Outcome analysis in patients with primary necrotizing fasciitis of the male genitalia

Objectives. To characterize patients with primary necrotizing fasciitis of the male genitalia (Fournier's gangrene) and to identify risk factors and p rognostic variables of survival. Methods. Fifty consecutive patients with primary necrotizing fasciitis of t he male genitalia treated at our institution during a 15-year period betwee n 1984 and 1998 were retrospectively analyzed. Of these patients, 44 (88.0% ) were found to be eligible for analysis of the outcome parameters. Univari ate survival analysis was performed using the Kaplan-Meier algorithm follow ed by multivariate analysis of statistically significant variables. Six pat ients (12.0%) who were severely immunocompromised were studied separately. Results. Medical comorbidities were prevalent, with diabetes being the most common condition (50%). The overall mortality rate was 20% (10 of 50). Thr ee statistically significant predictors of outcome were identified among th e variables analyzed. These were the extent of the infection (P = 0.0262), the depth of the necrotizing infection (P = 0.0107), and treatment with hyp erbaric oxygen (P = 0.0115). Multivariate regression analysis of these vari ables identified the extent of the infection (P = 0.0234) as the only stati stically significant, independent predictor of outcome in the presence of o ther covariables. Conclusions, The involved body surface area appears to be the most importan t prognostic variable, with a significant impact on outcome. Given the high mortality of the disease entity and a trend toward the improved survival o f patients receiving hyperbaric oxygen, this treatment form appears indicat ed in more severe cases. Immunocompromised patients, who frequently have an atypical and fulminant clinical course, appear to constitute a separate gr oup with a dismal prognosis. UROLOGY 56: 31-36, 2000. (C) 2000, Elsevier Sc ience Inc.