Impractical CME programs: Influential parameters in Iran.

Background: Traditional approaches in Continuing Medical Education (CME) appear to be ineffective in any improvement of the patients' care, reducing the medical errors, and/or altering physicians' behaviors. However, they are still executed by the CME providers, and are popular among the majority of the physicians. In this study, we aimed to explore the parameters involved in the degree of effectiveness of CME program in Iran. Methods: In this study, 31 participants, consisting of general practitioners, CME experts and providers were recruited to participate in in-depth interviews and field observations concerning experiences with CME. Application was made of the qualitative paradigm along with the qualitative content analysis, using grounded theory data analysis methodology (constant comparative analysis). Results: Based on the participants' experiences, the insufficient consistency between the training program contents and the demands of GPs, in addition to the non-beneficiary programs for the physicians and the non-comprehensive educational designs, created a negative attitude to the continuing education among physicians. This could be defined by an unrealistic continuing education program, which is the main theme here. Conclusion: Impracticable continuing education has created a negative attitude toward the CME programs among physicians so much that they consider these programs less important, resulting in attending the said programs without any specific aim: they dodge absenteeism just to get the credit points. Evidently, promoting CME programs to improve the performance of the physicians requires factual needs assessment over and above adaptation of the contents to the physicians' performance.

Human papillomavirus infection in women with and without cervical cancer in Tehran, Iran.

No data exist on the population prevalence of, or risk factors for, human papillomavirus (HPV) infection in Iran or the Middle East. Cervical specimens were obtained from 825 married women aged 18-59 years from the general population of Tehran, Iran and from 45 locally diagnosed invasive cervical cancers (ICC) according to the standardized protocol of the International Agency for Research on Cancer HPV Prevalence Surveys. HPV was detected and genotyped using a GP5+/6+ PCR-based assay. HPV prevalence in the general population was 7.8% (95% confidence interval: 6.0-9.8) (5.1% of high-risk types), with no significant variation by age. HPV positivity was significantly higher among divorced women, women in polygamous marriages and those reporting husband's absence from home for >7 nights/month. HPV16/18 accounted for 30 and 82.2% of HPV-positive women in the general population and ICC, respectively. Cervical cancer prevention policies should take into account the relatively low HPV prevalence in this population.

miR-106b-5p Intensifies the Proliferative Potential of Spermatogonial Stem Cells as a Prerequisite for Male Infertility Treatment.

Although numerous studies have investigated the molecular basis of male infertility, various aspects of this area have remained uncovered. Over the past years, researchers have reported the significant potential of miRNAs in posttranscriptional regulatory roles. By targeting mRNAs, these notable molecules can modulate the processes related to male infertility. On the other side, the outstanding potential of male germline stem cells, SSCs, includes their application in infertility treatment. SSCs retain normal spermatogenesis and fertility by adjusting both SSC self-renewal and differentiation. Therefore, for the characterization and manipulation of SSCs, effective and efficient in vitro culture methods are essential in supporting their maintenance and development. In this regard, the present investigation was undertaken to evaluate the impact of one of the recently conspicuous miRNAs, miR-106b, in SSCs enrichment. As a result, we first found that the SSCs induced with miR-106b-5p highly express TGF-ß1, which is known as a regulator of epigenetic modifiers and downstream genes. We next sought to show that self-renewal markers, including c-Myc, Oct-4, and Sox2, are increased in the induced SSC group. The intended miRNA also induced the inhibitor of differentiation 4 (ID4) and aided to remain unmethylated in SSCs. Additionally, for the tumorigenicity possibility of the manipulation, we indicated that PTEN, a tumor-suppressor gene, expressed remarkably in the induced SSCs. In conclusion, our findings showed that miR-106b-5p enhances the proliferative potential of SSCs, making it a substantial factor for therapeutic strategies of male infertility.

The Effect of miR-106b-5p Expression in The Production of iPS-Like Cells from Mice SSCs during The Formation of Teratoma and The Three Embryonic Layers.

