Long-term functional outcomes of perineal gangrene: worse than expected?—an observational retrospective study

  • A. Le FoulerJr
  • A. Hamy
  • J. Barbieux
  • V. Souday
  • P. Bigot
  • P. Le Naoures
  • R. JaouenJr
  • C. Brochard
  • Aurélien Venara
Original Article
  • 43 Downloads

Abstract

Purpose

For survivors of perineal gangrene (PG), quality of life and functional prognosis of pelvic functions are probably overestimated. The aim of this study was to report long-term anal and urinary sphincter dysfunctions, sexual sequelae, and patients’ quality of life after treatment of perineal gangrene.

Methods

This retrospective observational study was conducted in one university hospital over 16 years. Seventy-three patients experienced PG; 22 were subject to long-term follow-up. Three questionnaires were sent to patients to assess pelvic dysfunction and quality of life: the GIQLI, the Cleveland Incontinence Score, and the USP score for urinary dysfunction. Sexual sequelae were considered if orchiectomy or penile resection for male patients and vulvar resection for female patients were performed.

Results

Of the 72 patients included, seven died before discharge (9.7%) and at least 14 died during follow-up (19.4%), despite a mean age of 62 years (± 13). Among the surviving patients, seven experienced an alteration of their quality of life (44%) (GIQLI < 96). Six patients still had a colostomy, and among the remaining patients, 11 experienced minimal to mild incontinence (68.7%), while one experienced constipation (6.2%). One patient suffered from urinary incontinence (4.5%), and six suffered from dysuria (27.3%). Three male patients (14%) underwent an orchiectomy, and one female patient (100%) underwent a vulvar resection.

Conclusion

PG leads to a high rate of anal and urinary dysfunctions. Urinary dysfunctions are taken into account and treated; however, anal incontinence is not investigated even though it could lead to decreased quality of life.

Keywords

Perineal gangrene Anal incontinence Urinary dysfunction Long-term quality of life 

Notes

Contributions

Adrien LeFouler: data collection, analysis, and interpretation. Manuscript author, provided a critical review of the manuscript, drafted the article. Final approval of the version to be published.

Antoine Hamy: conception and design, provided care for study patients, provided a critical review of the manuscript, drafted the article, and revised it for important intellectual content. Final approval of the version to be published.

Julien Barbieux: data collection, provided a critical review of the manuscript, drafted the article, and revised it for important intellectual content. Final approval of the version to be published.

Vincent Souday: provided care for study patients, data collection, provided a critical review of the manuscript, drafted the article, and revised it for important intellectual content. Final approval of the version to be published.

Pierre Bigot: provided care for study patients, provided a critical review of the manuscript, drafted the article, and revised it for important intellectual content. Final approval of the version to be published.

Paul Le Naoures: provided care for study patients, provided a critical review of the manuscript, drafted the article, and revised it for important intellectual content. Final approval of the version to be published.

Charlene Brochard: conception and design, analysis and interpretation, provided a critical review of the manuscript, drafted the article, and revised it for important intellectual content. Final approval of the version to be published.

Romain Jaouen: provided care for study patients, data collection, provided a critical review of the manuscript, drafted the article, and revised it for important intellectual content. Final approval of the version to be published.

Aurélien Venara: conception, design, analysis, and interpretation of data, manuscript author, provided a critical review of the manuscript, drafted the article, and revised it for important intellectual content. Final approval of the version to be published.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Czymek R, Kujath P, Bruch H-P, Pfeiffer D, Nebrig M, Seehofer D, Guckelberger O (2013) Treatment, outcome and quality of life after Fournier’s gangrene: a multicentre study. Color Dis 15:1529–1536CrossRefGoogle Scholar
  2. 2.
    Theiss M, Hofmockel G, Eckert P, Frohmüller H (1996) Cosmetic and functional long-term outcome after operation of Fournier gangrene. Urol Ausg A 35:338–341Google Scholar
  3. 3.
    Eypasch E, Williams JI, Wood-Dauphinee S, Ure BM, Schmulling C, Neugebauer E, Troidl H (1995) Gastrointestinal Quality of Life Index: development, validation and application of a new instrument. Br J Surg 82:216–222CrossRefPubMedGoogle Scholar
  4. 4.
    Slim K, Bousquet J, Kwiatkowski F, Lescure G, Pezet D, Chipponi J (1999) First validation of the French version of the Gastrointestinal Quality of Life Index (GIQLI). Gastroenterol Clin Biol 23:25–31PubMedGoogle Scholar
  5. 5.
    Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97CrossRefPubMedGoogle Scholar
  6. 6.
    Haab F, Richard F, Amarenco G, Coloby P, Arnould B, Benmedjahed K, Guillemin I, Grise P (2008) Comprehensive evaluation of bladder and urethral dysfunction symptoms: development and psychometric validation of the Urinary Symptom Profile (USP) questionnaire. Urology 71:646–656CrossRefPubMedGoogle Scholar
  7. 7.
    Damon H, Guye O, Seigneurin A, Long F, Sonko A, Faucheron JL, Grandjean JP, Mellier G, Valancogne G, Fayard MO, Henry L, Guyot P, Barth X, Mion F (2006) Prevalence of anal incontinence in adults and impact on quality-of-life. Gastroentérologie Clin Biol 30:37–43CrossRefGoogle Scholar
  8. 8.
    Nelson R, Norton N, Cautley E, Furner S (1995) Community-based prevalence of anal incontinence. JAMA 274:559–561CrossRefPubMedGoogle Scholar
  9. 9.
    Abramowitz L, Sobhani I, Ganansia R, Vuagnat A, Benifla JL, Darai E, Madelena P, Mignon M (2000) Are sphincter defects the cause of anal incontinence after vaginal delivery? Results of a prospective study. Dis Colon Rectum 43:590–596 discussion 596–8CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • A. Le FoulerJr
    • 1
    • 2
  • A. Hamy
    • 1
    • 2
    • 3
  • J. Barbieux
    • 1
    • 2
  • V. Souday
    • 4
  • P. Bigot
    • 2
    • 5
  • P. Le Naoures
    • 1
  • R. JaouenJr
    • 1
    • 2
  • C. Brochard
    • 6
    • 7
  • Aurélien Venara
    • 1
    • 2
    • 3
    • 6
  1. 1.Department of Digestive and Endocrinal SurgeryCHU AngersAngersFrance
  2. 2.LUNAM, University of AngersAngersFrance
  3. 3.UMR INSERM HIFIAngersFrance
  4. 4.Intensive Care Unit and Department of Hyperbaric MedicineCHU AngersAngersFrance
  5. 5.Department of UrologyCHU AngersAngersFrance
  6. 6.UMR INSERM U1235, TENSNantesFrance
  7. 7.Department of GastroenterologyCHU RennesRennesFrance

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