Treatment outcome of Fournier's gangrene and its associated factors: A retrospective study


https://doi.org/10.4081/aiua.2023.11318
Vol. 95 No. 2 (2023)
Submitted: March 15, 2023
Accepted: March 25, 2023
Published: May 29, 2023
Fournier's gangrene, Necrotizing fasciitis, Risk factor, Mortality, Outcome
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Authors

Introduction: Fournier's gangrene (FG) is a rapidly progressive necrotizing infection that affects the perineal and abdominal regions and is known for its high mortality rate. This study aims to present the practical experience of managing FG patients and identify factors that may affect their clinical outcomes. Materials and methods: A retrospective study was conducted from April 2009 to December 2020 at General Military Hospital in Sana'a, Yemen including 26 patients who were diagnosed with FG and treated on. Data on demographic characteristics, time to admission, surgical intervention, and treatment outcomes were collected. Univariate analysis was performed to determine factors that affect patient outcomes. Result: The mean age of the patients was 65.77 ± 5.04 years, and 65.4% of them were over the age of 65. Most patients (57.7%) presented after five days of experiencing symptoms, and 65.4% were in septic conditions. Of the patients, 17 (65.4%) survived, and the total mortality rate was 34.6%. Univariate analysis showed that delayed presentation (p = 0.001), a history of diabetes mellitus (p < 0.001), end-stage renal disease (p < 0.001), heart failure (p < 0.001), cerebrovascular accident (p = 0.032), liver cirrhosis (p < 001), presence of multiple comorbidities (p < 001), involvement of lager area (p < 001), septic conditions (p = 0.009), advanced age (p = 0.018), and intensive care unit admission (p = 0.002) were found to be risk factors for mortality in patients with FG. Conclusions: FG is a potentially life-threatening medical condition, even with aggressive and specialized treatment. Our study revealed a mortality rate of 34.6%. Factors such as older age, the presence of multiple comorbidities, septic conditions, the abdominal spread of the disease, intensive care unit admission, and delayed presentation contribute to higher mortality rates.


Doluog˘lu Ö G, Karagöz MA, Kılınç MF, et al. Overview of different scoring systems in Fournier's Gangrene and assessment of prognostic factors. Turk J Urol. 2016; 42:190-6.

Misiakos EP, Bagias G, Papadopoulos I, et al. Early Diagnosis and Surgical Treatment for Necrotizing Fasciitis: A Multicenter Study. Front Surg. 2017; 4:5.

Milanese G, Quaresima L, Dellabella M, et al. A conservative approach to perineal Fournier's gangrene. Arch Ital Urol Androl. 2015; 87:28-32.

Benjelloun el B, Souiki T, Yakla N, et al. Fournier's gangrene: our experience with 50 patients and analysis of factors affecting mortality. World J Emerg Surg. 2013; 8:13.

Wetterauer C, Ebbing J, Halla A, et al. A contemporary case series of Fournier's gangrene at a Swiss tertiary care center-can scoring systems accurately predict mortality and morbidity? World J Emerg Surg. 2018; 13:25.

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40:373-83.

Laor E, Palmer LS, Tolia BM, et al. Outcome prediction in patients with Fournier's gangrene. J Urol. 1995; 154:89-92.

Azmi YA, Alkaff FF, Purba AKR, et al. Factors for In-Hospital Mortality in 145 Male Patients with Fournier's Gangrene: A 10-Year Observational Study from a Single Tertiary Referral Center in Indonesia. Med Sci Monit. 2022; 28:e938578.

Olivieri V, Ruggiero G, Abate D, et al. Fatal infections in andrology. Atypical clinical presentation of a Fournier's disease. Arch Ital Urol Androl. 2020; 92:213

Tahmaz L, Erdemir F, Kibar Y, et al. Fournier's gangrene: report of thirty-three cases and a review of the literature. Int J Urol. 2006; 13:960-7.

