title: Fournier gangrene: our approach and patients.
abstract: OBJECTIVE
  This retrospective analysis presents our experience in treating Fournier gangrene (FG) and aims to bring in focus diagnostic and therapeutic problems as well as early and aggressive treatment.
  
  
  METHODS
  A total of 16 male patients were included in the study. The gastrointestinal form was seen in 5 and the urogenital form in 11 patients. The subjects ranged in age from 39 to 74 years (average 61) for the urogenital, and from 48 to 72 (average 58) for the gastrointestinal form. Other conditions were seen in 9 patients (diabetes mellitus was most common). Most patients were infected with several bacteria. We performed colostomy in 1 patient, orchidectomy in 2 patients, cystostomy in 2 patients and penis amputation in 1 patient. Ultrasound-guided biopsy or aspiration, and CT was also used. Aggressive surgical necrectomy and aggressive antimicrobial therapy was used.
  
  
  RESULTS
  Treatment was successful in 14 of 16 patients (87.5%). The length of hospitalization was 19-58 days (average 48) for the urogenital form and 24-56 days (average 41) for the gastrointestinal form. Mortality was 12.5%. A lethal outcome was recorded in two patients infected with methicillin-resistant Staphylococcus aureus. The average time between onset and hospitalization was 3-11 days (5 on average) for urogenital FG and 4-10 days (average 6) for gastrointestinal FG. Treatment was significantly longer in patients with a comorbidity, such as diabetes or liver cirrhosis due to alcohol abuse.
  
  
  CONCLUSIONS
  Early diagnosis as well as intensive and aggressive treatment are key to successful treatment of FG. Comorbidity increases length of therapy and lowers the chance for recovery. Disease can be seen again several years after the initial outburst.
authors.affiliation: Department of Surgery, County Hospital Pozega, Pozega, Croatia.
authors.forename: Josip
authors.initials: J
authors.lastname: Fajdic
authors.forename: Nikola
authors.initials: N
authors.lastname: Gotovac
authors.forename: Zlatko
authors.initials: Z
authors.lastname: Hrgovic
mesh_terms: D000328:Adult; D000368:Aged; D018934:Fournier Gangrene / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D008297:Male; D052801:Male Urogenital Diseases / Q000175:diagnosis / Q000473:pathology; D055624:Methicillin-Resistant Staphylococcus aureus / Q000378:metabolism; D008875:Middle Aged; D009336:Necrosis; D011379:Prognosis; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000401:mortality; D016896:Treatment Outcome