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Stizzo M, Manfredi C, Spirito L, Sciorio C, Otero JR, Salamanca JIM, Crocetto F, Verze P, Imbimbo C, Fusco F, De Sio M, Arcaniolo D. Hyperbaric oxygen therapy as adjuvant treatment for surgical site infections after male-to-female gender affirmation surgery: A ten-year experience. Andrology 2022; 10:1310-1316. [PMID: 35726785 PMCID: PMC9541545 DOI: 10.1111/andr.13214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Several urological conditions that share an impairment of tissue oxygenation can benefit from hyperbaric oxygen therapy (HBO), limited evidence is available on the impact of HBO in patients undergoing male-to-female (MtF) Gender Affirmation Surgery (GAS). AIM To evaluate the efficacy and safety of HBO as adjuvant treatment for surgical site infections in patients undergoing MtF GAS. METHODS This research was conducted as an observational retrospective study. Patients undergoing MtF GAS at the principal investigators' Institution from January 2009 to September 2019, with a discharge diagnosis of complicated superficial or deep wound infections, were included. All patients underwent standard management of wound infection. Subjects received HBO or not at the surgeon's discretion and were assigned to the HBO vs. non-HBO group accordingly. Complete wound healing rate (primary outcome), duration of antibiotic therapy, perineal drain time, bladder catheter time, and hospital stay were recorded. All adverse events that occurred during the study period were described. RESULTS A total of 156 patients underwent MtF GAS in the study period. Thirty-three patients were enrolled. Fifteen subjects belonged to the HBO group, the other 18 to the non-HBO group. No statistically significant differences were found between the two groups at baseline. Penile inversion vaginoplasty and intestinal vaginoplasty were performed in 9 (60%) and 6 (40%) patients of the HBO group. Only penile inversion vaginoplasty was performed in subjects of the non-HBO group. Complete wound healing was obtained in 15 patients (100%) of the HBO group and 17 patients (94.4%) of the non-HBO group (p = 0.35). Duration of antibiotic therapy, perineal drain time, bladder catheter time, and hospital stay were significantly lower in the HBO group (p<0.05). CONCLUSION Our preliminary data suggest a role of HBO as adjuvant treatment for surgical site infection in patients undergoing MtF GAS. Randomized controlled trials properly powered are needed to confirm our findings. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Marco Stizzo
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Celeste Manfredi
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Lorenzo Spirito
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.,Department of General and Specialized Surgeries, Renal Transplantation, Nephrology, Care and Pain Management, University of Naples Federico II, Naples, Italy
| | | | - Javier Romero Otero
- Department of Urology, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Hospital Universitario 12 Octubre, Madrid, Spain
| | | | - Felice Crocetto
- Department of General and Specialized Surgeries, Renal Transplantation, Nephrology, Care and Pain Management, University of Naples Federico II, Naples, Italy
| | - Paolo Verze
- Urology Unit, Department of Medicine, University of Salerno, Salerno, Italy
| | - Ciro Imbimbo
- Department of General and Specialized Surgeries, Renal Transplantation, Nephrology, Care and Pain Management, University of Naples Federico II, Naples, Italy
| | - Ferdinando Fusco
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco De Sio
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Davide Arcaniolo
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
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Aridogan IA, Izol V, Abat D, Karsli O, Bayazit Y, Satar N. Epidemiological characteristics of Fournier's gangrene: a report of 71 patients. Urol Int 2012; 89:457-61. [PMID: 23076238 DOI: 10.1159/000342407] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 07/27/2012] [Indexed: 12/23/2022]
Abstract
INTRODUCTION To identify the predisposing factors, etiological and clinical characteristics as well as the Fournier's gangrene (FG) severity index (FGSI) in the outcomes of patients with FG. MATERIALS AND METHODS The data from 71 patients diagnosed with FG in a period of 17 years were retrospectively reviewed for the age of the patient, their history, predisposing factors, etiology, prodromal symptoms, FGSI, culture results, hospitalization period, surgical interventions, responses to the therapy and complications. RESULTS All of the patients were Caucasian males, and the mean age was 61.3 (range 36-92) years. The mean duration from the onset of symptoms to surgery was 7.5 days. The mean hospitalization time was 27.4 days and the most common etiological factor for FG was a perineal abscess. The overall mortality rate was 29.6%. The relationship between the number of predisposing factors and mortality rates in patients with FG was the most statistically significant parameter (p = 0.001). CONCLUSIONS Multiple predisposing factors predict a poor prognosis and correlate significantly with mortality. Extension of the disease and the FGSI score were not predictive of outcome. The most essential intervention for stopping the rapidly progressing infectious process of FG consists of early recognition of the disease, proper management of the predisposing factors and aggressive surgical debridement. Such an intervention can improve clinical outcomes.
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Affiliation(s)
- I Atilla Aridogan
- Department of Urology, Faculty of Medicine, University of Çukurova, Adana, Turkey
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