El-Qushayri AE, Khalaf KM, et al. Fournier's gangrene mortality: A 17-year systematic review and meta-analysis. Int J Infect Dis. 2020; 92:218-25.

Tuncel A, Keten T, Aslan Y, et al. Comparison of different scoring systems for outcome prediction in patients with Fournier's gangrene: experience with 50 patients. Scand J Urol. 2014; 48:393-9.

Martinschek A, Evers B, Lampl L, et al. Prognostic aspects, survival rate, and predisposing risk factors in patients with Fournier's gangrene and necrotizing soft tissue infections: evaluation of clinical outcome of 55 patients. Urol Int. 2012; 89:173-9.

Yeniyol CO, Suelozgen T, Arslan M, Ayder AR. Fournier's gangrene: experience with 25 patients and use of Fournier's gangrene severity index score. Urology. 2004; 64:218-22.

Hong KS, Yi HJ, Lee RA, et al. Prognostic factors and treatment outcomes for patients with Fournier's gangrene: a retrospective study. Int Wound J. 2017; 14:1352-8.

Lewis GD, Majeed M, Olang CA, et al. Fournier's Gangrene Diagnosis and Treatment: A Systematic Review. Cureus. 2021; 13:e18948.

McCormack M, Valiquette AS, Ismail S. Fournier's gangrene: A retrospective analysis of 26 cases in a Canadian hospital and literature review. Can Urol Assoc J. 2015; 9:E407-10.

Korkut M, Içöz G, Dayangaç M, et al. Outcome analysis in patients with Fournier's gangrene: report of 45 cases. Dis Colon Rectum. 2003; 46:649-52.

Cakmak A, Genç V, Akyol C, et al. Fournier's gangrene: is it scrotal gangrene? Adv Ther. 2008; 25:1065-74.

Meki CS, Mangwiro TI, Lazarus J. Fournier's gangrene: outcome analysis and prognostic factors. S Afr J Surg. 2018; 56:43-6.

Mulla ZD, Gibbs SG, Aronoff DM. Correlates of length of stay, cost of care, and mortality among patients hospitalized for necrotizing fasciitis. Epidemiol Infect. 2007; 135:868-76.

Spirnak JP, Resnick MI, Hampel N, Persky L. Fournier's gangrene: report of 20 patients. J Urol. 1984; 131:289-91.

Auerbach J, Bornstein K, Ramzy M, et al. Fournier Gangrene in the Emergency Department: Diagnostic Dilemmas, Treatments and Current Perspectives. Open Access Emerg Med. 2020; 12:353-64.

Yilmazlar T, Ozturk E, Ozguc H, et al. Fournier's gangrene: an analysis of 80 patients and a novel scoring system. Tech Coloproctol. 2010; 14:217-23.

Faisal Ahmed, Department of Urology, College of Medicine, Ibb University, Ibb

 

 

 

 

 

 

 

 

Faisal Ahmed,MD

PERSONAL DETAILS:

 

 

Name                                                           Faisal Ahmed

Address                                                       Department of Urology, ShahidFaghihiHospital                                                                Shiraz/ I.R IRAN

 

Telephone                                                   (+967  776089579)

                          

Date of Birth                                              1.01.1986

Marital Status                                             Married

Nationality                                                  Yemeni

Place of Birth                                             IBB, Yemen

Speciality                                           Urology

Current Appointment                         Urologist

Ibb Medical University

 

E-Mail                                                         fmaaa2006@yahoo.com

 

Personal Information:

 

Date of birth: Jun.1.1986

Place of birth: IBB, YEMEN

Gender: Male

Marital status: Married

Spous's name: Afrah Salem

Spous's Job: Student

Children: 3(two son and one daughter)

 

 

 

EDUCATION

Phase

Year

Institution

 

Degree Awarded

GPA

High school

 

 

2003

 

 

Al Nahda School, Ibb, Yemen

High School Diploma

91.62%

 

University

(Under graduation)

 

2006-2014

 

