Evaluation of Fournier's necrosis in a high complexity hospital

Abstract

Objectives: To determine clinical characteristics of the population with Fournier's necrosis at Hospital Universitario del Valle (HUV) in Cali during the period 2003-2008.

Methods: We performed a retrospective review of patients with the diagnosis of Fournier's necrosis at HUV during the period 2003-2008. We collected information on age,personal history, duration of illness, hospitalization, surgeries performed, time to surgical treatment, isolated germs, and mortality. Univariate descriptive analysis was performed in STATA v 10.1.

Results: 42 patients with mean age 51 years and 12 days mean disease duration. 26% had diabetes mellitus and 21.4% urethral trauma before admission. Average time to surgical debridement was 41.4 hours. 62% required suprapubic cystostomy, 14.3% derivative colostomy, 9.5% and 2.4% orchiectomy and penectomy respectively. The average hospital stay was 23 days and 12% required ICU care. Scrotal cultures were positive in 59.5%: 64% a single germ and 36% polymicrobial. Reported mortality was 17%.

Conclusion: Fournier's necrosis is a life-threatening clinical entity in patients with multiple comorbidities requiring multiple interventions. Broad-spectrum antimicrobial therapy, aggressive debridement of necrotic tissue and comprehensive management of these patients are the mainstays in the treatment of these severely ill patients.