SCIENCE, PRACTICE AND EDUCATION DOI: 10.35279/jowm2022.23.03.02 Patient-reported outcomes and health-related quality of life in male long-term survivors of Fournier’s gangrene Laila Schneidewind 1 , Vanessa Roßberg 1 , Desiree L. Dräger 1 , Fabian P. Stangl 2 , Joachim Steffens 3 , Oliver W. Hakenberg 1 , Jennifer Kranz 4,5 1 .University Medical Center Rostock, Dept. of Urology, Rostock, Germany. 2. Bern University Hospital, Inselspital, Dept. of Urology, Bern, Switzerland 3. St. Antonius Hospital Eschweiler gGmbH, Dept. of Urology, Eschweiler, Germany. 4. University Medical Center RWTH Aachen, Dept. of Urology, Aachen, Germany. 5. Martin-Luther-University, Dept. of Urology and Kidney Transplantation, Halle (Saale), Germany Correspondence: Laila Schneidewind, laila.schneidewind@med.uni-rostock.de Conflict of interest: None Keywords: Fournier’s gangrene; health-related quality of life (HRQoL); long-term survivors; patient-reported outcomes (PROs); wound healing ABSTRACT Objectives To describe patient-reported outcomes and health- related quality of life (HRQoL) in male long-term survivors of Fournier’s gangrene (FG). Methods We retrospectively identified male patients treated for FG via ICD-10 coding in two centres between January 2010 and December 2020. Patients who survived the in-house treatment were invited to par- ticipate and to complete the validated questionnaires International Prostate Symptom Score (IPSS), Inter- national Index of Erectile Function (IIEF-5), Quality of Life in chronic wounds (WOUND-QoL), Freiburger Life Quality Assessment – wound module (FLQA-w) and the Short Form Health (SF-36). Results Finally, 39 patients with a median age of 65.0 years (IQR 53.0–74.0) were identified. Twenty patients had died (51.3%), nine patients were lost to fol- low up (23.1%) and ten patients participated in the survey (25.6%). The median survival time was 27.0 months (IQR 9.0 – 60.0). The median IPSS was 13.5 (IQR 4.3 – 22.3); five patients (50.0%) had severe erectile dysfunction. Three patients (30.0%) reported problems with the wound, two (20.0%) complained of wound pain and one (10.0%) about the wound- healing situation. The mean global health score on the WOUND-QoL was 1.83 (SD 1.1), which is signifi- cantly lower than in the German reference popula- tion (p<0.001). In the FLQA-w, the mean subscales were for physical aliment 1.8 (SD 1.1), everyday life 1.5 (SD 0.5), social life 1.6 (SD 0.8) and psycho- logical well-being 1.8 (SD 1.2). The mean general health score on the SF-36 was 64.0 (SD 10.5). Conclusions In long-term survivors of FG, the wound situation has a deeply negative impact on HRQoL. INTRODUCTION Fournier’s gangrene (FG) is a very rare, life-threat- ening, necrotising infection affecting the perineum, perineal region and genitals (1, 2, 3). As the incidence rate is very low, most of the limited knowledge about FG arises from retrospective single-institution studies with very small patient cohorts (4–8). The incidence of FG is 1.6 cases per 100,000 male patients in the United States (9). Unfortunately, the prognosis, sur- vival and outcome of FG has not improved in recent years, despite more intensive critical-care therapy for these patients (3, 10). Kranz et al. showed in JOURNAL OF WOUND MANAGEMENT OFFICIAL JOURNAL OF THE EUROPEAN WOUND MANAGEMENT ASSOCIATION 143
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