Fournier Gangrene Following Iatrogenic Urethral Trauma

Abstract

Objectives: To assess outcome of 17 patients with Fournier gangrene due to iatrogenic urethral trauma after aggressive treatment. Materials and Methods: Record of patients with Fournier gangrene due to iatrogenic urethral trauma was reviewed retrospectively between Jan 2000 to Dec 2007 in Department of Urology Services Hospital, Lahore.  Etiology, duration of injury, extent of involvement, management, hospital stay and course of rehabilitation were evaluated. Results: Seventeen patients were identified. Mean age of the patients was 43.5 years. Mode of urethral injury included traumatic catheterization (9 cases), traumatic bougienage (6 cases) and urological endoscopy (2 cases). Mean time interval between injury and presentation in the hospital was 7.14 days (range 1-30 days).  All patients were treated with broad spectrum antibiotics,  suprapubic  cystostomy and multiple sessions of debridement (mean 3.07).  Mean hospital stay was 21.3 days and mean time taken for rehabilitation of urethra and skin cover was 16.5 weeks.  Optical urethrotomy was required in 11 patients, end to end urethral anastomosis in four and perineal urethrostomy in one patient. Bilateral orchiectomy was done in two and penectomy in one patient. Five patients required skin grafting.  Conclusion: Urethral trauma due to transurethral manipulations may lead to Fournier gangrene.  Patients usually present late in our set up.  Multidisciplinary approach towards management including aggressive repeated sessions of debridement can improve survival.  Rehabilitation takes a long course. Measures should be taken to prevent iatrogenic urethral injury.