https://doi.org/10.4081/aiua.2025.13207

Enhanced patient recovery with early extensive surgical deb-ridement in Fournier's Gangrene: evaluation of perioperative outcomes in a multicentric experience

Authors

Giovanni Cochetti
Department of Medicine and Surgery, Urology Clinic, University of Perugia, Italy.
Alessio Paladini
Department of Medicine and Surgery, Urology Clinic, University of Perugia, Italy.
Luca Lepri
Department of Medicine and Surgery, Urology Clinic, University of Perugia, Italy.
Andrea Vitale
andrea.vitale69@yahoo.it
https://orcid.org/0009-0002-9567-8780
Department of Medicine and Surgery, Urology Clinic, University of Perugia, Italy.
Raffaele La Mura
https://orcid.org/0009-0001-1873-4032
Department of Medicine and Surgery, Urology Clinic, University of Perugia, Italy.
Miriam Russo
Department of Medicine and Surgery, Urology Clinic, University of Perugia, Italy.
Paolo Mangione
Department of Medicine and Surgery, Urology Clinic, University of Perugia, Italy.
Matteo Mearini
Department of Medicine and Surgery, Urology Clinic, University of Perugia, Italy.
Andrea Fabiani
https://orcid.org/0000-0003-1781-0889
Surgery Department, Urology Unit, Macerata Civic Hospital, Area Vasta 3 Asur Marche, Macerata, Italy.
Emanuele Iacobone
https://orcid.org/0000-0002-1508-0651
Surgery Department, Urology Unit, Macerata Civic Hospital, Area Vasta 3 Asur Marche, Macerata, Italy.
Lucilla Servi
Surgery Department, Urology Unit, Macerata Civic Hospital, Area Vasta 3 Asur Marche, Macerata, Italy.
Ettore Mearini
Department of Medicine and Surgery, Urology Clinic, University of Perugia; Department of Medicine and Surgery, Urological Andrological Surgery and Minimally Invasive Techniques Unit, S. Maria Hospital, University of Perugia, Terni, Italy.
Michele Del Zingaro
Department of Medicine and Surgery, Urology Clinic, University of Perugia, Italy.

Objective: Fournier's gangrene (FG) is a rare, life-threatening necrotizing fasciitis primarily affecting the perineal, genital, and perianal regions. This rapidly progressing bacterial infection predominantly affects middleaged and elderly men. This multicenter study aims to describe the management in a wide cohort of Fournier's gangrene cases that presented to three tertiary centers with early extensive surgical debridement.
Materials and Methods: We retrospectively collect data from patients with FG who were referred to the Urology Clinic of the Department of Medicine and Surgery (Perugia), the Urological Andrological Surgery and Minimally Invasive Techniques Unit (Terni) of the University of Perugia, and the Urology Unit of the Surgery Department of the Macerata Civic Hospital between January 2019 and March 2024 for onset of classic signs and symptoms of FG. Extensive surgical debridement was immediately performed under general anesthesia to reach normochromic and vascularized tissue in wide and depth extension, assuring vital and healthy margins. For all patients, intravenous daptomycin plus piperacillin/tazobactam were administered.
Results: 28 male patients with FG underwent early surgical debridement. In two cases, orchidectomy and partial penectomy were required during surgical debridement due to extensive necrosis. Colon diversion and urinary diversion were not necessary for any of the patients. 32.1% complications were recorded according to the Clavien Dindo classification; 6 patients died in the perioperative. Excluding death data, the average duration of antibiotic therapy was 22.0±9.1 days, and the average length of stay was 17.6±11.8 days.
Conclusions: Fournier's gangrene has high mortality rates. It requires timely surgical debridement and antibiotic therapy to achieve positive outcomes. This study shows that a primary extensive debridement can help reduce the need for further intervention and shorten the hospital stay.

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How to Cite

Cochetti, G., Paladini, A., Lepri, L., Vitale, A., La Mura, R., Russo, M., Mangione, P., Mearini, M., Fabiani, A., Iacobone, E., Servi, L., Mearini, E., & Del Zingaro, M. (2025). Enhanced patient recovery with early extensive surgical deb-ridement in Fournier’s Gangrene: evaluation of perioperative outcomes in a multicentric experience. Archivio Italiano Di Urologia E Andrologia. https://doi.org/10.4081/aiua.2025.13207
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