Prognostic Factors and Outcome of Treatment in Patients With Fournier's Gangrene in a Tertiary Institution in Nigeria.

Abstract

ABSTRACT

Objective: Fournier's gangrene is an extreme life threatening Urological condition. The objective of this study
was to identify the prognostic factors and outcome of treatment in patients with Fournier's gangrene in a tertiary institution in South East Nigeria. Methodology: This was a prospective study of 21 (twenty one) male patients diagnosed with Fournier's gangrene in our hospital, from June 2012 to June 2019. History and comprehensive physical examination as well as resuscitatory measures were commenced at the emergency units and continued through the wards. Laboratory investigations were conducted. Patients were assessed using Fournier's gangrene severity index scoring system FGSI. Extent of tissue involvement was assessed during debridement within 24 hours of presentation. Definitive treatment measures were commenced, and patients followed up till discharge. Performance status at discharge was assessed. Data generated were analysed using SPSS version 23 (IBM STATISTICS) Results: The mean age of the patients was 56years ± 13.3 (range of 22 to 78years). The peak age incidence was in the 60th decade. The commonest systemic predisposing factor was diabetes mellitus (23.8%) as a single independent etiologic factor, and 71.4% in combination with other systemic predisposing factors. Two patients (9.5%) were obese, diabetic, and presented with anal abscess. No systemic predisposing factor was identified in 4 patients (19.1%). Four patients (19.1%) had bladder outlet obstruction secondary to urethral stricture disease, and has had attempts at urethral catheterization. Four patients (19.1%) had ischio- rectal abscess, while two patients (9.5%) had scrotal injuries from trauma. Fever, malodorous scrotal swelling, anaemia and shock were the common clinical features. Scrotal gangrene was seen in 10 patients (47.6%), scroto-perineal gangrene in 6 patients (28.5%), scroto-abdominal gangrene in 4 patients (19.1%), while only one patient (4.8%) had scroto-penile gangrene. The mean FGSI score at presentation was 7.0 ± 4.0. The mean hospital stay was 52 days ± 45 (range 3 - 210 days). Following debridement, the testes were exposed in 12 patients. Mean performance status at discharge was 1.4. Three mortalities were recorded, and all had diabetic ketoacidosis with mean FGSI score of 10 at presentation. Conclusion: Complicated diabetes mellitus and poor FGSI scores are major predictors of mortality in patients with Fournier's gangrene. Proper and aggressive management protocol gives good outcome.