BACKGROUND Fournier's gangrene (FG) is a serious, aggressive and often deadly polymicrobial infection of the soft tissues of the perineum, the rectum and the external genital organs. It is an anatomical subcategory of necrotizing fasciitis, which has a similar etiology and treatment strategy. CASE SUMMARY A 60-year-old man was admitted to the hospital during severe acute respiratory syndrome coronavirus 2 pandemic with complaints of fever up to 38.9 °C, abdominal pain, and edema of the scrotum, the penis, the perineum, and the right gluteal region for 2 d. Computed tomography of the abdomen and the pelvis revealed extensive inflammatory infiltrations of the subcutaneous tissue of the hypogastrium, and the penis; along with liquefaction and presence of gas in the subcutaneous tissues of the scrotum, the perineum, and the right gluteal region. The patient was diagnosed with FG, and was urgently qualified to undergo surgery in the Department of Urology. After performing the necessary examinations, a resection of the necrotic tissues with bilateral orchiectomy and excision of the penile and scrotal skin was performed. After surgery, he was transferred to the intensive care unit for further management. CONCLUSION Early management prevents the resection of the other organs by inhibiting the contiguous spread of infection.

Background: Urolithiasis is one of the most common diseases of the urinary system, the incidence of which is assumed to be up to 100,000 cases per million (10% of the population). The cause of it is dysregulation of renal urine excretion. Acromegaly is a very rare endocrine disorder that causes a somatotropic pituitary adenoma producing higher amounts of growth hormone. It occurs approximately in 80 cases per million (about 0.008% of the population). One of the acromegaly complications may be urolithiasis. Methods: Clinical and laboratory results of 2289 patients hospitalized for nephrolithiasis in the highest reference hospital were retrospectively analyzed, distinguishing a subgroup of patients with acromegaly. Statistical analysis was performed to compare the prevalence of the disease in the analyzed subgroup with the epidemiological results available in up-to-date literature. Results: The distribution of nephrolithiasis treatment was definitely in favor of non-invasive and minimally invasive treatment. The methods used were as follows: ESWL (61.82%), USRL (30.62%), RIRS (4.15%), PCNL (3.1%), and pyelolithotomy (0.31%). Such a distribution limited the potential complications of the procedures while maintaining the high effectiveness of the treatment. Among two thousand two hundred and eighty-nine patients with urolithiasis, two were diagnosed with acromegaly before the nephrological and urological treatment, and seven were diagnosed de novo. Patients with acromegaly required a higher percentage of open surgeries (including nephrectomy) and also had a higher rate of kidney stones recurrence. The concentration of IGF-1 in patients with newly diagnosed acromegaly was similar to those treated with somatostatin analogs (SSA) due to incomplete transsphenoidal pituitary surgery. Conclusions: In the population of patients with urolithiasis requiring hospitalization and interventional treatment compared to the general population, the prevalence of acromegaly was almost 50-fold higher (p = 0.025). Acromegaly itself increases the risk of urolithiasis.

Introduction: Retroperitoneal schwannoma is a rare tumor that originates from the Schwann cells of the peripheral nerve sheath. It is mostly located in the brain and spinal cord, but can affect other untypical places such as the scrotum and penis. Aim: The aim of this study was to present two different cases of retroperitoneal schwannoma. Case study: The authors present two cases of patients with benign and malignant retroperitoneal schwannomas (malignant peripheral nerve sheath tumor – MPNST). Results and discussion: It has been reported that only 0.7% of schwannomas occur in the retroperitoneum. It is difficult to diagnose this tumor preoperatively because of the clinical variety and a lack of the characteristic symptoms. These tumors can mimic different conditions, such as pancreatic tail tumors, a hepatic tumor in the caudate lobe, or lymph node metastases. They can arise at any age, but generally occur between 30 and 50 years of age and develop in any race. Based on the literature published in the last 20 years regarding schwannomas arising in retroperitoneum 20 cases were reported. Conclusions: Careful monitoring is highly recommended after retroperitoneal schwannoma removal.

Aim: The aim of the study was to assess the impact of hyperbaric oxygen therapy on the rate of wound healing in Fournier’s gangrene. Materials and Methods: This was a retrospective analysis of 13 patients treated for Fournier’s gangrene at the Military Institute of Medicine from October 2017 to November 2020. The study group consisted of males (n = 13) aged 24 to 83 years. Two groups of patients were distinguished: group 1 – patients who underwent hyperbaric oxygen therapy as an adjuvant treatment, group 2 – patients who did not undergo hyperbaric oxygen therapy. Results: In the first group, hyperbaric oxygen therapy was used as an adjuvant treatment of wound healing in in 8/13 patients (62%) with Fournier’s gangrene. In this group, significant acceleration of this process and shorter hospital stay were observed (mean = 29 days). In the second group, the hospitalisation time was significantly longer (mean = 51 days) in 5 out of 13 patients (38%). There were no deaths in either group 1 or group 2. Conclusions: Hyperbaric oxygen therapy is an effective adjuvant therapy in the treatment of Fournier’s gangrene. It has an impact on the rate of wound healing and shorter hospitalisation time.