DOI: https://doi.org/10.36347/sasjs.2026.v12i06.008

Pages: 570-573

Penile prosthesis implantation is a standard treatment for severe refractory erectile dysfunction, with high satisfaction rates; however, device infection remains its most feared complication, particularly in diabetic patients [1-4]. We report the case of an adult diabetic patient, initially managed for severe erectile dysfunction, in whom implantation of a penile prosthesis was decided after clear counseling regarding the increased infectious risk associated with diabetes. The postoperative course rapidly deteriorated, with extensive penile necrosis. Upon admission to our department, emergency surgical exploration revealed necrotic involvement extending from the urethral meatus to the base of the penis, necessitating prosthesis explantation, total penectomy, and creation of a definitive perineal urethrostomy. Initial septic control was achieved, but follow-up was subsequently complicated by symptomatic stenosis of the perineal urethrostomy. Temporary urinary diversion with a suprapubic catheter was first required, followed by delayed reconstructive surgery consisting of excision of the stenotic segment and definitive perineal anastomosis, with restoration of satisfactory voiding [to be specified]. This case illustrates a rare and particularly severe cascade of complications, progressing from penile implant infection to penile-predominant Fournier's gangrene, and subsequently to secondary failure of perineal urinary diversion. It highlights the importance of early recognition of prosthetic sepsis, prompt excisional surgery when extensive necrosis compromises tissue viability, and prolonged reconstructive follow-up to manage urinary sequelae.