Objective: According to the mounting data, microRNAs (miRNAs) may play a key role in reprogramming. miR-106b
is considered as an enhancer in reprogramming efficiency. Based on induced pluripotent stem cells (iPSCs), cell treatments have a huge amount of potential. One of the main concerns about using iPSCs in therapeutic settings is the possibility of tumor formation. It is hypothesized that a procedure that can reprogram cells with less genetic manipulation reduces the possibility of tumorigenicity.
Materials and Methods: In this experimental study, miR-106b-5p transduced by pLV-miRNA vector into mice isolated spermatogonial stem cells (SSCs) to achieve iPS-like cells. Then the transduced cells were cultured in specific conditions to study the formation of three germ layers. The tumorigenicity of these iPS-like cells was investigated by transplantation into male BALB/C mice.
Results: We show that SSCs can be successfully reprogrammed into induced iPS-like cells by pLV-miRNA vector to transduce the hsa-mir-106b-5p into SSCs and generating osteogenic, neural and hepatoblast lineage cells in vitro as a result of pluripotency. Although these iPS-like cells are pluripotent, they cannot form palpable tumors in vivo.
Conclusion: These results demonstrate that infection of hsa-mir-106b-5p into SSCs can reprogram them into iPSCs
and advanced germ cell lineages without tumorigenicity. Also, a novel approach for studying the generation of iPSCs
and the application of iPS or iPS-like cells in regenerative medicine is presented.

Circular RNAs in renal cell carcinoma: Functions in tumorigenesis and diagnostic and prognostic potentials.

Circular RNAs (circRNAs) are non-coding RNAs with closed ends which makes them resistant to degrading enzyme RNAse R. These RNA molecules show cell, tissue or organ specific expression. Regulatory functions have been reported for a number of circRNAs. Particularly, they have been found to affect cell cycle and control cell proliferation. CircRNAs are involved in physiological processes like natural organ development. Their dysregulation in high-throughput technologies have been shown in a growing number of diseases especially many types of cancers such as renal cell carcinoma (RCC). Differentially expressed circRNAs in RCC tissues compared to normal tissues may affect carcinogenesis process. Overexpressed circRNAs promote tumorigenic functions of RCC cell lines while down-regulated transcripts repress them. Both dysregulated circRNAs are correlated with clinicopathological features, prognosis and survival in RCC patients which along with their acceptable diagnostic values suggest them as potential biomarkers in diagnosis or prediction of prognosis of RCC patients. In this review, we have assessed tumorigenic or tumor-suppressing effects of circRNAs and also their diagnostic and prognostic potentials in RCC.

Accuracy of Paris 2016 System for Non-invasive Diagnosis Bladder Malignancy.

Background & Objective: The Paris System for Reporting Urinary Cytology (TPS) is a new method for evaluating urinary cytology designed to reduce unreproducible reports. The aim of this study was to reclassify and compare urinary cytology reports with TPS criteria to determine the frequency of unreproducible reports compared to the previous system. Methods: In this study, the laboratory electronic registration system analyzed patients' urine samples taken by voided or washing and brushing methods. The cytological evaluation was performed considering the previous system and TPS by a pathologist. The results of the two systems were compared, and the sensitivity and specificity of TPS were calculated. Results: Urine samples were taken from 876 patients. The mean age of patients was 63.36 ± 12.62. Comparing the routine classification system and TPS, it was observed that the number of atypical reports in the TPS system decreased by 12%, and all of these cases were downgraded to the negative group in the new classification. The sensitivity and specificity of TPS were 29.4% and 95.1%, respectively, if suspected malignancy and positive reports for malignancy were considered. Finally, if positive reports for malignancy were selected, sensitivity and specificity changed to 11.8% and 100%, respectively. Conclusion: Although the TPS system has low sensitivity for the diagnosis of urothelial malignancies, due to its high specificity, it is possible to consider and use this classification for screening patients.

Misplacement of DJ stent into inferior vena cava in a patient with retroperitoneal fibrosis, a case report.

Intravascular migration of DJ stent is a rare complication that needs immediate attention to prevent severe complication. We reported a rare case of intravascular migration of DJ stent in a patient with retroperitoneal fibrosis. The DJ stent was removed by cystoscopy with no complication.

Evaluation of P53 and CK20 Immunohistochemical Markers in Comparison with Morphologic Findings in Low- and High-grade Urothelial Carcinomas.

