{"id":10222,"date":"2026-05-27T20:00:00","date_gmt":"2026-05-27T13:00:00","guid":{"rendered":"https:\/\/drsoaraweeurology.com\/?p=10222"},"modified":"2026-08-15T04:53:51","modified_gmt":"2026-08-14T21:53:51","slug":"%d8%ba%d8%b1%d8%ba%d8%b1%d9%8a%d9%86%d8%a7-%d9%81%d9%88%d8%b1%d9%86%d9%8a%d9%8a%d9%87%d8%8c-%d8%aa%d8%a3%d9%85%d9%84%d8%a7%d8%aa-%d8%b7%d8%a8%d9%8a%d8%a8-%d9%85%d8%b3%d8%a7%d9%84%d9%83-%d8%a8%d9%88","status":"publish","type":"post","link":"https:\/\/drsoaraweeurology.com\/ar\/2026\/05\/27\/fournier-gangrene-urologist-reflection\/","title":{"rendered":"\u063a\u0631\u063a\u0631\u064a\u0646\u0627 \u0641\u0648\u0631\u064a\u064a\u0647: \u062a\u0623\u0645\u0644\u0627\u062a \u062c\u0631\u0627\u062d \u0627\u0644\u0645\u0633\u0627\u0644\u0643 \u0627\u0644\u0628\u0648\u0644\u064a\u0629 \u0641\u064a \u0625\u0646\u0642\u0627\u0630 \u0627\u0644\u0623\u0631\u0648\u0627\u062d \u0645\u0646 \u062e\u0644\u0627\u0644 \u0627\u0644\u062c\u0631\u0627\u062d\u0629 \u0648\u0627\u0644\u062a\u0648\u0627\u0635\u0644"},"content":{"rendered":"\n<div class=\"wp-block-columns coblocks-author-columns has-background is-layout-flex wp-container-core-columns-is-layout-e269d6e6 wp-block-columns-is-layout-flex\" style=\"background-color:#8C8C971A;padding-top:2.5rem;padding-right:2.5rem;padding-bottom:2.5rem;padding-left:2.5rem\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:25%\">\n<figure class=\"wp-block-image size-full is-style-rounded\"><img data-recalc-dims=\"1\" fetchpriority=\"high\" decoding=\"async\" width=\"800\" height=\"800\" data-attachment-id=\"7037\" data-permalink=\"https:\/\/drsoaraweeurology.com\/ar\/new-photo-2024\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" data-orig-size=\"800,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=800%2C800&#038;ssl=1\" alt=\"Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand\" class=\"wp-image-7037\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?w=800&amp;ssl=1 800w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=300%2C300&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=150%2C150&amp;ssl=1 150w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=768%2C768&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=12%2C12&amp;ssl=1 12w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=600%2C600&amp;ssl=1 600w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=400%2C400&amp;ssl=1 400w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=200%2C200&amp;ssl=1 200w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:75%\">\n<p class=\"wp-block-paragraph\"><strong><a href=\"https:\/\/drsoaraweeurology.com\/\">Soarawee Weerasopone, Urologist<\/a><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" target=\"_blank\" rel=\"noreferrer noopener\">Bangkok hospital Headquarter, Bangkok<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"tel:+66880221445\">Samitivej Sriracha hospital, Chonburi \u2014 088-022-1445<\/a><\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button is-style-outline is-style-outline--1\"><a class=\"wp-block-button__link 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1.246.262.353.175.622.443.806.804.044.083.083.157.117.222.034.066.069.144.105.235.022.054.011.099-.034.135l-.66.292c-.045.027-.082.013-.112-.045a4.043 4.043 0 0 0-.155-.27 1.247 1.247 0 0 0-.49-.495c-.225-.131-.522-.196-.892-.196-.402 0-.726.064-.972.193-.247.13-.422.302-.527.518-.027.045-.054.099-.082.16a1.39 1.39 0 0 0-.067.197 2.46 2.46 0 0 0-.05.282 5.51 5.51 0 0 0-.033.43c-.008.17-.013.376-.013.617 0 .242.005.448.013.618.008.17.02.314.034.43.013.117.03.21.05.282.02.072.042.137.066.197.105.216.28.39.527.518.246.13.57.193.972.193.4 0 .714-.07.94-.21.227-.14.394-.346.503-.617a2.43 2.43 0 0 0 .104-.395c.018-.123.027-.282.027-.477V13.2H2.34c-.04 0-.06-.02-.06-.062v-.5c0-.04.02-.062.06-.062h1.812c.04 0 .062.02.062.06v.5c0 .156-.005.296-.014.422a4.71 4.71 0 0 1-.04.342 1.732 1.732 0 0 1-.064.262c-.13.523-.402.913-.815 1.17-.413.255-.95.382-1.61.382z\"\/>\n    <\/svg>\n  <\/a>\n  \n  <a href=\"https:\/\/orcid.org\/0009-0004-8387-3559\" \n     target=\"_blank\" \n     rel=\"noopener\"\n    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aria-label=\"View Google Scholar Profile\"\n     style=\"text-decoration: none; color: #4285F4; transition: transform 0.2s; display: inline-block;\"\n     onmouseover=\"this.style.transform='scale(1.15)'\"\n     onmouseout=\"this.style.transform='scale(1)'\">\n    <svg width=\"28\" height=\"28\" viewBox=\"0 0 24 24\" fill=\"currentColor\">\n      <path d=\"M5.242 13.769L0.5 9.5 12 1l11.5 8.5-4.742 4.269C17.548 11.249 14.978 9.5 12 9.5c-2.977 0-5.548 1.748-6.758 4.269zM12 10a7 7 0 1 0 0 14 7 7 0 0 0 0-14z\"\/>\n    <\/svg>\n  <\/a>\n  \n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\">It is a profound honour to share this reflection. Looking back at the <strong><a href=\"https:\/\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/26th-Annual-Scientific-Meeting.