A three–year review of the management of Fournier’s gangrene presenting in a single Saudi Arabian institute

Abstract

IntroductionFournier‘s gangrene (FG), is a rare life threatening urologic emergency that requires immediate admission of metabolic stabilization and surgical debridement. The mortality rate ranges from 16% to 40%. This study was conducted to investigate the reasons behind the excellent survival rate in our center.Materials and methodA retrospective analysis of the medical records of 20 FG cases from January 2010 to January 2013 was conducted. Data was collected on patients’ comorbidity, survivals, Fournier‘s severity index (FSI) at presentation, length of hospital stay (LOS), the number of intensive care unit (ICU) and operating room (OR) entries, the total phalli and testes removed, colostomies created, and cystostomies performed.ResultsAll 20 cases (100%) collected for the study survived. All patients were male. The median age of the patients was 55.95 years (39–78 year). Only one patient (5%) was admitted to ICU post–operatively. Penile amputation was carried out in three of the 20 cases (15%). The total number of OR entries was 34 (average of 1.7). A majority of 12 patients (60%) were diabetic. A total of six testes were extirpated from the study group. None of the patients required colostomy creation. Only one patient (5%) required a cystostomy tube insertion. FSI was 5.65 ranging from 0 to 14. The average length of hospital stay was 22.3 days.ConclusionIn contrast to what is published in the literature, FG is not rare in our center. Perfect survival rate owes to the moderate severity of the cases treated, but mostly to the urgent surgical intervention with extensive debridement.

Simple scoring system for prediction of mortality in Fournier’s gangrene

“…Rare presentation with heterogeneous clinical findings and the lack of identification of reliable criteria's and statistical analyses are described as the main restrictions to demonstrate similar outcomes with identical prognostic markers [18]. The FG mortality rate varies from 0 to 88 % [10,13,15,[18][19][20][21][22]. In our study, we have reviewed 84 cases during four-year period with a mortality rate of 11.9 %.…”

Fournier's gangrene: outcome analysis and prognostic factors

“…This resulted in significant morbidity with 15% having a penile amputation and 30% of their patients an orchiectomy. [10] This demonstrate the heterogeneity of cases of Fournier's gangrene across the different national populations. The lack of easy access and availability of critical care support for patients with severe sepsis may explain the rather still higher mortality among our series of a developing country.…”

“…[7,8,9] A recent 3 year review study on 20 patients from Saudi Arabia recorded zero mortality. [10] They attributed the good prognosis to the moderate severity of their cases and aggressive radical surgical debridement. This resulted in significant morbidity with 15% having a penile amputation and 30% of their patients an orchiectomy.…”

Contemporary diagnosis and management of Fournier’s gangrene

“…The inferior epigastric and deep circumflex iliac arteries supply the lower aspect of the anterior abdominal wall, whereas the external and internal pudendal arteries supply the scrotal wall. With the exception of the internal pudendal artery, each of these vessels travels within Camper's fascia and can therefore become thrombosed in the progression of FG [Katib et al 2013]. The Colles fascia is attached laterally to the pubic rami and fascia lata and posteriorly to the urogenital diaphragm, thus limiting progression in these directions.…”