Benchekroun A, Lachkar A, Bjijou Y, Soumana A, Faik M, Marzouk M, Belahnech Z, Farih M H
Clinique Urologique A, CHU Ibn Sina, Rabat, Maroc.
J Urol (Paris). 1997;103(1-2):27-31.
Gangrène of the male external genitalia (GMEG) is characterized by necrotizing cell evolving toward necrotizing of the soft tissues of the male genitalia and possibly death. The cause may be primary infection called Fournier's gangrene (5%) or secondary infection (95%) due to general or local factors. GMEG is a real urinary emergency because of its local and general complications which lead to death in 20% of cases. Precocious and massive antibiotherapy, a surgery to unbridle and possibly reanimation, oxygenotherapy, urinary diversion or colostomy, are required. We have treated 55 men with this affection from january 1988 to may 1996. Mean age was 58 years (range 20 to 85). The prodromial period was about 12 days. Toxi-infectious shock was noted in 8 patients (14%). Six patients (10%) developed renal acute insufficiency. Lesions were localized to the male external genitalia in 24 cases and stretched to the inguinalis, to the abdomen or to the thorax in 34 patients. The cause was a stricture of urethra in 23 cases (41%) diabetes in 18 cases (32%), anal abscess in 7 cases (13%). No etiology was found in 6 cases (10%). Emergency treatment involved three antibiotics, surgery to unbridle necrotizing tissue in all patients, reanimation in 20 patients (35%), oxygenotherapy in 4 patients (7%), colostomy in 2 cases and urinary drainage in 23 patients (42%). Free skins grafts were necessary in 6 patients (10%), 5 patients (9%) died due to septic shock. On the basis of these observations and a review of the literature, we analyzed the ethiopathogenic, bacteriological and therapeutic aspects of this affection marked by high mortality in spite of therapeutic progress.
男性外生殖器坏疽（GMEG）的特征是细胞坏死，进而发展为男性生殖器软组织坏死，甚至可能导致死亡。其病因可能是原发性感染，即福尼尔坏疽（5%），也可能是由全身或局部因素引起的继发性感染（95%）。由于GMEG会引发局部和全身并发症，导致20%的病例死亡，因此它是一种真正的泌尿系统急症。需要尽早进行大量抗生素治疗、解除坏死组织的手术以及可能的复苏治疗、氧疗、尿液改道或结肠造口术。1988年1月至1996年5月，我们共治疗了55例患有这种疾病的男性患者。平均年龄为58岁（范围为20至85岁）。前驱期约为12天。8例患者（14%）出现感染性休克。6例患者（10%）发生急性肾功能不全。24例患者的病变局限于男性外生殖器，34例患者的病变扩展至腹股沟、腹部或胸部。病因包括尿道狭窄23例（41%）、糖尿病18例（32%）、肛门脓肿7例（13%）。6例（10%）未发现病因。紧急治疗包括使用三种抗生素，所有患者均接受了解除坏死组织的手术，20例患者（35%）接受了复苏治疗，4例患者（7%）接受了氧疗，2例患者进行了结肠造口术，23例患者（42%）进行了尿液引流。6例患者（10%）需要进行游离皮片移植，5例患者（9%）因感染性休克死亡。基于这些观察结果并结合文献回顾，我们分析了这种疾病的发病机制、细菌学和治疗方面，尽管治疗取得了进展，但该疾病的死亡率仍然很高。