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">26th Annual Scientific Meeting of the Cambodian Society of Surgery<\/a><\/strong>, held on <strong>February 6, 2021<\/strong>, I recognise it as a pivotal milestone in my career. Serving as the speaker for the Cambodian Urology Society while representing the Urology Department of Royal Phnom Penh Hospital was not just a professional duty \u2014 it was a chance to share lessons learned from the front line of surgical emergencies.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Today I want to walk through a case that tested every part of my clinical skill and the foundation of the doctor-patient relationship. This is a reflection on managing <strong>Fournier&#8217;s gangrene<\/strong> \u2014 a life-threatening urological emergency \u2014 during the height of the COVID-19 pandemic, while I was practising urology in Cambodia.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"600\" data-attachment-id=\"10243\" data-permalink=\"https:\/\/drsoaraweeurology.com\/ar\/fourniers-gangrene-6-lessons-from-a-urologist\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Fourniers-Gangrene-6-Lessons-from-a-Urologist.jpg?fit=800%2C600&amp;ssl=1\" data-orig-size=\"800,600\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"Fournier&amp;#8217;s Gangrene \u2014 6 Lessons from a Urologist | Visual Summary by Dr. Soarawee\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Fournier&amp;#8217;s Gangrene \u2014 6 lessons from a urologist&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Fourniers-Gangrene-6-Lessons-from-a-Urologist.jpg?fit=800%2C600&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Fourniers-Gangrene-6-Lessons-from-a-Urologist.jpg?resize=800%2C600&#038;ssl=1\" alt=\"Visual summary infographic by Dr. Soarawee Weerasopone \u2014 6 lessons from a urologist on Fournier's gangrene, the life-threatening genital and perineal necrotizing fasciitis, including risk factors, warning signs, and the doctor-patient relationship as a life-saving angel\" class=\"wp-image-10243\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Fourniers-Gangrene-6-Lessons-from-a-Urologist.jpg?w=800&amp;ssl=1 800w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Fourniers-Gangrene-6-Lessons-from-a-Urologist.jpg?resize=300%2C225&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Fourniers-Gangrene-6-Lessons-from-a-Urologist.jpg?resize=768%2C576&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Fourniers-Gangrene-6-Lessons-from-a-Urologist.jpg?resize=16%2C12&amp;ssl=1 16w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Fournier&#8217;s gangrene \u2014 6 lessons from a urologist<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">What Is Fournier&#8217;s Gangrene?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Named after the French dermatologist <strong>Dr. Alfred Fournier<\/strong>, this condition is a form of <strong>necrotising fasciitis<\/strong> affecting the genital and perineal area. It is a true surgical emergency \u2014 every hour of delay matters.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-medium is-resized\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"800\" data-attachment-id=\"10221\" data-permalink=\"https:\/\/drsoaraweeurology.com\/ar\/dr-alfred-fournier\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Dr.-Alfred-Fournier.jpg?fit=800%2C800&amp;ssl=1\" data-orig-size=\"800,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"Dr. Alfred Fournier \u2014 French Dermatologist and Namesake of Fournier&amp;#8217;s Gangrene (Necrotizing Fasciitis)\" data-image-description=\"\" data-image-caption=\"\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Dr.-Alfred-Fournier.jpg?fit=800%2C800&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Dr.