Shiraz University of Medical Sciences, School of Medicine

Doctor of Medicine

16.03 out of 20

University

(Post Graduation)

 

2014-2018

Shiraz University of Medical Sciences, School of Medicine

 

 

 

Degree in Urology     Specialty

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

graduated

 

 

 

 

 

 

 

 

 

 

 

 

Urology Board Degree

(written exam)

 

2018

Iranian Board of Urology

 

Passed (105/150)

A

 

 

 

 

MEDICAL TRAINING & WORK EXPERIENCE

  Appointments:  

 

2013-2014                             Internship; Namazi Hospital, Faghihi Hospital– Shiraz-Iran

 

2014-2018                      Residency in Urology; Namazi Hospital,Faghihi Hospital and

                                           Ali Asghar Hospital, Shiraz-Iran.

 

2018- at present time             work in Al-thora General hospital (Yemen) as consultant

 

Training:

 

 2010     1day    Clinical reasoning, Shiraz, Iran

 

2011     2days   Workshop on CPCR, Shiraz, Iran

2013     3days   Methodology on research, Shiraz, Iran

2014     6days   Workshop on EDC (education development center), Shiraz, Iran

2014     2days   Research methods, Shiraz, Iran

 

2015     3days   Workshop on medical ethics, Shiraz, Iran

 

2016     1days   Workshop on Legal doctrines and documentation of medical services and       prevention of medical errors, Shiraz, Iran

2017     7days   Congress on Iranian Urological Association, Shiraz, Iran

 

 

 

Language Skills: 

  • English: Good in reading, speaking, writing and listening.
  • Persian: Fluent in reading, speaking, writing and listening.
  • Arabic: Native speaker.

Professional skills:

  • Able to perform all usual open, endourologic and pediatric surgeries, alone.
  • Able to perform rare urologic surgeries with assistance.

IT Skills:

  • Expert in online communications and primary works like MS word, PowerPoint etc.

Interests & Hobbies:

1- Study in urology and religious field.

2- Succor, Swimming.

 

 

                                                     

RESEARCH

      WRITED PAPERS

 

  1. Penile enhancement using amniotic membrane in a rabbit model.
  2. Evaluation of proper timing for ventral meatus clamping in meatotomy procedure.
  3. Evaluation of SDF1 and CXCR4 expression in adipose derived stem cells (ASCs) around prostate in benign and malignant diseases.
  4. An Investigation of the Pathology Report of Bladder Cancer Patients With Radical Cystectomy in Southern Iran during 2013 and 2018: A Cross-Sectional Study
  5. Graft and Patient Survival Rate in Kidney Transplantation, and its Associated Factors: A Systematic Review and Meta-analysis in Iran
  6. Outcome of Ultrasound-guided Percutaneous Nephrolithotomy in Children Under Age of 16: Experience with 40 Cases
  7. Comparison Among Mini-Percutaneous Nephrolithotomy (M-PCNL) Using Ultrasonography versus Fluoroscopy in Patients Under Age of 18 Years
  8. Comparison of the Efficacy of Epidural Injection of Methylprednisolone Versus Methylprednisolone and Calcitonin in Patients with lumbosacral Spinal Stenosis: A Randomized Clinical Trial
  9. IS there any sympathetic skin response (SSR) abnormality in Raynaud phenomenon?

 

 

PUBLISHED PAPERS

 

 

