Objectives: To evaluate the etiologic factors and the effects of surgical debridement and adjunctive therapies on morbidity and mortality of Fournier’s gangrene. Methods: 27 males, 1 female, a total of 28 patients with a mean age of 58 years treated for Fournier’s gangrene were evaluated retrospectively. Results: Predisposing factors including diabetes, alcohol abuse, paraplegia and renal insufficiency were identifiable in 54% of the patients. Etiologic origin of the gangrene was urogenital, cutaneous and anorectal in 43, 25 and 11% of the patients, respectively. The pathology was limited to genitalia in 10, extending to perineum in 8, the umbilicus in 7 and even up to the axilla in 3 patients. Suprapubic cystostomy and colostomy were necessary in 18 and 2 cases, respectively. We used hyperbaric oxygen therapy in 2 and honey in 6 patients to accelerate wound healing. A repeat debridement was necessary in 39% of the cases. Plastic surgery and grafting were done in 14 patients. Our mortality rate was 7%. Conclusion: Early recognition of the pathology and aggressive surgical debridement are the mainstay of the management of Fournier’s gangrene. Additional strategies to improve wound healing and increase patient survival are also needed.
Objective To compare the efficacy of standard transurethral electroresection of the prostate (TURP) and visual laser ablation in the treatment of benign prostatic hyperplasia (BPH).
Patients and methods In a randomized prospective study, the prostate glands of 60 patients with symptomatic bladder outlet obstruction caused by BPH were treated with TURP or visual ablation with the Ultraline side‐firing Nd:YAG laser; the patients were assessed using standard symptom scores, the measurement of residual urine and uroflowmetry both before and at 3 and 6 months after treatment.
Results All patients in both treatment groups had a significant improvement in symptoms and objective measures of voiding. The laser treatment gave significantly better improvements in symptom score than did TURP (P=0.034), but TURP produced significantly better peak urinary flow rates (P=0.025).
Conclusion These early results indicate that laser ablation of BPH may be a good alternative in the surgical treatment of this disease.
We have evaluated the long-term functional and cosmetic results of the Snodgrass technique in the treatment of anterior and midpenile hypospadias. A total of 70 patients who presented in the period between 1997 and 2002 underwent the Snodgrass procedure for the treatment of hypospadias. Patients who had been operated on 2 or more years previously were recalled for evaluation. Of the 31 cases identified, 19 (61%) were contacted and came for reevaluation. Genital examination and urinary flow measurements were made. Maximum urinary flow rates and voided urine volumes were assessed using the nomograms described by Toguri et al. The mean age of the patients was 6 years (range 2-12) at the time of surgery and 8 years (range 4-17) at the time of evaluation, and the mean follow-up period was 3.1 years (range 2-5). Two patients had had at least one previous surgery, and 17 were primary patients. The hypospadiac meatus was anterior in 16 patients and midpenile in three. Although some patients had urinary spraying due to skin irregularity in the meatus during voiding, 18 patients had normal peak urinary flow rate (Qmax) corresponding to their age group. Only one patient in the equivocally obstructed group had meatal stenosis, which was corrected with meatotomy. All patients had a cosmetic view of a vertical slit tip of the glans. Tubularized incised plate urethroplasty (TIPU) is a successful technique with good functional and cosmetic long-term results in distal hypospadias.
In this prospective study the incidence of gynecomastia was not as high as previously believed. Although prophylactic breast irradiation seemed to decrease the gynecomastia rate in patients on 150 mg bicalutamide, our study proves that not all patients need prophylaxis since only 52% were significantly bothered by gynecomastia. Thus, individual assessment is needed to select patients who need prophylactic radiation while on 150 mg bicalutamide.
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