Necrotising myofasciitis as the initial presentation of a vesico-urethral anastomotic leak after radical prostatectomy

Necrotising soft tissue infections present as acute or sub-acute necrotising variants of cellulitis, fasciitis or myositis. Fulminant tissue destruction and systemic toxicity with a mortality rate of 14-59% is common. Risk factors for NF include diabetes, recent surgery, peripheral vascular disease, alcohol abuse and immunosuppression. Learning points are as follows: (1) In at-risk patients, VUAL can lead to necrotising myofasciitis, therefore, a low threshold for diagnosing NF is recommended. (2) In patients with multiple co-morbidities, a more conservative approach in the management of any VUAL, including urine cultures at IDC removal should be considered. (3) Dorsal venous complex haemorrhage can present significant intra-operative challenges during RRP.