A survey on the knowledge, opinions, and approaches in clinical practice of urology physicians about hyperbaric oxygen therapy application in Fournier gangrene

Abstract

Objective: Fournier gangrene is a form of necrotizing fasciitis with high mortality. Hyperbaric oxygen therapy (HBOT) is a successful and supportive treatment option for Fournier’s gangrene (FG). This study aimed to analyze urologists’ knowledge, opinions, and preferences about HBOT application in FG.
Material and Methods: An online or face-to-face questionnaire was applied to physicians who are experts in the field of Urology or who have been continuing Urology residency training for at least one year.
Results: Ninety urology physicians filled out the questionnaire. Most of them (56.4%) never refer FG cases to HBOT. Physicians (55.3%) mostly preferred HBOT only in patients unresponsive to surgical debridement and antibiotherapy. Besides, 27.3% of them stated they had no information when asked to self-assess their knowledge. Only 12 physicians (13.3%) had previously been in an HBOT center, and 15 (16.7%) physicians had participated in a scientific study on HBOT. Only three physicians (3.4%) stated HBOT was not beneficial to FG patients. Urologists’ opinions about HBOT efficiency in FG were examined (3-point-Likert type questions) in 5 questions; the median score was 2 points (minimum-maximum: 1-3 points). On the other hand, physicians who did not know HBOT had more negative opinions about HBOT efficiency in FG (p = 0.002).
Conclusion: Urology physicians’ knowledge of HBOT, their doubts about HBOT in FG, and their relatively low experience with HBOT are clearly shown in this study. Therefore, urology physicians should be encouraged to increase their HBOT experience in FG and participate in scientific studies. Also, Urology Associations should discuss HBOT efficiency more effectively in guidelines and meetings.

Keywords

• fournier gangrene
• hyperbaric oxygenation
• questionnaire
• urologists

Üroloji hekimlerinin Fournier gangreninde hiperbarik oksijen tedavisi uygulamasına dair bilgi düzeyleri, görüşleri ve pratik uygulamadaki yaklaşımları

Abstract

Amaç: Fournier gangreni, yüksek mortaliteye sahip bir nekrotizan fasiit formudur. Hiperbarik oksijen tedavisi (HBOT) başarılı bir destek tedavi seçeneği olarak gösterilmektedir. Bu çalışmada, üroloji doktorlarının Fournier gangreninde HBOT uygulaması hakkındaki bilgi düzeyleri, görüşleri ve pratik uygulamadaki tercihlerini bir anket ile sorgulamayı amaçladık.
Gereç ve Yöntemler: Üroloji alanında uzman olan veya en az 1 yıldır uzmanlık eğitimine devam eden doktorlarımıza online veya yüz yüze olarak anket uygulanmıştır.
Bulgular: Anketi dolduran 90 üroloji hekiminin %69,7’si Ankara’da çalışan hekimlerdi. Hekimlerin %42,2’si yılda 1-5 Fournier gangreni vakasını tedaviye etmekteydi; ancak çoğunlukla (%56,4) hastaları HBOT için hiçbir zaman yönlendirmedikleri görüldü. Çoğunluk (%55,3) HBOT’ni ancak cerrahi debridman ve antibiyoterapiye yanıtsız durumlarda tercih ettiğini belirtti. Hekimlerin HBOT hakkındaki bilgi düzeylerini kendilerinin değerlendirmeleri istendi; %27,3’ü hiçbir bilgisi olmadığını bildirdi. Daha önce bir HBOT merkezinde bulunmuş olan 12 hekim (%13,3), HBOT ile ilgili bir bilimsel çalışmada yer aldığını bildiren 15 hekim (%16,7) vardı. Fournier gangreni hastalarında HBOT’nin faydası olmadığını düşünen sadece 3 hekim (%3,4) vardı. Fournier gangreninde HBOT etkinliği hakkındaki görüşler 3’lü likert tipi şeklinde 5 soru halinde sorulmuştur; ortanca puan 2 (minimum-maksimum: 1-3) olarak hesaplanmıştır. HBOT hakkında hiçbir bilgisi olmayan hekimlerin, Fournier gangreninde HBOT uygulaması hakkındaki daha olumsuz görüşlere sahip olduğu görüldü (p=0,002).
Sonuç: Üroloji hekimlerimizin Fournier gangreninde HBOT hakkındaki bilgilerinin az olması, pratik uygulamadaki çekinceleri ve farkındalıklarının az olması çalışmamızda net olarak görülmüştür. Hekimlerimizin HBOT deneyimlerini arttırmaları, bilimsel çalışmalar planlamaları ve üroloji dernekleri tarafından bu konunun tartışmaya açılması gerektiğini düşünüyoruz.

Keywords

• fournier gangreni
• hiperbarik oksijenasyon
• anket
• ürolog

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