Abstract
Introduction: Fournier’s gangrene (FG) is the necrotizing fasciitis of the perineum and genital area with high mortality. Materials and Methods: A retrospective review included 41 patients diagnosed with FG in our hospitals from 1995 to 2010, divided into survivors and nonsurvivors. We analyzed anamnestic, clinical and laboratory data. Results: The mortality rate was 36.6% (15/41 patients). Elevated heart and respiratory rates, high serum creatinine, low serum bicarbonate, pre-existing kidney disease, and higher median extent of affected body surface were associated with higher mortality. Severe sepsis on admission and hypotension below 90 mm Hg were also predictive for higher mortality. The median FG severity index (FGSI) score was higher in nonsurvivors (11 compared to 6, p < 0.0001). No cases of testicular necrosis were noted. Conclusion: Besides standard clinical and laboratory parameters included in the FGSI calculation, higher extent of affected body surface area and presence of hypotension on admission were also positively associated with mortality.
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References
1.
Fournier JA: Gangrene foudroyante de la verge. Semin Med 1883;3:345–348.
2.
Schaeffer AJ, Schaeffer EM: Infections of urinary tract; in Kavoussi LR, Novick AC, Partin AW, Peters CA, Wein AJ (eds): Campbell-Walsh Urology. Philadelphia, Saunders Elsevier, 2007, pp 301–302.
3.
Eke N: Fournier’s gangrene: a review of 1,726 cases. Br J Surg 2000;87:718–728.
[PubMed]
4.
Sorensen MD, Krieger JN, Rivara FP, Broghammer JA, Klein MB, Mack CD, Wessells H: Fournier’s gangrene: population based epidemiology and outcomes. J Urol 2009;181:2120–2126.
[PubMed]
5.
Ecker K, Baars A, Topfler J, Frank J: Necrotizing fasciitis of the perineum and the abdominal wall-surgical approach. Eur J Trauma Emerg Surg 2008;34:219–228.
6.
Laor E, Palmer LS, Tolia BM, Reid RE, Winter HI: Outcome prediction in patients with Fournier’s gangrene. J Urol 1995;154:89–92.
[PubMed]
7.
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992;101:1644–1655.
[PubMed]
8.
Abraham E, Singer M: Mechanisms of sepsis-induced organ dysfunction. Crit Care Med 2007;35:2408–2416.
[PubMed]
9.
Villanueva-Sáenz E, Martínez Hernández-Magro P, Valdés Ovalle M, Montes Vega J, Alvarez-Tostado FJF: Experience in management of Fournier’s gangrene. Tech Coloproctol 2002;6:5–10.
[PubMed]
10.
Frezza EE, Atlas I: Minimal debridement in the treatment of Fournier’s gangrene. Am Surg 1999;65:1031–1034.
11.
Yeniyol CO, Suelozgen T, Arslan M, Ayder AR: Fournier’s gangrene: experience with 25 patients and use of Fournier’s gangrene severity index score. Urology 2004;64:218–222.
[PubMed]
12.
Tuncel A, Aydin O, Tekdogan U, Nalcacioglu V, Capar Y, Atan A: Fournier’s gangrene: three years of experience with 20 patients and validity of the Fournier’s Gangrene Severity Index Score. Eur Urol 2006;50:838–843.
[PubMed]
13.
Chawla SN, Gallop C, Mydlo JH: Fournier’s gangrene: an analysis of repeated surgical debridement. Eur Urol 2003;43:572–575.
[PubMed]
14.
Erol B, Tuncel A, Hanci V, Tokgoz H, Yildiz A, Akduman B, Kargi E, Mungan A: Fournier’s gangrene: overview of prognostic factors and definition of new prognostic parameter. Urology 2010;75:1193–1198.
15.
Sahin H, Aflay U, Kilinç N, Bircan MK: Coagulation parameters in the patients with Fournier’s Gangrene. Int Urol Nephrol 2005;37:733–737.
[PubMed]
16.
Czymek R, Frank P, Limmer S, Schmidt A, Jungbluth T, Roblick U, Bürk C, Bruch HP, Kujath P: Fournier’s gangrene: is the female gender a risk factor? Langenbecks Arch Surg 2010;395:173–180.
17.
Corcoran AT, Smaldone MC, Gibbons EP, Walsh TJ, Davies BJ: Validation of the Fournier’s gangrene severity index in a large contemporary series. J Urol 2008;180:944–948.
[PubMed]
18.
Marín AG, Gil JM, Rodríguez AV, Rodríguez TS, Palacios JT, Oliver JL, Fuentes FT: Fournier’s gangrene: analysis of prognostic variables in 34 patients. Eur J Trauma Emerg Surg 2011;37:141–145.
19.
Palmer LS, Winter HI, Tolia BM, Reid RE, Laor E: The limited impact of involved surface area and surgical débridement on survival in Fournier’s gangrene. Br J Urol 1995;76:208–212.
[PubMed]
20.
Dahm P, Roland FH, Vaslef SN, Moon RE, Price DT, Georgiade GS, Vieweg J: Outcome analysis in patients with primary necrotizing fasciitis of the male genitalia. Urology 2000;56:31–35.
[PubMed]
21.
Korkut M, Içöz G, Dayangaç M, Akgün E, Yeniay L, Erdoğan O, Cal C: Outcome analysis in patients with Fournier’s gangrene: report of 45 cases. Dis Colon Rectum 2003;46:649–652.
[PubMed]
22.
Koukouras D, Kallidonis P, Panagopoulos C, Al-Aown A, Athanasopoulos A, Rigopoulos C, Fokaefs E, Stolzenburg JU, Perimenis P, Liatsikos E: Fournier’s gangrene, a urologic and surgical emergency: presentation of a multi-institutional experience with 45 cases. Urol Int 2011;86:167–172.
[PubMed]
23.
Ayan F, Sunamak O, Paksoy SM, Polat SS, As A, Sakoglu N, Cetinkale O, Sirin F: Fournier’s gangrene: a retrospective clinical study on forty-one patients. ANZ J Surg 2005;75:1055–1058.
[PubMed]
24.
Smith GL, Bunker CB, Dinneen MD: Fournier’s gangrene. Br J Urol 1998;81:347–355.
[PubMed]
25.
Campos JA, Martos JA, Gutiérrez del Pozo R, Carretero P: Synchronous caverno-spongious thrombosis and Fournier’s gangrene. Arch Esp Urol 1990;43:423–426.
© 2012 S. Karger AG, Basel
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2012
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