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Fournier’s Gangrene: A 10-Year Clinical Experience at a Tertiary Academic Medical Center
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Woo Seop Seong, Byeong Jin Kang, A Reum Kim, Kyung Hwan Kim, Hong Koo Ha
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Urogenit Tract Infect 2023;18(2):64-69. Published online August 31, 2023
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DOI: https://doi.org/10.14777/uti.2023.18.2.64
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 Abstract
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- Purpose: This retrospective study examined the factors influencing clinical outcomes and mortality in patients with Fournier's Gangrene (FG). The medical history, diagnostic procedures, treatment approaches, complications, and mortality factors associated with FG were analyzed.
Materials and Methods: This study retrospectively analyzed the medical records of 40 patients with FG treated over 10 years. The collected data included the patient demographics, comorbidities, vital signs, laboratory tests, Fournier’s Gangrene Severity Index (FGSI) scores, wound swab culture results, treatment approaches, and length of hospitalization.
Results: Among the patients with FG, diabetes mellitus and hypertension were the most common comorbidities. The hemodialysis dependence has been identified as a significant risk factor of mortality. In addition, septic shock and an FGSI >9 were associated with increased mortality. Escherichia coli was the most prevalent bacterium in wound swab cultures, and the presence of antibiotic-resistant bacteria was significantly higher in the non-survivors. Treatment involved broad-spectrum antibiotics, emergency surgical debridement, and subsequent adjustments based on culture results.
Conclusions: Early diagnosis and prompt initiation of treatment are essential for improving the outcomes of patients with FG. Hemodialysis dependency, septic shock, FGSI scores, and the presence of antibiotic-resistant bacteria are important factors associated with mortality in patients with FG. Further research will be needed to validate these findings and explore adjunctive therapies to enhance the patient outcomes and improve FG management.
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Treatment Modality of Prostatic Abscess according to Size: A Retrospective Study
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Gwon Kyeong Lee, Kyoung Ha Jang, Woo Seop Seong, Byeong Jin Kang, Kyung Hwan Kim, Hong Koo Ha
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Urogenit Tract Infect 2022;17(3):96-102. Published online December 31, 2022
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DOI: https://doi.org/10.14777/uti.2022.17.3.96
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Abstract
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- Purpose: This study aimed to determine the treatment modality for prostatic abscesses according to size.
Materials and Methods: Twenty-five patients diagnosed with prostatic abscesses were retrospectively reviewed. All patients were treated with intravenous empirical and appropriate antibiotics according to culture results. They were grouped according to the size of the prostate abscess based on computed tomography results (group A, with prostate abscess ≤2 cm, n=10; group B, with prostate abscess size >2 cm, n=15), and their treatment modality and outcomes were compared.
Results: The prostatic abscess sizes were 1.31±0.37 and 3.49±1.06 cm for groups A and B, respectively. Prostate-specific antigen, prostatic volume, and comorbidity were not significantly different (p>0.05), whereas pelvic pain was significantly different (p=0.028). There was no difference in the microorganisms isolated from urine and blood culture, empirical antibiotics, and broad-spectrum antibiotics between the two groups (p>0.05). More patients in group B underwent transurethral abscess deroofing than those in group A (p=0.040). Patients in group B had a more extended hospitalization period and intravenous antibiotics duration than those in group A (p=0.024 and p=0.013, respectively). Group B had more cases of septic shock, intensive care unit admission, and mortality events than group A (p=0.024, p=0.001, and p=0.061, respectively). However, prostatic abscess recurrence and urological chronic complication did not significantly differ (p>0.05).
Conclusions: Appropriate use of antibiotics is crucial. This study shows that the treatment of patients with prostatic abscess >2 cm is more difficult, but transurethral abscess deroofing can lower mortality, prostatic abscess recurrence, and urological chronic complications.
