Urologic implications of necrotizing fasciitis

Necrotizing fasciitis of the perineum or Fournier's gangrene is a well-described, uncommon, life-threatening infection. Optimal treatment involves early recognition of the infectious process, an understanding of the relevant anatomy, aggressive operative debridement, implementation of broad-spectrum antibiotics, and ultimately, the provision of tissue coverage. Although lower gastrointestinal tract disease is responsible for the majority of instances of Fournier's gangrene, multiple organ systems can be involved with the rapidly progressive infectious process. The urologic considerations of Fournier's gangrene include debridement of the scrotum, preservation of the testis, tissue coverage of the scrotum and penis, and discussion of the role of suprapubic urinary drainage. A well-formulated preoperative plan regarding the care of the genitourinary tract is helpful in the care of these very ill patients. Copyright (C) 2000 by W.B. Saunders Company.