Advertisement

Presentation and Diagnosis of Fournier Gangrene

Published:November 13, 2017DOI:https://doi.org/10.1016/j.urology.2017.10.031
      Necrotizing fasciitis is a severe type of necrotizing soft tissue infection involving the superficial fascia and subcutaneous tissues. Fournier gangrene, a type of necrotizing fasciitis, affects the genitalia or perineum. Although a rare health condition, Fournier gangrene can result in significant morbidity and unnecessary mortality following delay in diagnosis and management. We provide a review of relevant presenting features to aid diagnosis and allow timely surgical management of this serious infectious condition.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Fournier J.A.
        Gangrene foudroyante de la verge [over-whelming gangrene].
        Semin Med. 1883; 3: 345-347
        • Baurienne H.
        Sur une plaie contuse qui s'est terminee par le sphacele de la scrotum.
        J Med Chir Pharm. 1764; 20: 251-256
        • Wilson B.
        Necrotizing fasciitis.
        Am Surg. 1952; 18: 416-431
        • Jones J.
        Investigation upon Nature, Causes and Treatment of Hospital Gangrene as It Prevailed in the Confederate Armies 1861-1865.
        US Sanitary Commission, New York, NY1871
        • Eke N.
        Fournier's gangrene: a review of 1726 cases.
        Br J Surg. 2000; 87: 718-728
        • Sorensen M.D.
        • Krieger J.N.
        • Rivara F.P.
        • et al.
        Fournier's gangrene: population based epidemiology and outcomes.
        J Urol. 2009; 181: 2120-2126
        • Osbun N.
        • Hampson L.A.
        • Holt S.K.
        • et al.
        Low-volume vs high-volume centers and management of Fournier's gangrene in Washington State.
        J Am Coll Surg. 2017; 224 (e271): 270-275
        • Misiakos E.P.
        • Bagias G.
        • Patapis P.
        • et al.
        Current concepts in the management of necrotizing fasciitis.
        Front Surg. 2014; 1: 36
        • Kim S.Y.
        • Dupree J.M.
        • Le B.V.
        • et al.
        A contemporary analysis of Fournier gangrene using the National Surgical Quality Improvement Program.
        Urology. 2015; 85: 1052-1056
        • Tang L.M.
        • Su Y.J.
        • Lai Y.C.
        The evaluation of microbiology and prognosis of Fournier's gangrene in past five years.
        Springerplus. 2015; 4: 14
        • Aridogan I.A.
        • Izol V.
        • Abat D.
        • et al.
        Epidemiological characteristics of Fournier's gangrene: a report of 71 patients.
        Urol Int. 2012; 89: 457-461
        • Malik A.M.
        • Sheikh S.
        • Pathan R.
        • et al.
        The spectrum of presentation and management of Fournier's gangrene—an experience of 73 cases.
        J Pak Med Assoc. 2010; 60: 617-619
        • 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: 173-179
        • Ayan F.
        • Sunamak O.
        • Paksoy S.M.
        • et al.
        Fournier's gangrene: a retrospective clinical study on forty-one patients.
        ANZ J Surg. 2005; 75: 1055-1058
        • Czymek R.
        • Hildebrand P.
        • Kleemann M.
        • et al.
        New insights into the epidemiology and etiology of Fournier's gangrene: a review of 33 patients.
        Infection. 2009; 37: 306-312
        • Ulug M.
        • Gedik E.
        • Girgin S.
        • et al.
        The evaluation of microbiology and Fournier's gangrene severity index in 27 patients.
        Int J Infect Dis. 2009; 13: e424-e430
        • Backhaus M.
        • Citak M.
        • Tilkorn D.J.
        • et al.
        Pressure sores significantly increase the risk of developing a Fournier's gangrene in patients with spinal cord injury.
        Spinal Cord. 2011; 49: 1143-1146
        • Wroblewska M.
        • Kuzaka B.
        • Borkowski T.
        • et al.
        Fournier's gangrene—current concepts.
        Pol J Microbiol. 2014; 63: 267-273
        • Morris Jr, M.W.
        • Aru M.
        • Gaugler A.
        • et al.
        Necrotizing fasciitis of the perineum associated with a Bartholin abscess.
        Surg Infect (Larchmt). 2014; 15: 131-133
        • Lin W.T.
        • Chao C.M.
        • Lin H.L.
        • et al.
        Emergence of antibiotic-resistant bacteria in patients with Fournier gangrene.
        Surg Infect (Larchmt). 2015; 16: 165-168
        • Giuliano A.
        • Lewis Jr, F.
        • Hadley K.
        • et al.
        Bacteriology of necrotizing fasciitis.
        Am J Surg. 1977; 134: 52-57
        • Hakkarainen T.W.
        • Kopari N.M.
        • Pham T.N.
        • et al.
        Necrotizing soft tissue infections: review and current concepts in treatment, systems of care, and outcomes.
        Curr Probl Surg. 2014; 51: 344-362
        • Jain D.
        • Kumar Y.
        • Vasishta R.K.
        • et al.
        Zygomycotic necrotizing fasciitis in immunocompetent patients: a series of 18 cases.
        Mod Pathol. 2006; 19: 1221-1226
        • Goh T.
        • Goh L.G.
        • Ang C.H.
        • et al.
        Early diagnosis of necrotizing fasciitis.
        Br J Surg. 2014; 101: e119-e125
        • Kaufmann J.A.
        • Ramponi D.
        Recognition of risk factors and prognostic indicators in Fournier's gangrene.
        Crit Care Nurs Q. 2015; 38: 143-153
        • Wong C.H.
        • Khin L.W.
        • Heng K.S.
        • Tan K.C.
        • Low C.O.
        The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections.
        Crit Care Med. 2004; 32: 1535-1541
        • Schuster L.
        • Nunez D.E.
        Using clinical pathways to aid in the diagnosis of necrotizing soft tissue infections synthesis of evidence.
        Worldviews Evid Based Nurs. 2012; 9: 88-99
        • Bozkurt O.
        • Sen V.
        • Demir O.
        • et al.
        Evaluation of the utility of different scoring systems (FGSI, LRINEC and NLR) in the management of Fournier's gangrene.
        Int Urol Nephrol. 2015; 47: 243-248
        • Laor E.
        • Palmer L.S.
        • Tolia B.M.
        • et al.
        Outcome prediction in patients with Fournier's gangrene.
        J Urol. 1995; 154: 89-92
        • Levenson R.B.
        • Singh A.K.
        • Novelline R.A.
        Fournier gangrene: role of imaging.
        Radiographics. 2008; 28: 519-528
        • Anaya D.A.
        • Dellinger E.P.
        Necrotizing soft-tissue infection: diagnosis and management.
        Clin Infect Dis. 2007; 44: 705-710