BACKGROUND: Fournier's gangrene is necrotizing fasciitis of the genitalia, perineal and perianal region associated with a significant mortality rate. The potentially fatal disease is caused both by aerobic and anaerobic bacteria and primarily occurs in men. The majority of Fournier's gangrene cases is idiopathic or derived from perineal and genital skin infections. Early surgical debridement of necrotic tissues and antibiotics are fundamental. CASE: We report a rare case of Fourniers gangrene of a 57-year-old man secondary to circumcision. The patient presented due to painful swelling of the scrotum and perineum associated with high-grade fever. The patient received broad-spectrum antibiotics and underwent immediate surgical debridement; a total of five other debridements were performed during the recovery until the wounds healed. On a second recovery phase, we performed a penile reconstruction with full thickness skin graft with satisfactory cosmetic and functional results. CONCLUSION: FG remains an urgent condition associated with a high mortality rate, requiring immediate treatment. More statistical reports and standard guidelines are necessary to improve the rate of its survival.
- Klíčová slova
- Fournier’s gangrene, necrotizing fasciitis, penile reconstruction, surgical debridement,
- MeSH
- cirkumcize u mužů * MeSH
- Fournierova gangréna * etiologie chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- perineum MeSH
- skrotum chirurgie MeSH
- transplantace kůže MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
UNLABELLED: Acute scrotum (AS) is a clinical syndrome, in which authors indicate a surgical exploration of the scrotum. We retrospectively analyzed the group of 354 patients in 10 years (1997-2006) to compare the preoperative findings with the diagnosis of surgical exploration. The aim was to actualize diagnostics and therapeutic management. PATIENTS AND METHODS: We focused on the age of patients, incidence of nosological units of AS and preoperative and surgical diagnosis. RESULTS: 334 boys were operated on from the whole group - 354 patients. Most frequent incidence of AS was in the age group 8-12 (55%). Torsion of testicular appendix or epididymis is the most frequent cause of AS in our group - 204, 59%. In this group of patients ultrasound confirmed the diagnosis only in 120 patients, 65%. Testicular torsion was managed in 74 boys (30 neonates), in 40 of them we decided, mostly at the second look operation after 48-72 hours, for testicle ablation caused by the organ avitality. In all patients with testicular torsion ultrasound confirmed the diagnosis, 100%. In 10 boys we found testicular tumor. In the group of 334 patients operated on, there were no serious complications. DISCUSSION: Testicular torsion and tumor are the units in which the surgical exploration is performed without discussion. Beside that, torsion of the testicular or epididymic appendix is the most frequent occurring diagnosis. There is a group of surgeons, who performed in this unit conservative management. CONCLUSIONS: after the analysis of the group of our patients we actualized the guidelines used in the management of AS in children. Urgent surgical exploration in boys with AS still seems to be the method of choice.
- MeSH
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- skrotum chirurgie MeSH
- torze semenného provazce diagnóza chirurgie MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
Eight patients with male pseudohermaphroditism were treated between the years 1988-1994. They showed various physical-sexual anomalies. In 4 patients the existing penis was lengthened, the urethra was created and the split scrotum was fused. In the 4 remaining patients a new penis was created from lateral groin or abdominal tubed or skin-gracilis flaps, and made rigid by means of a silicon implant. The scrotum was reconstructed. The results were satisfying. On the basis of our own experience it may be said that the reconstruction of genitals must be planned individually, depending on the abnormalities in the physical-sexual development and the psycho-sexual orientation of the patient.
- MeSH
- chirurgické laloky metody MeSH
- dospělí MeSH
- estetika MeSH
- kosterní svaly transplantace MeSH
- křemík MeSH
- lidé MeSH
- mladiství MeSH
- penilní protézy MeSH
- penis chirurgie MeSH
- plastická chirurgie MeSH
- poruchy sexuálního vývoje chirurgie MeSH
- psychosexuální vývoj MeSH
- skrotum chirurgie MeSH
- transplantace kůže metody MeSH
- uretra chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- křemík MeSH
Postoperative hematoma and edema are the most frequent complications of scrotal surgery. The authors refer their own experience with a simple, reliable method for prevention of postoperative hematoma and edema described by Oesterling.
In the submitted paper the authors give an account of their experience with the treatment of a patient with severe scrotal hypoplasia which is a very rare inborn defect. In a group of 1403 boys operated in the last ten years on account of cryptorchism this anomaly recorded only once, i.e. in 0.071%. The authors recommend a two-stage operation. In the first stage they use a V-Y plastic operation to create a neoscrotum. In the second stage orchidopexy is performed. Collaboration with a child endocrinologist is important. The aim of endocrinological examination is not only evidence of the presence and function of the gonads by a hormonal test, but in case of associated anomalies, also the assessment of genetic, genital and gonadal sex.
- MeSH
- kojenec MeSH
- kryptorchismus chirurgie MeSH
- lidé MeSH
- metody MeSH
- skrotum abnormality chirurgie MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
- MeSH
- autologní transplantace MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mužská infertilita etiologie MeSH
- penis zranění chirurgie MeSH
- psychosomatické poruchy etiologie MeSH
- rány a poranění komplikace MeSH
- skrotum zranění chirurgie MeSH
- spermatogeneze MeSH
- transplantace kůže MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- dospělí MeSH
- lidé MeSH
- lymfedém * chirurgie MeSH
- skrotum * chirurgie MeSH
- tropické lékařství * MeSH
- urologické nemoci MeSH
- Wuchereria izolace a purifikace MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Etiopie MeSH
