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  • Review Article
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A contemporary update on Fournier's gangrene

Nature Reviews Urology volume 14, pages 205–214 (2017)Cite this article

Subjects

Key Points

  • Fournier's gangrene is a rare but potentially fatal disease

  • The Fournier's gangrene severity index (FGSI) has been developed as a prognostic indicator

  • The infection is most commonly polymicrobial, but monomicrobial infections with resistant bacteria have also been described

  • Clinical tools, including laboratory tests and imaging, exist to assist in the diagnosis of the disease in equivocal cases, but if clinical suspicion of Fournier's gangrene is high, surgical treatment should not be delayed for imaging studies to be carried out

  • Fluid resuscitation, broad-spectrum antibiotic therapy, and prompt surgical debridement are key elements of the initial management of the disease

  • Genital reconstruction techniques can help with optimal functional and cosmetic outcomes after extensive genital skin loss

Abstract

Despite advances in the evaluation, treatment, and pathophysiological understanding of necrotizing soft-tissue infections, Fournier's gangrene remains a life-threatening urological emergency. Although the condition can affect patients of any age and gender, it might be more prevalent in some high-risk groups with certain comorbidities. Several prognostic and diagnostic tools have been developed to assist with clinical decision-making once the diagnosis is made — primarily based on the physician's physical exam and potentially supported by laboratory and imaging findings. Expedited treatment with resuscitation, antibiotic administration, and rapid, wide surgical debridement are key elements of the initial management. These procedures must be followed by meticulous wound care and liberal use of planned subsequent surgical debridements. Once the patient has overcome the associated systemic illness, several reconstructive options for the genitalia and perineum can be considered to improve functionality and cosmesis.

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Figure 1: Fournier's gangrene of the scrotum.
Figure 2: Pelvic CT scan of a patient with Fournier's gangrene.
Figure 3: Ultrasonography of the scrotum of a patient with Fournier's gangrene.
Figure 4: Pelvic radiography of patient with Fournier's gangrene.
Figure 5: The scrotum and testicles immediately after debridement (same patient as shown in Fig. 2).
Figure 6: Extensive debridement of the entire scrotum, penile shaft, and right flank up to the clavicle, owing to extensive progression of Fournier's gangrene.
Figure 7: Vacuum-assisted closure (VAC) system placement after split-thickness skin graft resurfacing of the penis, testes, and groin.
Figure 8: Surgical treatment of Fournier's gangrene.
Figure 9: Reconstruction after Fournier's gangrene debridement.

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  1. Department of Urology, University of Washington, 325 9th Avenue, Seattle, 98104, Washington, USA

    Judith C. Hagedorn & Hunter Wessells

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J.C.H. researched data for the article and wrote the manuscript. Both authors contributed to discussions of content and reviewed and edited the manuscript before submission.

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Correspondence to Judith C. Hagedorn.

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Hagedorn, J., Wessells, H. A contemporary update on Fournier's gangrene. Nat Rev Urol 14, 205–214 (2017). https://doi.org/10.1038/nrurol.2016.243

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