Fournier's gangrene

Fournier's gangrene is a rare but very serious polymicrobial infection of the male genitalia, leading to fasciitis and gangrene soft tissues in the area. It is ranked among the most serious conditions in urology. This is a superficial process affecting the skin of the scrotum or penis (the testicles are not affected), the perineum and perianal area may also be affected. Fournier gangrene is a disease with high mortality.

Etiology
The cause of Fournier's gangrene is a polymicrobial infection that spreads from the anorectum, urogenital tract, or external genitalia. It often arises as a result of urological or colorectal disease or surgery in these areas. It can also be the result of an external injury from prostate, urethral, ​​endoscopic, hemorrhoids or perianal fistula surgery. Predisposing factors are immunodeficiency, malnutrition, alcoholism, tumor cachexia, diabetes mellitus and other conditions leading to weakening of the organism. The cause of the infection is usually a mixed flora with a predominance of anaerobes.

Clinical picture and diagnostics
Fournier gangrene is a peracute disease. It is accompanied by fever, chills and pain in the genitals. The clinical picture includes swelling of the testicles (in advanced forms and lower abdomen) with crepitation in the subcutaneous tissue (gas-forming bacteria). Examination of the blood count shows leukocytosis, thrombocytopenia, coagulation disorders. Creatinine rises.

Therapy
If Fournier gangrene is suspected, hospitalization of the patient and intensive comprehensive treatment are indicated. Broad-spectrum antibiotics covering the entire bacterial spectrum, including aerobic and anaerobic bacteria, are immediately administered. Urgent surgical treatment with necrectomy of all gangrenous tissues, peroxide lavages, drainage, anti-inflammatory and anti-tetanus sera, and hyperbaric therapy in case of extensive penile involvement is also necessary.

Combination of antibiotics in gangrenous genital infection

 * Aminoglycosides;
 * beta-lactams (cephalosporins generation III);
 * always Metronidazole.

Forecast
The prognosis of the disease is poor. Even with immediate and aggressive therapy, Fournier's gangrene has 50% lethality''.

Related Articles

 * Acute scrotum

Used literature

 * DVOŘÁČEK, Jan. Urologie :  obecná a speciální urologie. 2. vydání. Praha : Karolinum, 1999. s. 224-225.  ISBN 80-7184-745-3.


 * HERÁČEK, Jiří a Michael URBAN, et al. Urologie pro studenty : Akutní skrotální syndrom [online] . 2.0. vydání. 2012. Dostupné také z < http://www.urologieprostudenty.cz/uploads/pdf/akutni-skrotalni-syndrom.pdf >.  ISBN 978-80-254-1859-8.

Recommended literature

 * HANUŠ, Tomáš. Urologie. 1. vydání. V Praze : Triton, 2011.  ISBN 978-80-7387-387-5.


 * MACEK, Petr a Tomáš HANUŠ. Urologie :  pro všeobecné praktické lékaře. 1. vydání. Praha : Raabe, 2011.  ISBN 9788086307855.