Fournier's gangrene, a urologic and surgical emergency: presentation of a multi-institutional experience with 45 cases

Abstract

Objective: To review multi-institutional, multidisciplinary experience in the management of Fournier's gangrene (FG) in an attempt to identify etiologic parameters as well as to propose methods of efficient management.

Patients and methods: Retrospective chart review of 45 patients diagnosed with FG and treated in three departments (general surgery and urology departments) was performed.

Results: Average patient age was 50 ± 15.8 (range 33-81) years. Five female and 40 male patients. Seven patients deceased due to the disease. In 26 and 6 cases, perianal or ischiorectal abscess was present, respectively. These abscesses were extending up to the level of rectovesical/Douglas pouch in 12 cases. Abscesses in the scrotum and perineum were revealed in 10 and 6 cases, respectively. A fistula to the rectum and 8 sinuses to the skin were observed. Colostomy was performed in 25 cases, diverting cystostomy in 17, and orchidectomy in 12 cases. In 18 patients (40%) repeat debridement was deemed necessary. Three patients required more than 3 debridement procedures. Average hospitalization time was 15.7 ± 11.6 (range 4-40) days.

Conclusion: FG is a life-threatening form of necrotizing soft tissue infection. The disease is unpredictable and the currently proposed methods for prognosis are promising but still questionable.