-Alfred-Fournier.jpg?resize=800%2C800&#038;ssl=1\" alt=\"Historical portrait of Dr. Alfred Fournier, the 19th-century French dermatologist who first described the rapidly progressive necrotizing fasciitis of the genital and perineal area that bears his name today as Fournier's gangrene \u2014 a life-threatening urological emergency\" class=\"wp-image-10221\" style=\"width:400px\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Dr.-Alfred-Fournier.jpg?w=800&amp;ssl=1 800w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Dr.-Alfred-Fournier.jpg?resize=300%2C300&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Dr.-Alfred-Fournier.jpg?resize=150%2C150&amp;ssl=1 150w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Dr.-Alfred-Fournier.jpg?resize=768%2C768&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Dr.-Alfred-Fournier.jpg?resize=12%2C12&amp;ssl=1 12w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Dr. Alfred Fournier \u2014 the French dermatologist whose name is given to this rare but life-threatening emergency.<\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">The disease is <strong>polymicrobial<\/strong>, meaning it involves a mix of aerobic and anaerobic bacteria \u2014 such as <em>E. coli<\/em> and <em>Pseudomonas aeruginosa<\/em> \u2014 working together to destroy soft tissue at an alarming rate. It often begins subtly: a <a href=\"https:\/\/drsoaraweeurology.com\/services\/uti-treatment-bangkok\/\">urinary tract infection<\/a>, a small perineal abscess, or a minor genital procedure. Once it takes hold of the fascia, the layer of tissue beneath the skin, it spreads rapidly.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Why Early Diagnosis Saves Lives<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Reported mortality varies widely between published series \u2014 older reports describe figures above half of all patients, while modern series with early surgery and intensive care report considerably lower rates. That spread is itself the point. The single variable that moves it most is <strong>time from onset to the operating theatre<\/strong>, which is one of the few things a patient can influence directly by seeking help early. Outcome also depends on age, the extent of tissue involvement, and how unwell the patient is on arrival.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This is why <strong>early diagnosis is the key to survival<\/strong>. The window between a small painful area and a life-threatening emergency can be measured in hours rather than days.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Who Is at Risk?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Certain conditions make people significantly more vulnerable. The most important risk factors include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Uncontrolled or undiagnosed diabetes mellitus<\/strong> \u2014 the single most common risk factor.<\/li>\n\n\n\n<li><strong>Heavy alcohol use<\/strong> \u2014 which weakens the immune system and impairs nutrition.<\/li>\n\n\n\n<li><strong>Immunosuppression<\/strong> \u2014 from chronic illness, chemotherapy, HIV, or long-term steroid use.<\/li>\n\n\n\n<li><strong>Malnutrition<\/strong> \u2014 reflected in low serum albumin levels.<\/li>\n\n\n\n<li><strong>Recent perineal procedures, perianal abscesses, or untreated urinary infections.<\/strong><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Two things that are commonly missed, and both matter.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>It is not only a men&#8217;s disease.<\/strong> Fournier&#8217;s gangrene is far more common in men, which is why it is usually discussed in a urological setting, but women and occasionally children develop it too. A woman with rapidly worsening perineal or vulval pain out of proportion to what can be seen should be taken exactly as seriously.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>SGLT2 inhibitors carry a specific warning.<\/strong> This class of diabetes medicine \u2014 the drugs whose names end in <em>-gliflozin<\/em>, such as dapagliflozin, empagliflozin and canagliflozin \u2014 has been the subject of a regulatory safety warning about a rare association with Fournier&#8217;s gangrene. These are valuable drugs with real cardiovascular and kidney benefits, and the risk is small. <strong>Do not stop taking one because you have read this.