BACKGROUND & OBJECTIVE: Urothelial carcinoma is the seventh most common cancer in the world. The histological classification of papillary carcinoma is one of the most important determinants for its prognosis. Sometimes there is an overlap in the extent of the tumor, and the accurate microscopic diagnosis of the tumor is not always easy. The aim of this study was to evaluate P53 and CK20 immunohistochemical markers in comparison with morphologic findings in low- and high-grade urothelial carcinomas. METHODS: For this descriptive study, urinary bladder samples were collected from 50 cancer patients who had undergone biopsy and surgery in Shohaday-e Tajrish Hospital of Tehran, Iran, during the years 2015-2016. P53 and CK20 were studied, and the demographic and histopathological characteristics of the tumor were also analysed. RESULTS: The mean age of patients enrolled in this study (48 males and 2 females) was 65.8±11.9. Twenty-five cases presented with low-grade and 25 cases presented with high-grade papillary urothelial carcinomas. Sensitivity, specificity, and positive and negative predictive values for P53 were 48%, 80%, 70.5%, and 60.6%, respectively, while the same values for CK20 were 44%, 92%, 84.6%, and 62.2%, respectively. Immunohistochemical results were also positively correlated with the extent of the tumor. CONCLUSION: Based on the results, P53 and CK20 may serve as specific markers for diagnosis of low- and high-grade papillary urothelial carcinoma but not sensitive. P53 and ck20 staining have also a high specificity as 80% and 92% and low sensitivity compared to the low and high morphology of papillary carcinoma, thus their positive and their staining intensity are valuable for diagnosis, but their negative results are not determinant.

Evaluation of the Standardization in Semen Analysis Performance According to the WHO Protocols Among Laboratories in Tehran, Iran.

BACKGROUND AND OBJECTIVE: Infertility refers to the failure in achieving pregnancy of a couple after one year of regular sexual intercourse without using a protection method. The purpose of this research work was to evaluate the current status of the test and quality control performance in semen analysis in selected laboratories. MATERIAL AND METHODS: The semen analysis was performed in the Laboratory of Andrology in terms of macroscopic examination which include volume, color, viscosity, pH and acidity, and in terms of microscopy: the rate of sperm movement, the exact number of sperms per ml of semen, the percentage of sperm viability and movement, the presence of germ cells and white blood cells. Several questions for each part of the test were selected and answered by the director of the laboratories or andrology section supervisor. RESULTS: There was a wide range in the performance of selected medical laboratories in Tehran regarding the standards of semen analysis according to the World Health Organization (WHO) Laboratory Manual for the examination and processing of human semen, fifth edition in 2010. They followed the instructions related to the sample collection in about 70% of the evaluated parameters, initial macroscopic examination in about 87% of the selected subjects, and the microscopic evaluation of sperm in about 65% of the test parameters. CONCLUSION: some laboratories do not follow the instructions of the WHO in performing semen analysis, and most of them do not follow the suggested methods in all parts of the test.

Effects of Varicocelectomy on Serum Testosterone Levels among Infertile Men with Varicocele.

BACKGROUND: The main purpose of this study is to evaluate the effects of varicocelectomy on serum testosterone levels and semen quality in infertile men who suffer from varicocele. MATERIALS AND METHODS: This prospective study enrolled 115 subjects with clinical varicocele grades II and III and 240 fertile men as the control group. Total volume of testosterone serum level (ng/dl) and semen quality were compared before and after microscopic varicocelectomy. We normalized testosterone serum levels for age, grade, and testis size basis. SPSS 20 software was used to analyze the data. All results of continuous variables were reported as mean ± SD. Statistical significance was set at a P<0.05. RESULTS: The mean ages of individuals who participated in the treatment (32.2 ± 5.23) and control (32.8 ± 5.27) groups were similar. There were similar mean values for adjusted testosterone levels between the varicocele (567 ± 222 ng/ml) and control (583 ± 263 ng/ml) groups. In the varicocele group, the adjusted testosterone levels insignificantly increased to 594 ± 243 ng/ml. Among semen parameters, only mean sperm concentration significantly increased after varicocelectomy. CONCLUSION: Despite increases in sperm concentration, adjusted testosterone levels did not significantly improve after varicocelectomy.

Impacted upper-ureteral calculi >1 cm: blind access and totally tubeless percutaneous antegrade removal or retrograde approach?

