[Gangrene of the external genital organs. Apropos of 55 cases]

Gangrène of the male external genitalia (GMEG) is characterized by necrotizing cell evolving toward necrotizing of the soft tissues of the male genitalia and possibly death. The cause may be primary infection called Fournier's gangrene (5%) or secondary infection (95%) due to general or local factors. GMEG is a real urinary emergency because of its local and general complications which lead to death in 20% of cases. Precocious and massive antibiotherapy, a surgery to unbridle and possibly reanimation, oxygenotherapy, urinary diversion or colostomy, are required. We have treated 55 men with this affection from january 1988 to may 1996. Mean age was 58 years (range 20 to 85). The prodromial period was about 12 days. Toxi-infectious shock was noted in 8 patients (14%). Six patients (10%) developed renal acute insufficiency. Lesions were localized to the male external genitalia in 24 cases and stretched to the inguinalis, to the abdomen or to the thorax in 34 patients. The cause was a stricture of urethra in 23 cases (41%) diabetes in 18 cases (32%), anal abscess in 7 cases (13%). No etiology was found in 6 cases (10%). Emergency treatment involved three antibiotics, surgery to unbridle necrotizing tissue in all patients, reanimation in 20 patients (35%), oxygenotherapy in 4 patients (7%), colostomy in 2 cases and urinary drainage in 23 patients (42%). Free skins grafts were necessary in 6 patients (10%), 5 patients (9%) died due to septic shock. On the basis of these observations and a review of the literature, we analyzed the ethiopathogenic, bacteriological and therapeutic aspects of this affection marked by high mortality in spite of therapeutic progress.