  1. Hassanpour A, Ahmed F, Yeganeh BS, Jahromi BN, Makarem A. Spontaneous Rupture of Renal Cell Carcinoma in Pregnancy, Surgical Management With Fetal Preservation: A Case Report. Urology Journal. 2018 Apr 23.
  2. Ahmed F, Askarpour MR, Eslahi A, Nikbakht HA, Jafari SH, Hassanpour A, Makarem A, Salama H, Ayoub A. The role of ultrasonography in detecting urinary tract calculi compared to CT scan. Research and reports in urology. 2018;10:199.
  3. Natami M, Makarem A, Ahmed F, Dastgheib N, Zahraei AH. a giant ureteral stone in a 32-year-old man: a case report. International Medical Case Reports Journal. 2019;12:43
  4. Shirazi M, Rajabalian MB, Noorafshan A, Karbalay-Doust S, Jahanabadi Z, Ahmed F. The comparison of the effect of phenylephrine and epinephrine on penile spongy tissue in rats after experimental hypospadias surgery: a quantitative stereological study. BMC urology. 2019 Dec;19(1):1-6.
  5. Jahromi SE, Ahmed F, Pourahmad S, Roozbeh J, Najafi I, Ebrahimi V. Predictors of peritoneal dialysis associated peritonitis; application of the zero-inflated negative binomial model. Journal of Nephropathology. 2019 Jul 23;8(4):e36
  6. Nasrollahi H, Ariafar A, Ahmed F, Mokhtari M, Eslahi A, Ansari M, Chowdhury U. Isolated schwannoma of the urinary bladder: a case report and review of the literature. The Pan African Medical Journal. 2020 Apr 8;35(108).
  7. SALEHIPOUR M, ANBARDAR M, HAKIMELAHI H, MONSEF A, AHMED F, ADIB A. Incidentally Detected Adrenal Ganglioneuroma in an adult Female with left Adrenal Mass.
  8. Ariafar A, Zeighami S, Salehipour M, Ahmed F, Shahabi Z, Nikbakht HA. An Investigation of the Pathology Report of Prostate Cancer Patients with Radical Prostatectomy in Southern Iran, during 2013 and 2018: A Cross-sectional Study. Middle East Journal of Cancer. 2020 Jul 29.
  9. Shirazi M, Aminsharifi A, Ahmed F, Makarem A, Zahraei SA, Asmaarian N. The impact of post-procedural ureteric stent duration on the outcome of retrograde endopyelotomy for management of failed open pyeloplasty in children: a preliminary report. Med J Islam Repub Iran. 2020 (xx);34:x. https://doi.org/10.34171/mjiri.34.x
  10. Eslahi A, Farpour H, Hosseini A, Ahmed F, Chowdhury U, Nikbakht HA. Evaluation of the Sympathetic Skin Response in Men with Chronic Prostatitis: A Case-Control Study. Res Rep Urol. 2020;12:239-245
  11. Al-wageeh S, Ahmed F, Nikbakht HA, Al-shami E, Askarpour MR, Chowdhury U. An Investigation of the Histopathological Pattern of Thyroid in Patients Undergoing Thyroid Operations: A Cross-Sectional Study. Open Access Surgery. 2020 Jul 22;13:47-52.
  12. Ahmed F, Naji M, Al-Hitari A, Amer Q, Al-sagheer M, Chowdhury U. Use of tunica vaginalis graft for repair of traumatic bilateral testicular rupture after gunshot: a case report. The Pan African Medical Journal. 2020 Aug 12;36(268). doi: 10.11604/pamj.2020.36.268.21988
  13. Al-Wageeh S, Ahmed F, Al-Naggar K, Askarpour MR, Al-Shami E. Use of anterolateral thigh flap for reconstruction of traumatic bilateral hemipelvectomy after major pelvic trauma: a case report. Surg Case Rep. 2020 Oct 1;6(1):247. doi: 10.1186/s40792-020-01009-2. PMID: 33000349.
  14. Surgical Management of Giant Cervico-Axillo-Thoracic Cystic Hygroma: A Case Report(Accepted in MEJC)
  15. Ahmed F, Al-wageeh S, Al-shami E, Al-naggar K, Askarpour MR, Naji M. Congenital Isolated Penile Torsion: A Case Report in 2 Brothers. Open Access Surgery. 2020;13:75-78

https://doi.org/10.2147/OAS.S275810

  1. Ahmed F, Al-Wageeh S, Al-Shami E, Al-Naggar K, Askarpour MR, Naji M. Penile Injury During Ritual Circumcision. Research and Reports in Neonatology. 2020;10:95-99

https://doi.org/10.2147/RRN.S281896

 

 

 

[1]

Log book:

 

*Operations which I have observed only, and I can aid for them.