PURPOSE: To compare blind access and totally tubeless percutaneous antegrade removal and pneumatic transurethral ureterolithotripsy for the management of impacted upper-ureteral calculi >1 cm. PATIENTS AND METHODS: Seventy patients (41 male, 29 female) with impacted upper-ureteral calculi >1 cm were selected in randomized order for pneumatic transurethral ureterolithotripsy (35 patients) or blind access and totally tubeless percutaneous nephrolithotomy (PCNL) (35 patients). Ultrasonography and intravenous urography were performed for all patients before surgery. After operation, plain films and ultrasonography were done. RESULTS: In the PCNL group, blind access was achieved from the lumbar notch area in all 35 patients, but in 3 patients, the exposure was not optimal for approaching the ureteropelvic junction (UPJ). So we injected contrast material into the collecting system, and, under fluoroscopic control, another access was achieved. In 33 patients (94.3%), intact removal of the stones was performed. In the other two patients, we fragmented the stones with the Swiss Lithoclast by an antegrade approach. The success rate thus was 100%. The mean operative time was 38 minutes (range 25-48 minutes). In the transurethral lithotripsy group, 12 stones (34.2%) migrated upward to the pelvis of kidney, and 5 stones (14.2%) fragmented incompletely. In these cases, a double- J stent was inserted, and SWL was performed. In follow-up, plain films and ultrasonography showed complete clearance in these patients. Eighteen calculi (51.4%) fragmented completely with the Lithoclast. The mean operative time in this group was 34 minutes (range 20-58 minutes). CONCLUSION: In the presence of moderate to severe hydronephrosis, blind access and totally tubeless PCNL is an effective option for large, impacted upper-ureteral calculi. Flexible ureteroscopy with laser lithotripsy is expensive and not readily available. Pneumatic transurethral ureterolithotripsy has a back-pressure effect and pushes back the calculi to the kidney. Thus, this procedure does not have satisfactory results in the management of these calculi.

Improving continuing medical education by enhancing interactivity: lessons from Iran.

INTRODUCTION: Continuing Medical Education (CME) has been considered as a lifelong commitment for doctors to provide the optimal care for patients. Despite a long history of creating CME programs, outcomes are far from ideal. The present qualitative study aims to clarify the barriers affecting effectiveness of the CME programs in Iran based on the experiences of general practitioners. METHODS: Sixteen general practitioners were recruited to participate in in-depth interviews and field observations concerning experiences with CME. The study was performed using a qualitative content analysis method. The codes, categories and themes were explored through an inductive process in which the researchers moved from specific to general. RESULTS: The participants' experiences identified a number of barriers, particularly insufficient interaction with the instructors; additional problems included the teachers' use of an undifferentiated approach; unreal and abstract CME; and ignorance of the diverse reasons to participate in CME. CONCLUSION: Based on the study results, there are multiple barriers to effective implementation of CME in Iran. The key barriers include insufficient interaction between the trainees and providers, which must be considered by other stakeholders and program designers. Such interactions would facilitate improved program design, invite more specific tailoring of the education to the participants, allow for more effective educational methods and set the stage for outcome evaluation from the learners actually applying their new knowledge in practice. Replication of these findings with another sample would improve confidence in these recommendations, but these findings are broadly consistent with findings in the educational literature on improving the efficacy of CME.

Burden of Breast Cancer in Iranian Women is Increasing.

BACKGROUND: Breast cancer (BC) is the leading cause of oncological death for women, in both developed and developing countries. In Iran, breast cancer ranks first among cancers diagnosed in women. The aim of this study was to present the burden of this cancer including incidence, mortality and years life lost (YLL) due to breast cancer in Iranian women. MATERIALS AND METHODS: National incidence data from the Iranian annual National Cancer Registration reports from 2003 to 2009 and national death statistics reported by the Ministry of Health and Medical Education from 1995 to 2010, stratified by age group, were included in this analysis. Also calculated YLLs provided by the Institute for Health Metrics and Evaluation (IHME) for the years 1990, 1995, 2000, 2005 and 2010 were employed to express the years lost due to BC for Iranian women. RESULTS: The general mortality rate of breast cancer increased during these years from 0.96 to 4.33 per 100,000 and incidence increased from 16.0 to 28.3 per 100,000 for the years under study. YLLs calculated by IHME showed both increasing and decreasing patterns, with a tendency for stabilization. CONCLUSIONS: The burden of breast cancer for Iranian women is still increasing. Thus, health education programs to inform women regarding the signs and risk factors, and national screening to facilitate early diagnosis are needed for the female community in Iran.