<\/strong> What is worth doing is knowing the warning signs below, and seeking care urgently rather than waiting if genital or perineal pain, swelling or redness develops while you are on one.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Warning Signs You Should Never Ignore<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">One of the most dangerous features of Fournier&#8217;s gangrene is that early symptoms can resemble a simple infection or abscess \u2014 but the disease behaves entirely differently. The following table is intended as a patient-safety guide:<\/p>\n\n\n\n<table style=\"width:100%; border-collapse: collapse; margin: 1.5rem 0; font-family: inherit;\">\n  <thead>\n    <tr style=\"background-color: #1a3a6b; color: #ffffff;\">\n      <th style=\"padding: 12px; text-align: left; border: 1px solid #1a3a6b;\">Common Infection<\/th>\n      <th style=\"padding: 12px; text-align: left; border: 1px solid #c8102e;\">Red-Flag Emergency Signs<\/th>\n    <\/tr>\n  <\/thead>\n  <tbody>\n    <tr style=\"background-color: #f5f7fa;\">\n      <td style=\"padding: 12px; border: 1px solid #d1d5db; vertical-align: top;\">Localized pain at the affected site<\/td>\n      <td style=\"padding: 12px; border: 1px solid #d1d5db; vertical-align: top;\"><strong>Pain that spreads quickly<\/strong> beyond the original area, often disproportionate to what you can see on the skin<\/td>\n    <\/tr>\n    <tr>\n      <td style=\"padding: 12px; border: 1px solid #d1d5db; vertical-align: top;\">Mild redness and swelling<\/td>\n      <td style=\"padding: 12px; border: 1px solid #d1d5db; vertical-align: top;\"><strong>Skin that turns dusky, dark, or mottled<\/strong>, or develops blisters or a foul odour<\/td>\n    <\/tr>\n    <tr style=\"background-color: #f5f7fa;\">\n      <td style=\"padding: 12px; border: 1px solid #d1d5db; vertical-align: top;\">Pain controllable with paracetamol<\/td>\n      <td style=\"padding: 12px; border: 1px solid #d1d5db; vertical-align: top;\"><strong>Severe pain that ordinary painkillers cannot control<\/strong><\/td>\n    <\/tr>\n    <tr>\n      <td style=\"padding: 12px; border: 1px solid #d1d5db; vertical-align: top;\">Mild fever, generally well<\/td>\n      <td style=\"padding: 12px; border: 1px solid #d1d5db; vertical-align: top;\"><strong>Confusion, rapid heartbeat, low blood pressure, or feeling dramatically unwell<\/strong> \u2014 signs of sepsis<\/td>\n    <\/tr>\n    <tr style=\"background-color: #f5f7fa;\">\n      <td style=\"padding: 12px; border: 1px solid #d1d5db; vertical-align: top;\">Symptoms improving with oral antibiotics<\/td>\n      <td style=\"padding: 12px; border: 1px solid #d1d5db; vertical-align: top;\"><strong>Symptoms worsening despite antibiotics<\/strong>, especially in someone with diabetes or alcohol use<\/td>\n    <\/tr>\n  <\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>If you or someone you know experiences any of these red-flag signs, go to the nearest emergency department immediately \u2014 not to a clinic appointment, and not to a message.<\/strong> Fournier&#8217;s gangrene is one of the few conditions in urology where the difference between life and death is measured in hours.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"535\" data-attachment-id=\"9932\" data-permalink=\"https:\/\/drsoaraweeurology.com\/ar\/feb-2021-cambodia\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/FEB-2021-Cambodia.webp?fit=906%2C606&amp;ssl=1\" data-orig-size=\"906,606\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"26th Annual Scientific Meeting of the Cambodian Society of Surgery\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;26th Annual Scientific Meeting of the Cambodian Society of Surgery&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/FEB-2021-Cambodia.webp?fit=800%2C535&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/FEB-2021-Cambodia.webp?resize=800%2C535&#038;ssl=1\" alt=\"26th Annual Scientific Meeting of the Cambodian Society of Surgery\" class=\"wp-image-9932\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/FEB-2021-Cambodia.webp?w=906&amp;ssl=1 906w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/FEB-2021-Cambodia.webp?resize=300%2C201&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/FEB-2021-Cambodia.webp?resize=768%2C514&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/FEB-2021-Cambodia.webp?resize=18%2C12&amp;ssl=1 18w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">26th Annual Scientific Meeting of the Cambodian Society of Surgery<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">A Patient Story \u2014 Lessons From the Front Line<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><em>The account that follows is drawn from cases I managed during my years in urology. Identifying details have been changed or combined, and it is presented for what it teaches rather than as a record of any one person.