Fournier's gangrene in men: symptoms, diagnosis, treatment
Fournier's gangrene is a serious urological disease, which is accompanied by rapidly progressive skin necrosis in the genital area. Synonyms - phlegmon of the perineum, idiopathic gangrene of the scrotum, gangrenous scrotum. The causes of Fournier's gangrene are still poorly understood. Doctors include the following as provoking factors:
- reduction of general and local immunity;
- infectious diseases of the scrotal organs;
- disruption of blood supply;
- injuries of the scrotum;
- diabetes, alcoholism;
- anal fissures and abscesses;
- insufficient personal hygiene.
Secondary provoking factors - genital tattoos, enemas with steroid drugs.
Fournier's gangrene in women is extremely rare.
Pathogenesis of the disease
At the initial stage, inflammation develops, which provokes the process of thrombus formation. Small lymphatic vessels, which are densely penetrated by the scrotum, are very quickly filled with small thrombi. The result is thrombosis of the venous and lymphatic vessels of the scrotum, which is accompanied by swelling that presses on the arterial trunks. Since the arterial network is poorly developed, the tissues of the scrotum very quickly "feel" the lack of oxygen. Blood flow in swollen tissues slows down, ischemia develops and, as a result, necrosis.
Symptoms of Fournier gangrene
To the early manifestations of the disease, experts include symptoms of general intoxication: headache and muscle pain, chills, temperature rise to 38 degrees, decreased (absence) of appetite. As the disease progresses, the patient begins to complain of pain in the perineum and redness of the scrotum.
Characteristic symptoms for Fournier's gangrene:
- swelling of tissues in the scrotum region;
- local increase in temperature;
- pain when palpating the scrotum;
- pain during ejaculation;
- presence of crepitation (in case of anaerobic infection).
As a rule, the swelling grows quite quickly and the scrotum increases in size, becomes tense and extremely painful. The swelling spreads to the penis, perineum and pubis. Due to pronounced swelling, the soft tissues of the penis can squeeze the urethra and provoke the development of acute urinary retention.
In parallel with Fournier's gangrene, men may develop lymphangitis and lymphadenitis.
Diagnosis of the disease
In the later stages, the diagnosis is made after a physical examination of the patient. A number of additional examinations are recommended for staging during early treatment, which include:
- general analysis of blood and urine;
- research for the causative agent;
- X-ray of pelvic organs;
- Ultrasound of the testicles;
- histological examination of affected tissues.
Differential diagnosis of pathology is carried out with such diseases as balanitis, inguinal lymphogranulomatosis, syphilis and diabetic vulvitis.
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Treatment of Fournier's gangrene
The mainstay of treatment is emergency removal of necrotic tissue followed by drainage and powerful antibiotic therapy. The doctor will tell you more about the surgery for Fournier's phlegmon during the consultation.
After the operation, detoxification therapy, hemosorption, plasmapheresis, and ultrasonography of blood are carried out. If the cause of the disease was an anaerobic infection, it is advisable to carry out oxybarotherapy. Treatment of Fournier's gangrene should be comprehensive.
Prognosis of the disease. With early diagnosis and timely treatment, the prognosis is favorable. With the rapid spread of the process after complex therapy, extensive tissue scarring may occur, the result of which will be a minor cosmetic defect. The mortality rate for Fournier's disease is quite high - from 10 to 45%. The reason is untimely seeking medical help.
Preventive measures. Daily personal hygiene of the external genitalia will prevent the development of infection, which is one of the main causes of suppuration of gangrenous scrotum. In addition, doctors recommend creating such conditions that after each visit to the toilet it is possible to wash the external genitalia and the area around the anus with water. This is argued by the fact that in Muslims who use ablution, and not toilet paper, Fournier's disease is diagnosed very rarely.
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