Endoscopic management of emphysematous periurethral and corporal abscess
A 48-year-old gentleman, with history of diabetes mellitus, presented to the emergency department with high grade fever, lower urinary tract symptoms and perineal pain for 3 weeks. Local examination revealed a mildly tender swelling at the penoscrotal [] and perineal region. Gentle perineal compression resulted in pus discharge from the urethra. Per-rectal examination revealed bogginess over the prostate, but the trans-rectal ultrasound was inconclusive. An urgent computed tomography scan revealed a moderate sized periurethral collection around the bulbo-membranous urethra extending into both the corporal bodies, containing specs of air foci []. Urine culture grew mixed flora. The patient was taken up for cystourethroscopy, which revealed the bulging area near bulbo-membanous junction with trickling of pus. The prostatic urethra and verumontanum were normal. Prostate was de-roofed, but was completely normal. The most bulging point in the bulbar urethra was de-roofed, which drained 75-80 ml of copious thick pus. A suprapubic catheter was placed. His fever and toxemia resolved after drainage and broad spectrum intravenous antibiotics. A retrograde urethrogram after 3 months revealed mild narrowing at bulbo-membranous region, which was managed endoscopically. He was put on self calibration and remained asymptomatic after 6 months and didn't have erectile dysfunction.