<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A man reached our department after several days of worsening perineal pain. He had been treated elsewhere for what was thought to be a simple perianal abscess, with oral antibiotics and ordinary pain relief. By the time he arrived the pain was unbearable, the skin was changing colour, and the tests showed what neither he nor the doctors before us had known: the familiar and dangerous combination of <strong>uncontrolled diabetes, heavy alcohol use and poor nutrition<\/strong>. Imaging confirmed <strong>Fournier&#8217;s gangrene<\/strong>. Circumstances at the time made transfer elsewhere impractical, and the cost of treatment was a real burden for him \u2014 both of which shaped everything that followed.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">The Surgeon&#8217;s Dilemma \u2014 When Trust Becomes Treatment<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Understandably, the patient was frightened and angry. He was dissatisfied with our inability to give him an exact timeline for recovery or a fixed final cost. At his lowest point he refused to speak with the urology team at all.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">I realised that to save his life, I first had to repair our relationship. So I changed approach:<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Rebuild the bond.<\/strong> I moved from being a provider of a service to being someone he could trust through the hardest weeks of his life.<\/li>\n\n\n\n<li><strong>Personal care.<\/strong> I performed bedside wound dressings myself, twice a day, every day.<\/li>\n\n\n\n<li><strong>Common ground.<\/strong> We talked about things he cared about \u2014 politics, the economy \u2014 and let those conversations carry us through the medical work.<\/li>\n<\/ol>\n\n\n\n<h2 class=\"wp-block-heading\">The Surgical Battle \u2014 A Marathon, Not a Sprint<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Treating Fournier&#8217;s gangrene is rarely a single operation. It is a marathon of <strong>staged surgical debridement<\/strong>, where the surgeon returns to theatre repeatedly to remove infected tissue until only healthy tissue remains. Each return allows the team to reassess what is alive, what is recovering, and what must still be removed. It is worth being honest that this can mean losing a significant amount of tissue, and that reconstruction afterwards is part of the plan rather than an afterthought.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Alongside the surgical work, three things ran in parallel:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Antibiotics:<\/strong> broad-spectrum coverage first, narrowed to targeted therapy once tissue cultures identified the responsible organisms.<\/li>\n\n\n\n<li><strong>Multidisciplinary teamwork:<\/strong> internal medicine colleagues brought his blood sugar under tight control, and the nursing team led meticulous wound care.<\/li>\n\n\n\n<li><strong>Reconstruction:<\/strong> once the infection was defeated, reconstructive surgery closed the wound and restored form and function.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Recovery and Reflection<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">By the time he left hospital, he was pleased with his outcome. Today he is doing well: his diabetes is controlled, his wound has healed, and he has returned to ordinary daily life.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">What stayed with me is not the surgery. It is that the turning point came when the relationship was repaired \u2014 a quiet reminder that while an operation repairs the body, it is trust that carries the person through the weeks afterwards.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Take-Home Messages<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Fundamentals matter.