PD12-05 TESTICULAR INVOLVEMENT IN FOURNIER’S GANGRENE: IS ORCHIECTOMY OVERUTILIZED?

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD12-05 TESTICULAR INVOLVEMENT IN FOURNIER’S GANGRENE: IS ORCHIECTOMY OVERUTILIZED? Amr A. Elbakry, Kareem Wasef, Andrea Pettit, Katharina Mitchell, Jennifer Mihalo, Stanley Kandzari, and John Barnard Amr A. ElbakryAmr A. Elbakry More articles by this author , Kareem WasefKareem Wasef More articles by this author , Andrea PettitAndrea Pettit More articles by this author , Katharina MitchellKatharina Mitchell More articles by this author , Jennifer MihaloJennifer Mihalo More articles by this author , Stanley KandzariStanley Kandzari More articles by this author , and John BarnardJohn Barnard More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003259.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The objective of our study is to evaluate the extent of testicular involvement in patients with genital soft tissue necrotizing fasciitis (Fournier’s Gangrene [FG]). The primary endpoint is to report the incidence of orchiectomy during initial or subsequent debridement. Secondary endpoints include the presence or absence of pathologic evidence of necrosis and thus concordance with clinical non-viability on intraoperative examination. METHODS: We identified patients who underwent radical debridement of FG our tertiary care center over the period of 10 years from January 2012 to June 2022. Careful review of the preoperative imaging and the operative details was conducted to confirm the diagnosis FG. We then identified the patients who underwent orchiectomy during the initial or the subsequent debridements. The reason for orchiectomy was collected from the operative notes as reported by the surgeon. We reviewed the pathology reports for all the orchiectomy specimen and recorded the reported findings. RESULTS: A total of 106 patients who underwent radical debridement for FG were identified. We found that 8 patients (7.5%) underwent orchiectomy at the time of initial or subsequent debridement. Two patients underwent bilateral, while 6 patients underwent unilateral orchiectomy. The most common reported reason for orchiectomy that was documented by the surgeon was “non-viable testicle with evidence of necrosis”; however, other etiologies such as “difficult wound care” were also encountered. Pathology report showed that all 10 submitted testicles were viable and free of necrosis. Mild chronic inflammation and partial degeneration with no necrosis was reported in two testicles in the same patient. Atrophic changes with no evidence of necrosis were reported in a 77-year-old patient and a 76-year-old patient. Tunica vaginalis was involved in inflammation or necrosis in 6 patients. CONCLUSIONS: Our study suggests significant discordance between clinical determination of testicular involvement in FG on exam and the pathologic findings. Orchiectomy may thus be overutilized in this cohort. The findings may guide treatment decisions particularly in situations where uncertainty exists regarding the extent of debridement (ie including tunica vaginalis but deferring orchiectomy when possible) and necessity for orchiectomy in FG. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e401 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amr A. Elbakry More articles by this author Kareem Wasef More articles by this author Andrea Pettit More articles by this author Katharina Mitchell More articles by this author Jennifer Mihalo More articles by this author Stanley Kandzari More articles by this author John Barnard More articles by this author Expand All Advertisement PDF downloadLoading ...