Fournier’s gangrene: Review of 36 cases

BACKGROUND: Fournier’s gangrene (FG) is a very rare disease in daily urological practice. Despite medical improvements, mortality in FG is still high. Early diagnosis is very important to reduce additional instrumentations and mortality. In this study, we aimed to present the characteristics of the patients with Fournier’s gangrene followed in two centers during ten years period.
METHODS: The medical records of patients with FG were reviewed retrospectively. The patient characteristics, causative pathogens, laboratory findings and treatment modalities were evaluated.
RESULTS: A total of 36 FG cases admitted between January 2008 and February 2018 were included in this study, consisting of 35 male patients, and one female patient with a mean age of 59.27±12.91 years. The mean duration of hospital stay was 19±10.44 days. The most common predisposing factor was diabetes mellitus, which was found in 28 patients. Malignancy was detected in three patients; prostate cancer in two patients and chronic lymphoblastic leukemia in one patient. Two patients had liver cirrhosis, and one patient had Behcet’s disease and psoriasis. The microbiological agent was isolated from a wound culture in nine patients. After urgent surgical debridement, daily dressing with nitrofurazone (Furacin) was done. Additional debridement was conducted when necessary. Orchiectomy was performed in 10 patients; two of them underwent bilateral orchiectomy. One patient died because of sepsis on the seventh day of hospital admission.
CONCLUSION: FG is a life-threatening urological emergency with a high mortality rate. Treatment with broad-spectrum antibiotics and urgent surgery is pivotal for the prevention of mortality.

Fournier gangreni: Otuz altý olgunun incelenmesi

AMAÇ: Fournier gangreni (FG) günlük üroloji pratiðinde çok nadir görülen bir hastalýktýr. Týbbi geliþmelere raðmen, FG’de mortalite hala yüksektir. Ýlave giriþimlerin ve mortalitenin düþürülmesi için erken taný çok önemlidir. Bu çalýþmada, on yýl süresince iki merkezde izlenen FG’li hastalarýn özelliklerini sunmayý amaçladýk.
GEREÇ VE YÖNTEM: Fournier gangrenli hastalarýn týbbi kayýtlarý geriye dönük gözden geçirildi. Hastalarýn özellikleri, etken patojenler, laboratuvar bulgularý ve tedavi yaklaþýmlarý deðerlendirildi.
BULGULAR: Ocak 2008–Þubat 2018 tarihleri arasýnda baþvuran 35’i erkek ve biri kadýn olmak üzere toplam 36 FG olgusu çalýþmaya alýndý. Hastalarýn yaþ ortalamasý 59.27±12.91 idi. Hastanede kalýþ süresi ortalama 19±10.44 gündü. En sýk predispozan faktör 28 hastada bulunan diyabetes mellitus idi. Ýki hastada prostat kanseri ve bir hastada kronik lenfoblastik lösemi olmak üzere üç hastada malignite saptandý. Ýki hastada karaciðer sirozu ve bir hastada da Behçet hastalýðý ve sedef hastalýðý vardý. Dokuz hastanýn yara kültüründen mikrobiyolojik etken izole edilmiþtir. Acil cerrahi debridman sonrasý nitrofurazone (Furacin) ile günlük pansuman yapýldý. Gerektiðinde ilave debridman gerçekleþtirildi. On hastaya orþiektomi uygulandý, bunlardan ikisi iki taraflý orþiektomi idi. Bir hasta hastaneye baþvurusunun yedinci gününde sepsis nedeniyle kaybedildi.
TARTIÞMA: Fournier gangreni yüksek mortalite oraný ile hayatý tehdit edici bir ürolojik acildir. Geniþ spektrumlu antibiyotikler ve acil cerrahi müdahale mortaliteyi önlemektedir.