Purpose-Case series have shown a Fournier's gangrene mortality rate of 20% to 40% with an incidence of as high as 88% in some studies. Because to our knowledge there are no population based data, we used a national database to investigate the epidemiology of Fournier's gangrene.Materials and Methods-We used the State Inpatient Databases, the largest hospital based database available in the United States, which includes 100% of hospital discharges from participating states. Inpatients diagnosed with Fournier's gangrene (ICD-9 CM 608.83) who underwent genital/perineal débridement or died in the hospital were identified from 13 participating states in 2001 and from 21 in 2004. Population based incidence, regional trends and case fatality rates were estimated.Results-We identified 1,641 males and 39 females with Fournier's gangrene. Cases represented less than 0.02% of hospital admissions. The overall incidence was 1.6/100,000 males, which peaked in males who were 50 to 79 years old (3.3/100,000) with the highest rate in the South (1.9/100,000). The overall case fatality rate was 7.5%. Patients with Fournier's gangrene were rarely treated at hospitals (mean ± SD 0.6 ± 1.2 per year, median 0, range 0 to 23). Overall 0 to 4 and 5 or greater cases were treated at 66%, 17%, 10%, 4%, 1% and 1% of hospitals, respectively. Conclusions-Patients withFournier's gangrene are rarely treated at most hospitals. The population based mortality rate of 7.5% was substantially lower than that reported in case series from tertiary care centers. Keywordsurology; male; female; gangrene; mortality Fournier's gangrene is a urological emergency characterized by progressive necrotizing infection of the external genitalia or perineum. 1 Most studies indicate a mortality rate of 20% to 40% with some studies showing a fatality rate of as high as 88% (table 1). 2 These data are from tertiary referral centers with the largest series including only 80 patients. 3 The generalizability of these data is limited. Previous reports reflect differences in referral patterns, surgical management, clinical volumes and many other institutional differences.* Correspondence: Department of Urology, University of Washington School of Medicine, 1959 Northeast Pacific St., Box 356510, Seattle, Washington 98195 (telephone: 206-543-3640; FAX: 206-543-3272 For example, reports diverge widely in recommendations for urinary and fecal diversion, hyperbaric oxygen use and early skin grafting. [3][4][5][6][7] There are sparse data from community hospitals and to our knowledge no population based data on incidence, regional trends or case fatality rates.To better understand epidemiology and outcomes in patients with Fournier's gangrene we examined a large, population based database to determine patient characteristics, and the incidence of and hospital experience with Fournier's gangrene. We hypothesized that previous case series from tertiary referral centers do not reflect the clinical spectrum and outcomes in the general population. MATERIALS AND METHODS Popula...

Kidney stone imaging is an important diagnostic tool and initial step in deciding which therapeutic options to use for the management of kidney stones. Guidelines provided by the American College of Radiology, American Urological Association, and European Association of Urology differ regarding the optimal initial imaging modality to use to evaluate patients with suspected obstructive nephrolithiasis. Noncontrast CT of the abdomen and pelvis consistently provides the most accurate diagnosis but also exposes patients to ionizing radiation. Traditionally, ultrasonography has a lower sensitivity and specificity than CT, but does not require use of radiation. However, when these imaging modalities were compared in a randomized controlled trial they were found to have equivalent diagnostic accuracy within the emergency department. Both modalities have advantages and disadvantages. Kidney, ureter, bladder (KUB) plain film radiography is most helpful in evaluating for interval stone growth in patients with known stone disease, and is less useful in the setting of acute stones. MRI provides the possibility of 3D imaging without exposure to radiation, but it is costly and currently stones are difficult to visualize. Further developments are expected to enhance each imaging modality for the evaluation and treatment of kidney stones in the near future. A proposed algorithm for imaging patients with acute stones in light of the current guidelines and a randomized controlled trial could aid clinicians.