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Clinical Features according to Co-morbidity in Patients Visiting Emergency Room due to Acute Hemorrhagic Cystitis
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Hong Koo Ha, Sang Don Lee
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Korean J Urogenit Tract Infect Inflamm 2009;4(2):184-189. Published online October 31, 2009
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- "Purpose: To evaluate the clinical features according to co-morbidity in patients with acute hemorrhagic cystitis who visited the emergency room. Materials and Methods: We evaluated 60 patients who visited the emergency room due to acute hemorrhagic cystitis symptoms. We evaluated voiding and storage symptoms, urine analysis, urine culture, and presence of co-morbidities, and analyzed clinical features between group of presence of co-morbidity (group I) and absence of co-morbidity (group II) through review of medical records. Results: The mean age of 60 patients was 55.3±22.3 years (19-84) including 14 male (23.3%) and 46 female (76.7%). The mean age of group I (n=37) and II (n=23) were 62.9±19.8 (22-84) and 43.4 ±17.8 years (19-74), respectively (p=0.102). The most common clinical symptom was dysuria (35.0%) followed by frequency (11.7%) and urgency (3.3%). Pyuria more than 5 WBC/HPF in urine was revealed in 36 patients (60.0%): 22 (59.5%) and 14 (60.8%) in group I and II, respectively (p>0.05). Positive urine culture was found in 25 patients (41.7%): 18 (81.8%) in group I and 7 (18.4%) in group II, respectively (p<0.05), and cultured organisms were E. coli (68.0%), Entrococcus (20.0%), Pseudomonas (4.0%) and Sphingomonas (4.0%). Conclusions: Patients with acute hemorrhagic cystitis were more frequently found in female. The most common symptom was dysuria and more than half of the patient showed positive urine culture. Positive urine culture was more frequently revealed in patients with co-morbidity."
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Effect of Associated Diseases to Renal and Perirenal Abscesses
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Dong Gil Shin, Hong Koo Ha, Jae Min Chung, Sang Don Lee
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Korean J Urogenit Tract Infect Inflamm 2009;4(2):202-209. Published online October 31, 2009
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- "Purpose: We analyzed the clinical experiences of patients with renal and perirenal abscesses during the last 10 years according to associated diseases. Materials and Methods: We reviewed the medical records of 63 patients with renal, perirenal, and mixed abscesses treated at two hospital from January 1999 to August 2009. The patients were divided into 3 groups: group A consisted of 11 patients without associated diseases, group B consisted of 31 patients with nonurological associated diseases and group C consisted of 21 patients with urological associated diseases. Results: A male to female sexual ratio of 63 patients was 1:2, and the mean age was 51.4±15.2 years, respectively. The most common associated diseases were diabetes mellitus (39.7%) and liver disease (19.0%). The most common urological associated diseases were nephrolithiasis (11.1%) and ureteral obstruction (7.9%). Fever or flank pain were the common symptom. The most common isolated uropathogen in urine, blood and pus culture was E. coli. The hospitalized, clinical and laboratory improvement duration of group A was significantly shorter than group B and C, respectively. The hospitalized, clinical and laboratory improvement duration was not significantly different between group B and C. Most patients are cured or improved on discharge from hospital in all abscesses. Conclusions: We suggest that the renal and perirenal abscesses with associated diseases needs longer hospitalized days and more intensive treatment than that without associated diseases."
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Comparison of Prostatic Biopsy Results according to Patterns of Prostate Specific Antigen after Antibiotic Therapy in Chronic Prostatitis Patients
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Hong Koo Ha, Sung Woo Park, Sang Don Lee
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Korean J Urogenit Tract Infect Inflamm 2008;3(2):204-209. Published online October 31, 2008
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- "Purpose: We investigated the prostatic cancer rate according to patterns of PSA after antibiotics medication. Materials and Methods: Ninety-five patients with lower urinary tract symptoms (LUTS) and pyuria were treated with quinolone. Pyuria defined as more than 5 WBC/HPF in expressed prostatic secretion or VB3. We evaluated serum PSA level before and after antibiotic treatment and prostatic biopsy results in patients without decreased PSA under 4ng/ml. We compared prostatic cancer rate between 23 patients with decreasing PSA but above 4ng/ml (group A) and 22 patients without decreasing PSA than premedication (group B). Results: Of the 96 patients, 51 patients (53.1%) demonstrated serum PSA decreased lower than 4ng/ml. The remaining 45 patients were underwent prostate biopsy and prostatic cancer was found in 6 patients. Mean age and mean prostate volume in group A and group B were 61.4±12.7years, 61.9±10.4years (p=0.702) and 32.0±8.7gm, 31.7±5.6gm (p=0.532), respectively. Mean serum PSA before and after treatment were 7.84±2.97 ng/ml, 8.05±3.62ng/ml (p=0.246) and 4.53±2.33ng/ml, 8.55±3.25 (p=0.042) in group A and B, respectively. Positive predictive value for prostatic cancer increased from 0.063 to 0.133 in pretreatment and posttreatment patients (p=0.644) and from 0.043 to 0.227 in group A and B, respectively (p=0.039). Conclustions: Antibiotic treatment can decrease the serum PSA for chronic prostatitis and improve positive predictive value for prostatic cancer. Therefore we should consider prostate biopsy in patient without decreasing PSA after antibiotic medication."
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