**Operations which I am fairly expert on them.

***Operations which I am expert on them and I can do them by myself.

 

  • Pediatric urology:

-Urethroplasty and phallic reconstruction for epispadias*

-Bladder neck reconstruction (Yong-Dees-Leadbetter procedure)*

-Excision of large ureterocele***

-One-stage rapair of extrophy-epispadias complex*

-Vesicostomy (Blocksom metod)**

-Closure of vesicostomy**

-Primary closure of the bladder in extrophy-epispadias complex***

-Nephrectomy of pediatric RCC and Wilms' tumor**

-Pyeloplasty (dismembered***, spiral flap***, vertical flap**)

-Ureteroneocystostomy (Cohen***, Polatino-Leadbetter*, Lich***, n   Gilvernet**,Glenn-Anderson**, Fish-mouth refluxing for kidney      transplantation***)

-Herniotomy***

-Orchiopexy***

-Retroperitoneal varicocelectomy***

-Circumcision and revision of circumcision***

-Ileocystoplasty***

-Ureterocystoplasty***

 

  • Endourology:

 

-Cystourethroscopy***

-Percutaneous nephrolithotomy***

-TUNA of the prostate*

-TUV of the prostate***

-TUR of the prostate***

-Incision of adult and pediatric ureterocele***

-Percutaneous endopyelotomy***

-Direct vision internal urethrotomy***

-Cystolitholapaxy***

-TUL***

-Percutaneous access to the kidney***

-TUR of the bladder tumor***

-TUR of the ejaculatory ducts***

-TUR of the bladder neck***

-PUV ablation***

-Incision of ureteric stricture***

-Incision of bladder neck contracture***

 

  • Infertility:

 

-Vasovasostomy***

-Testicular biopsy***

-Vasectomy (NSV method and conventional methods)***

-Exploration of the vasa defrentia for vasography (Is doing in Radiology Department, yet)***              

-Varicocelectomy (subinguinal***, inguinal***, retroperitoneal***)

 

  • Kidney, Ureter & retroperitoneum:

 

-Adrenalectomy for adrenal tumor***

-Drainage of nephric, perinephric and paranephric abcess***

-Nephrolithotomy in the horseshoe kidney***

-Kidney transplantation*

-Transposition of the left renal vein (Nut-Cracker syndrome)*

-Open drainage of huge retroperitoneal recurrent lymphocele***

-Partial nephrectomy of upper moiety***

-Partial nephrectomy for large calyceal diverticulum***

-Partial nephrectpomy for RCC***

-Bilateral nephrectomy of huge ADPCKD (pre-transplantation)***

-Nephrectomy of very huge MCDK***

-Simple nephrolithotomy***

-Anatrophic nephrolithotomy***

-Open drainage of different type of renal cyst***

-Simple pyelolithotomy***

-Extended pyelolithotomy***

-Nephrectomy of XGPN***

-Ureterolithotomy (proximal***, middle***, and distal***)

-Ureteroureterostomy***

-Transureteroureterostomy***

-Ureteral tapering (megaureter)***

-Open retropritoneal biopsy (IRF)***

-Repair of ruptured renal artery (Iiatrogenic)**

-Ureterocalycostomy***

 

  • Reconstructive urology and urinary diversion:

 

-Male to female transsexual surgery*

-Vaginoplasty using sigmoid colon*

-Reconstruction of ambigouos genitalia and orchiopexy*

-Orthotopic urinary diversion*

-Augmentation cecocystoplasty***

-Augmentation ileocystoplasty***

-Ureterocystoplasty***

-Ureterosigmoidostomy**

-Ileal conduit***

-Ileal reservoir (Kock pouch)**

-Indiana pouch*

-Ileocecal urinary diversion with Mitrofanoff continent stoma***

-Urethroplasty (MAGPI***, Snodgrass or TIP***, Matheiu**, Ducket***, Two-staged*,buccal mucosal graft*)

