PTU - Polskie Towarzystwo Urologiczne
list of articles:

Fournier\'s gangrene - analysis of 13 cases
Article published in Urologia Polska 2001/54/4.

authors

Adam Gołąb 1, Jan Sprogis 1, Alina Kaczmarek 2, Andrzej Sikorski 1
1 Katedra i Klinika Urologii Pomorskiej Akademii Medycznej, Szczecin
Kierownik kliniki: prof, dr hab. Andrzej Sikorski
2 Katedra i Zakład Mikrobiologii i Immunologii Pomorskiej Akademii Medycznej, Szczecin
Kierownik katedry: prof, dr hab. Stefania Giedrys-Kalemba

keywords

genito-urinary tract, Fournier\'s gangrene

summary

ntroduction: Fournier\'s gangrene (FG) is a rapidly progressing necrosis of the genitals, perineum or the abdominal wall. FG is a serious therapeutic problem. We report our experience with the management 13 patients with this pathologic entity.
Methods: Thirteen patients (ean age 58 years) with FG were treated from 1997 to 2000. Eight patients were diabetic and one manifested chronic alcoholism. Lesion were limited to the scrotum in most cases. Cultures showed mixed aerobic and anaerobic microorganisms. Broad-spectrum antimicrobial therapy and aggressive surgical debridement were performed to control the infection. One patient received hyperbaric oxygen.
Results: All patients underwent incision of the fascias of the perineum, resection of the necrotic areas and drainage. In 7 cases performed orchiectomy unilateral or bilateral, 3 - suprapubic catheter was inserted. One patient with broad gangrene underwent laparotomy, also one patient required amputation right thigh due to thrombotic complications. Free skin graft were harvested from the ventral aspect of the thigh and applied to one patient. Three patients died. Hospitalization averaged 30 days.
Conclusions: FG is a urologie emergency that requires prompt recognition, aggressive treatment with parenteral antibiotics, surgical debridement and hemodynamic stabilization. Despite optimal management the mortality rate in FG still remains high.

references

  1. 1. Basoglu M, Gul O, Yildirgan I, Balik A, Ozbcy I, Orcn D: Founder\\\'s gangrene: review of fifteen cases. Am Surg 1997, 63, 1019-1021.
  2. 2. Johnin K, Nakatoh M, Kadowaki T, Kushima M, Koizumi S, Okada Y: Fownier\\\'s gangrene caused by Candida species as the primary organism. Urology 2000, 56, 153.
  3. 3. Asci R, Sarikaya S, Buyukalpelli R, Yilmaz A, Yildiz S: Four-nier\\\'s Gangrene: Risk assessment and enzymatic debridement with fyophylizedcollagenase application. Eur Urol 1998, 34, 411-418.
  4. 4. Hejase M, Simonin J, Bihrlc R, Coogan C: Genital Fownier\\\'s gangrene: experience with 38 patients. Urology 1996, 47, 734-739.
  5. 5. Bubrick MP, Hitchcock CR: Necrotizing anorectal and perineal infections. Surgery 1979,86,655-662.
  6. 6. Corman J, Moody J, Aronson W: Fownier\\\'s gangrene in modern surgical setting: improved survival with aggressive management. Br J Urol 1999, 84, 85-88.
  7. 7. Tyloch F, Tyloch J, Gospodarek E: Zgorzel Poumiera w przebiegu zapalenia jądra i najądrza spowodowana przez Bacteroides melaninogenicus. Uroi Pol 1993, 1, 47-51.
  8. 8. Rodriguez de Velasquez A, Yoder I, Velasquez P. Papanicolaou N: Imaging the effects of diabetes on the genitourinary system. Radiographics 1995,15,1051-1068.
  9. 9. Biyani C, Mayor P, Powell C: Case Report: Fownier\\\'s gangrene - Roentgenographs and sonographic findings. Clin Radiol 1995, 50. 728-729.
  10. 10. Baskin LS, Carroll PR, Catlolica EV: Necrotizing soft tissue infections of the perineum and genitalia. Br J Urol 1990, 65, 524-529.
  11. 11. Capelli-Schellpfeffer M, Gerber G: The use of hyperbaric oxygen in urology. J Urol 1999, 162, 647-654.
  12. 12. Pizzorno R, Bonini F, Donelli A, Stubinski R, Medica M, Car-mignani G: Hyperbaric oxygen therapy in the treatment of Fownier\\\'s disease in 11 male patients. J Urol 1997, 158, 837-840.
  13. 13. Vick R, Carson C: Foumier\\\'s disease. Urol Clin Norlh Am 1999,26, 841-849.
  14. 14. Kuzaka B, Jardanowski R, Dobroński P: Zgorzel poumiera. Opis przypadku. Urol Pol 1998, 1, 93-100.
  15. 15. Dahm P, Roland F, Vaslef S, Moon R, Price D, Georgiade G, Vieweg J: Outcome analysis in patients with primary necrotizing fascitis of the male genitalia. Urology 2000, 56, 31-35.
  16. 16. Benizri E, Fabiani P, Milgiori G, Chcvallicr D, Peyrottes A, Raucoules M, Amiel J, Mouiel J, Toubol J: Gangrene of the perineum. Urology 1996, 47, 935-939.

correspondence

Adam Gołąb
ul. Dunikowskiego 27/2
70-123 Szczecin
adamgol@pam.szczecin.pl
tel kom. 0 601 927 471