Expression of Glycogen synthase kinase 3-ß (GSK3-ß) gene in azoospermic men.

BACKGROUND: The Wnt/ß- The Wnt/ß-catenin signaling pathway is involved in many developmental processes in both fetal and adult life; its abnormalities can lead to disorders including several types of cancers and malfunction of specific cells and tissues in both animals and humans. Its role in reproductive processes has been proven. OBJECTIVE: This study was designed to evaluate the expression of the key regulator of this signaling pathway GSK3-ß and its presumed role in azoospermia. MATERIALS AND METHODS: WNT3a protein concentration and GSK3-ß gene expression levels were measured and compared between two groups of infertile men. The test groups consisted of 10 patients with obstructive and 10 non-obstructive azoospermia. The control group was selected among healthy men after vasectomies that were willing to conceive a child using a testicular biopsy technique. Samples were obtained by testicular biopsy and screened for the most common mutations (84, 86 and 255) in the SRY region before analyzing. GSK3-ß gene expression was assessed quantitatively by real time-PCR. RESULTS: The WNT3a protein concentration had no significant difference between the two test groups and controls. Expression of GSK3-ß was down-regulated in non-obstructive azoospermia (3.10±0.19) compared with normal (7.12±0.39) and obstructive azoospermia (6.32±0.42) groups (p=0.001). CONCLUSION: Down-regulation of GSK-3ß may cause to non-obstructive azoospermia. Regulation and modification of GSK-3ß gene expression by drugs could be used as a therapeutic solution.

Optimal number of biopsies and impact of testicular histology on the outcome of testicular sperm extraction.

PURPOSE: To determine the optimal number of biopsies in patients with non-obstructive azoospermia (NOA) who undergo testicular sperm extraction (TESE), and assess the impact of testicular histology on outcome. MATERIALS AND METHODS: Seven hundred and forty-one patients with NOA who underwent TESE in our institution were enrolled in the study. Testicular sperm extraction was performed applying an open surgical technique on the larger testis. The number of biopsies varied according to the presence or absence of spermatozoa. No further biopsies were obtained once spermatozoa were detected. If no spermatozoa were seen, the procedure was continued to a maximum number of 5 biopsies, including a single biopsy of the contralateral testis. RESULTS: Spermatozoa were obtained in 330 (44.5%) patients after a single biopsy. The success rate increased to 381 (51.4%), 416 (56.1%), 433 (58.4%), and 441 (59.5%) after the second, third, fourth, and contralateral sampling, respectively. Multiple sampling increased the success rate; however, success rate did not increase considerably after the third sampling. Performing contralateral testicular biopsy was advantageous in patients with uniform or mixed pattern hypospermatogenesis. CONCLUSION: We recommend performing at least 3 biopsies in patients with NOA who undergo TESE. Further biopsies may also be advantageous when the NOA is a consequence of either uniform or mixed pattern hypospermatogenesis.

Value of prostate-specific antigen and prostate-specific antigen density in detection of prostate cancer in an Iranian population of men.

INTRODUCTION: The objective of this study was to evaluate the value of serum prostate-specific antigen (PSA) and prostate-specific antigen density (PSAD) in the diagnosis of prostate cancer. MATERIALS AND METHODS: A total of 330 consecutive patients suspected of having prostate cancer due to either abnormal digital rectal examination or elevated serum PSA levels underwent transrectal ultrasonography-guided sextant biopsy of the prostate. The PSA and PSAD values were assessed based on the biopsy results. RESULTS: One hundred and twenty-one patients (36.7%) had prostate cancer. In this group, the mean PSA was 31.60 +/- 30.85 ng/mL (range, 1.9 ng/mL to 166.0 ng/mL) and the mean PSAD was 0.83 +/- 1.01 (range, 0.04 ng/mL/cm3 to 6.38 ng/mL/cm3). In those without prostate cancer the mean PSA and PSAD levels were 13.80 +/- 18.72 ng/mL (range, 0.4 ng/mL to 130.0 ng/mL; P < .001) and 0.24 +/- 0.32 (range of 0.01 ng/mL/cm3 to 2.29 ng/mL/cm3; P < .001). The receiver operating characteristic curve analysis revealed that the discriminating power of serum PSA for detecting prostate cancer, as estimated by the area under the curve, was 0.74 while that for PSAD was 0.81 (P < .001). For the PSA range of 3.5 ng/mL to 41 ng/mL (gray zone) the areas under the curve was 0.68 for PSA, while it was 0.78 for PSAD (P < .001). CONCLUSION: The use of PSAD instead of PSA in the diagnosis of prostatic cancer improves the diagnostic accuracy.

