Jozef Marenčák
Background: Fournier’s gangrene (FG) is a rare but life – threatening disease challenging the treating medical staff. In recent years, several authors reported an effort to create an index severity of symptoms and signs – i.e. FGSI (Fournier’s Gangrene Severity Index) score, which may have prognostic value for the affected individuals. Objective: Retrospective evaluation of own group of patients with FG with respect to FGSI score. Material and methods: 17 men [mean age 68 years (57-83)] with FG were hospitalised in the Department of Urology in Hospital with policlinic Skalica in a period from 1 Jan 1986 to 31 Dec 2012. Diagnosis: history, assessment of potential risk factors for development FG, analysis of symptoms and signs, clinical and physical examination, laboratory tests – especially repeated sampling for bacterial examination and culture (urine, swabs, blood culture, and so on), imaging studies (mainly ultrasonography) and other. Treatment: derivation of urine (usually epicystostomy), antimicrobial therapy (combined, parenteral), intravenous hydration, metabolic and hemodynamic stabilisation, local treatment, symptomatic (mainly analgesic) therapy, patient isolation, and so on. Results: Probable aetiology and possible predisposing factors of FG: decreased immunity in 9/17, new onset/poorly controlled diabetes mellitus also in 9/17, local trauma in 6/17, and periurethral / perianal infection in 5/17, with no evidence of linkages in only one patient of this group. Most of 14/17 (82.4 %) affected had more than one possible inducing factor. Antisocial living was noted in 7/17 (41.2 %). The most common symptoms/signs at reception: swelling, redness and tension in the affected area in 6/17, severe pain and fever (> 38 °C) in 4/17 and the apparent presence of necrosis + sepsis in 4/17. 23.5 % (4/17) of patients died from sepsis (4 to 14 days after hospitalisation), 76.5 % (13/17) survived [average length of stay in hospital 27 days (21-52)]. In 12/13 (92.3 %) of survived men it was necessary to perform a secondary surgical reconstruction of local defect. FGSI was evaluable retrospectively in 15/17 (82.4 %) of patients: 6 from 15 (40 %) had FGSI score above 10 (3 men died); 9 from 15 (60 %) had FGSI less than 10 (in this subset only one man died). Conclusions: Duration (interval) from the start of clinical difficulties (symptoms) to the hospitalisation was too long (6.7 days on average). From men with FGSI score above 10 a half (50 %) died compared with patients with FGSI < 10, where only one affected patient (11.1 %) died. Rapid diagnosis and immediate, intense local and general treatment are crucial for a betterprognosis of individuals with FG. FGSI is a useful tool to evaluate the prognosis of patients with FG.