<\/strong> Sound clinical practice and basic surgical skill are the foundation of every good outcome.<\/li>\n\n\n\n<li><strong>The team wins it.<\/strong> Surgery, internal medicine, nursing and nutrition together \u2014 not the surgeon alone.<\/li>\n\n\n\n<li><strong>The relationship is part of the treatment.<\/strong> The ability to connect with a frightened patient can matter as much as the scalpel.<\/li>\n\n\n\n<li><strong>And for the reader, the only one that really counts:<\/strong> pain in the genital or perineal area that is spreading, disproportionate, or accompanied by feeling seriously unwell is an emergency \u2014 particularly with diabetes, heavy alcohol use or a suppressed immune system.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">If you notice any of the red-flag signs above \u2014 especially if you have diabetes, are immunosuppressed, or take an SGLT2 inhibitor \u2014 <strong>do not wait, and do not message anyone for advice. Go to the nearest emergency department.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For non-urgent urological concerns or follow-up, Dr. Soarawee Weerasopone consults at <a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" target=\"_blank\" rel=\"noreferrer noopener\">Bangkok Hospital Headquarters<\/a> and at <a href=\"tel:0880221445\">Samitivej Sriracha Hospital, Chonburi \u2014 088-022-1445<\/a>. The wider range of conditions covered is set out under <a href=\"https:\/\/drsoaraweeurology.com\/services\/general-urology\/\">general urology<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Bangkok Hospital Telemedicine is available for non-urgent matters, including for international patients \u2014 arrange it in advance by email to the Urology department at <a href=\"mailto:bhquro@bdms.co.th\">bhquro@bdms.co.th<\/a>. It is not appropriate for anything described on this page as a red flag: that needs an emergency department, in person, now. Samitivej Sriracha is in-person only.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"571\" data-attachment-id=\"2463\" data-permalink=\"https:\/\/drsoaraweeurology.com\/ar\/blog\/2020-cambodia-speaker\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/2020-Cambodia-Speaker.jpg?fit=1200%2C857&amp;ssl=1\" data-orig-size=\"1200,857\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"Dr. Soarawee Weerasopone Speaking at the 26th Cambodian Society of Surgery Annual Scientific Meeting (February 2021)\" data-image-description=\"\" data-image-caption=\"\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/2020-Cambodia-Speaker.jpg?fit=800%2C571&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/2020-Cambodia-Speaker.jpg?resize=800%2C571&#038;ssl=1\" alt=\"Dr. Soarawee Weerasopone speaking at the 26th Annual Scientific Meeting of the Cambodian Society of Surgery on February 6, 2021, representing the Cambodian Urology Society and Royal Phnom Penh Hospital \u2014 presenting on Fournier's gangrene management during the COVID-19 pandemic\" class=\"wp-image-2463\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/2020-Cambodia-Speaker.jpg?resize=1024%2C731&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/2020-Cambodia-Speaker.jpg?resize=300%2C214&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/2020-Cambodia-Speaker.jpg?resize=768%2C548&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/2020-Cambodia-Speaker.jpg?resize=16%2C12&amp;ssl=1 16w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/02\/2020-Cambodia-Speaker.jpg?w=1200&amp;ssl=1 1200w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Frequently Asked Questions About Fournier&#8217;s Gangrene<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">What is Fournier&#8217;s gangrene in simple terms?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Fournier&#8217;s gangrene is a rare but life-threatening bacterial infection of the soft tissues of the genital and perineal area. It is a form of necrotising fasciitis, meaning the infection rapidly destroys the deep tissue layer beneath the skin and can lead to sepsis and death if not treated urgently with surgery and antibiotics.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Who is most at risk for Fournier&#8217;s gangrene?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The most important risk factor is uncontrolled or undiagnosed diabetes mellitus. