DOI: https://doi.org/10.36347/sjmcr.2026.v14i08.028

Pages: 1882-1885

Background: Fournier's gangrene is a life-threatening necrotizing fasciitis of the perineal and genital regions that requires urgent recognition and aggressive surgical management. Although several genitourinary sources have been described, Fournier's gangrene caused by neglected suprapubic catheter calcification remains uncommon. Case presentation: A 68-year-old man with a history of urethro-scrotal fistula and suprapubic cystostomy presented to the emergency department with severe sepsis and clinical features consistent with Fournier's gangrene. He had been lost to follow-up for one year, during which the catheter had not been exchanged. Examination revealed perineal and scrotal pain, inflammatory edema, and focal skin necrosis. The suprapubic catheter was non-functional because of complete obstruction related to extensive calcification of the intravesical balloon. Emergency management included hemodynamic resuscitation, broad-spectrum antibiotic therapy, extensive surgical debridement, removal of the calcified catheter, and placement of a new suprapubic cystostomy. Because scrotal skin loss was limited, the scrotum was reconstructed using the remaining viable scrotal tissue, allowing adequate testicular coverage. Definitive repair of the urethro-scrotal fistula was deferred until complete resolution of infection. Conclusion: This case highlights the importance of structured urological follow-up and routine catheter replacement in patients with long-term indwelling catheters. Catheter encrustation and balloon calcification may result in obstruction, infected urinary stasis, and life-threatening complications such as Fournier's gangrene. Prompt multidisciplinary management, including resuscitation, broad-spectrum antibiotics, aggressive debridement, appropriate urinary diversion, and staged reconstruction, is essential for favorable outcomes.