Supracrural rerouting as a technique for resolution of posterior urethral disruption defects.

INTRODUCTION: Selection of an acceptable method for the treatment of posterior urethral disruption defects would be highly desirable. We determined the efficacy and success rate of some techniques including supracrural rerouting for removing of these defects among our patients. MATERIALS AND METHODS: Records of 200 consecutive men treated with anastomotic urethroplasty for traumatic posterior urethral strictures were reviewed at our teaching hospital. Prior treatment, surgical approach, and ancillary techniques required during reconstruction were evaluated. RESULTS: Success rate due to posterior urethral reconstruction was achieved in 78.0% of cases. Supracrural urethral rerouting was performed in 11 patients (5.5%), of whom 7 sustained recurrent stricture requiring intervention. The highest success rate of defect resolving was reported by urethral mobilization (92.4%). CONCLUSION: Supracrural rerouting is not an acceptable technique and can result in postoperative complications such as recurrent stricture in most of the patients with posterior urethral disruption defects.

Incidence of genitourinary cancers in the Islamic Republic of Iran: a survey in 2005.

We here report the incidence of different types of genitourinary cancers among the Iranian population according to the records of the Iran Ministry of Health and Medical Education. In a population-based cancer-registry study in 2005, all recorded data in pathology laboratories, freestanding cancer clinics and treatment centers, physician offices, and other state central registries were obtained with the assistance of Iran Universities of Medical Sciences and sent to the Diseases Management Center in the Health Ministry. The prevalences of urological cancers were as follows: bladder cancer 48.3%; prostate cancer 33.4%; renal cell carcinoma 10.3%; renal pelvis and ureter cancer 0.75%; testicular cancer 6.15%; penile cancer 0.15%; urethral cancer 0.45%; and other unspecified urinary cancers 0.43%. The male to female ratios for the various common urological cancers varied between 1.69 (renal cell carcinoma) and 7.75 (unspecified urinary cancers). The incidence of prostate cancer among our population was dramatically higher than in other countries of Asia. However, bladder cancer was found to be the commonest of the genitourinary cancers, especially in elderly patients, among our population.

MRI in the diagnosis of diphallia.

Diphallia or duplication of the penis is an extremely rare but well-documented anomaly. According to the presence of one or two corpora cavernosa in each of the penises, diphallia is classified into two major groups of bifid phallus or true diphallia, respectively. We report a 5-year-old boy with duplication of the penis. Significant separation of the penises and their morphology made them appear as true complete phalluses, but MRI established the definitive diagnosis of bifid phallus by demonstrating the presence of one corpus cavernosum in each penis. MRI is a valuable method for achieving the accurate diagnosis of these anomalies and associated malformations. It also provides the appropriate knowledge regarding anatomical detail and assists the surgeon in decision making and preoperative planning for the optimal surgical approach.

Fournier gangrene: a series of 12 patients.

INTRODUCTION: Fournier gangrene is a rare, rapidly progressive, necrotizing fasciitis of the external genitalia, the perineum, or the abdominal wall that is associated with high morbidity and mortality. In this series, we describe 12 patients with Fournier gangrene who had presented to our medical center. MATERIALS AND METHODS: Twelve men had been diagnosed with Fournier gangrene in Shohada-e-Tajrish hospital between March 2002 and September 2005. Their medical records were reviewed and the Fournier Gangrene Severity Index scores before and after the treatment were determined. RESULTS: Fifty percent of the patients were diabetic and their mean age was 58.2 +/- 17.8 years. The mean delay between the onset of the disease and the admission was 4.9 days and the mortality rate was 16.6%. The median Fournier Gangrene Severity Index scores before the admission and at the time of discharge were 4.5 (range, 0 to 11) and 0 (range, 0 to 9), respectively (P = .005). One of the patients who died had the scores of 11 and 9, respectively. Split-thickness skin graft was performed for 5 patients (41.7%). CONCLUSION: In Fournier gangrene, a rapid diagnosis and emergent surgical intervention is crucial. The Fournier Gangrene Severity Index seems to be an excellent tool for outcome prediction.