageous material for resolving urethral defects, especially when the surrounding circulation conditions are poor.

PMID:
30431606
PMCID:
PMC6257340
DOI:
10.1097/MD.0000000000013249
[Indexed for MEDLINE]
Free PMC Article

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