Exploring urological services in Indonesia
Exploring urological services in Indonesia
This thesis of Yufi Aulia Azmi investigates the clinical management and health economic aspects of Fournier’s gangrene (FG) within the Indonesian urological care system. It addresses gaps in national evidence by integrating epidemiological, clinical, and cost-effectiveness analyses, with a focus on risk factors, prognostic assessment, antibiotic use, and timing of surgery.
A multicenter observational study of 145 male FG patients identified a 26% mortality rate, with Clostridium perfringens infection and diabetes mellitus emerging as key predictors of death, underscoring the need for routine culture and optimal diabetes control. A systematic review on sodium–glucose cotransporter-2 inhibitors (SGLT2i) showed that FG incidence associated with SGLT2i is rare and typically improves after drug discontinuation, supporting continued use with careful risk mitigation and patient education. Prognostic performance evaluation of more than ten scoring systems demonstrated that the Fournier’s Gangrene Severity Index (FGSI) and the Sequential Organ Failure Assessment (SOFA) score had the highest accuracy for mortality prediction, highlighting their utility for early risk stratification in FG.
Case reports of neonatal FG and FG secondary to chronic urethral stones illustrated the spectrum of clinical presentations and emphasized the importance of early diagnosis, aggressive debridement, and source control. A cost-effectiveness analysis comparing early (<24 hours) versus delayed surgery (>24 hours) in 185 patients (with detailed cost data in 42 patients) showed that early surgery was the dominant strategy, providing both lower mean costs and greater life-years gained, despite some parameter uncertainty. Overall, the thesis supports early multidisciplinary management, rational antibiotic use, and timely surgery as essential to improving survival and optimizing limited healthcare resources, and it informs future national guidelines and policy for FG care in Indonesia.