-Urethroplasty with release of chordee**

-Perineal urethroplasty of urethral distraction injury**

-Transpubic urethroplasty*

 

  • Uro-oncology:

 

-Radical retropubic prostatectomy**

-Radical cystoprostatectomy***

-Female anterior pelvic exentration***

-Radical nephrectomy***

-Radical nephroureterectomy***

-Male and female urethrectomy for TCC***

-Radical inguinal orchiectomy***

-RPLND***

 

  • Trauma & urology emergencies:

 

-Orchiopexy for torsion of the spermatic cord***

-Open cystostomy***

-Distal ureteroneocystostomy and psoas hitch (gunshot)**

-Repair of grade III/IV kidney trauma***

-Partial nephrectomy for kidney trauma***

-Nephrectomy of shuttered kidney***

-Repair of penetrating kidney truma (stab wound*** and gunshot***)

-Repair of bladder rupture***

-Primary realignment of posterior urethral rupture***

-Percutaneous cystostomy (with trocath)***

-Repair of the corpora cavernosa (penile fracture)***

-Repair of the urethra and copora cavernosa (shotgun)***

-Repair of tunica albugina of the testis***

-Orchiectomy of shuttered testis***

-Percutaneous drainage of pyonephrosis***

-Nephrectomy of emphysematous pyelonephritis***

 

  • Female urology:

 

-MMK colposuspention*

-Trans-vaginal tape*

-Trans-obturator tape*

-Pubovaginal facial sling***

-Repair of vesicovaginal fistula***

-Excision of peri-urethral cyst***

-Excision of urethral diverticulum***

-Excision of urethral prolaps**

 

 

 

 

     9- Laparascopic surgery (L.):

 

-L. Varicocelectomy*

-L. Simple nephrectomy*

-L. Drainage of renal cyst*

-L. Orchiopexy*

-L. Inguinal herniorrhaphy*

-L. Drainage of seminal vesicle cyst*

-L. Adrenalectomy*

-L. Cholecystectomy*

 

  • Bladder & Urethra:

 

-Partial cystectomy***

-Simple cystectomy***

-Open cystolithotomy***

-Meatoplasty***

-Excision of benign penile mass***

-Urethrolithotomy***

 

  • Prostate & Testes:

 

-Simple transvesical prostatectomy***

-Simple retropubic prostatectomy***

-Hydrocelectomy***

-Adult orchiopexy***

-Denervatin of the spermatic cord for chronic orchialgia***

-Epidydimectomy for post-vasectomy chronic orchialgia***

-Inntratunical orchiectomy for hormonal ablation***

 

  • Penile surgery:

 

-Arterialization of deep dorsal vein of the penis*

-Excsion of Peyronie's plaque and dermal graft**

-Distal El-Ghorab spongiocavernosal shunt***

-Correction of chordee (Nesbit and dorsal placation)***

 

  • Miscellaneous:

 

-Male facial sling*

-Resection of large perineal rhabdomyosarcoma**

-Extensive dranaige of Fornier's gangerene***

-Perineal urethrostomy (BXO)***

 

14-General surgery:

-Spelenectomy*

-Repair of ruptured IVC (trauma)**

-Adrenalectomy**

 

-Apendectomy**

-Repair of rectal injury**

-Colostomy*

-Ileostomy*

-Compelete pelvic exentration*

-Inguinal herniorrhaphy and herniotomy***

 

 

 

 

 

[1]

Al-Kohlany, K., Baker, K., Ahmed, F., Mohamed, M., Alshami, M., & Badheeb, M. (2023). Treatment outcome of Fournier’s gangrene and its associated factors: A retrospective study. Archivio Italiano Di Urologia E Andrologia, 95(2). https://doi.org/10.4081/aiua.2023.11318

Copyright (c) 2023 the Author(s)

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