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.

Partial penectomy after debridement of a Fournier's Gangrene progressing with an isolated penile necrosis

“…Mortality rate was reported as 16% in a study including 1726 FG patients. [6][7][8] FG is a polymicrobial process starting with a triggering event. In etiology, both aerobic and anaerobic microorganisms play role.…”

“…[13] Patients without diffuse penile and urethral involvement usually don't need suprapubic catheterization and urethral catheter is usually enough. [7] Patients seldom need penis amputation and orchidectomy is indicated. [5] Hyperbaric oxygen treatment can be useful for the treatment of FG.…”

Teoria De Betty Neuman Na Abordagem De Pessoas Com Gangrena De Fournier

“…A definição precoce do quadro clínico de GF aumenta a chance de melhores prognósticos e menores índices de mortalidade (5)(6) . O enfermeiro, a partir do acompanhamento dos sinais e sintomas e de uma coleta de dados episódica, é capaz de atuar em conjunto com a equipe médica no diagnóstico rápido da GF, favorecendo tratamento e recuperação do indivíduo (4)(5)7) . Tão importante quanto o diagnóstico precoce é o tratamento eficaz da GF (3,8) .…”

“…Tão importante quanto o diagnóstico precoce é o tratamento eficaz da GF (3,8) . Considerada uma doença de alto risco de mortalidade, capaz de incapacitar o portador para as atividades de autocuidado e gerar impactos também no equilíbrio psicoespiritual e social do mesmo, a GF exige abordagem de enfermagem que contemple todas as dimensões que compõe o indivíduo, bem como as particularidades da doença e o caráter individualizado do cuidado (5,7,9) . A Sistematização da Assistência de Enfermagem (SAE) consiste em uma forma de organizar e executar o Processo de Enfermagem (PE), tendo como base o conhecimento científico, um referencial teórico, a utilização do raciocínio e julgamentos clínicos capazes de subsidiar a tomada de decisão (10)(11) .…”

Fournier’s Gangrene

“…However the first description is known to be made by Baurienne in 1764 [1,2]. Despite advances in treatment; overall mortality remains high [3][4][5].…”