Cochetti Giovanni, Paladini Alessio, Lepri Luca, Vitale Andrea, La Mura Raffaele, Russo Miriam, Mangione Paolo, Mearini Matteo, Fabiani Andrea, Iacobone Emanuele, Servi Lucilla, Mearini Ettore, Del Zingaro Michele
Department of Medicine and Surgery, Urology Clinic, University of Perugia.
Surgery Department, Urology Unit, Macerata Civic Hospital, Area Vasta 3 Asur Marche, Macerata.
Arch Ital Urol Androl. 2025 Mar 28;97(1):13207. doi: 10.4081/aiua.2025.13207. Epub 2025 Jan 30.
Fournier's gangrene (FG) is a rare, life-threatening necrotizing fasciitis primarily affecting the perineal, genital, and perianal regions. This rapidly progressing bacterial infection predominantly affects middleaged and elderly men. This multicenter study aims to describe the management in a wide cohort of Fournier's gangrene cases that presented to three tertiary centers with early extensive surgical debridement.
We retrospectively collect data from patients with FG who were referred to the Urology Clinic of the Department of Medicine and Surgery (Perugia), the Urological Andrological Surgery and Minimally Invasive Techniques Unit (Terni) of the University of Perugia, and the Urology Unit of the Surgery Department of the Macerata Civic Hospital between January 2019 and March 2024 for onset of classic signs and symptoms of FG. Extensive surgical debridement was immediately performed under general anesthesia to reach normochromic and vascularized tissue in wide and depth extension, assuring vital and healthy margins. For all patients, intravenous daptomycin plus piperacillin/tazobactam were administered.
28 male patients with FG underwent early surgical debridement. In two cases, orchidectomy and partial penectomy were required during surgical debridement due to extensive necrosis. Colon diversion and urinary diversion were not necessary for any of the patients. 32.1% complications were recorded according to the Clavien Dindo classification; 6 patients died in the perioperative. Excluding death data, the average duration of antibiotic therapy was 22.0±9.1 days, and the average length of stay was 17.6±11.8 days.
Fournier's gangrene has high mortality rates. It requires timely surgical debridement and antibiotic therapy to achieve positive outcomes. This study shows that a primary extensive debridement can help reduce the need for further intervention and shorten the hospital stay.
福尼尔坏疽（FG）是一种罕见的、危及生命的坏死性筋膜炎，主要影响会阴、生殖器和肛周区域。这种迅速进展的细菌感染主要影响中老年男性。这项多中心研究旨在描述一大群福尼尔坏疽病例的治疗情况，这些病例在三个三级中心接受了早期广泛的手术清创。
我们回顾性收集了2019年1月至2024年3月期间因出现FG典型体征和症状而转诊至佩鲁贾大学医学与外科学系泌尿外科诊所、佩鲁贾大学泌尿外科与男科学手术及微创技术科室（特尔尼）以及马切拉塔市立医院外科泌尿外科的FG患者的数据。在全身麻醉下立即进行广泛的手术清创，以达到广泛且深度延伸的正常色泽和血管化组织，确保切缘有活力且健康。所有患者均静脉给予达托霉素加哌拉西林/他唑巴坦。
28例FG男性患者接受了早期手术清创。在两例病例中，由于广泛坏死，手术清创期间需要进行睾丸切除术和部分阴茎切除术。所有患者均无需进行结肠造口术和尿流改道术。根据Clavien Dindo分类法记录的并发症发生率为32.1%；6例患者在围手术期死亡。排除死亡数据后，抗生素治疗的平均持续时间为22.0±9.1天，平均住院时间为17.6±11.8天。
福尼尔坏疽死亡率高。需要及时进行手术清创和抗生素治疗以取得良好疗效。本研究表明，初次广泛清创有助于减少进一步干预的需求并缩短住院时间。
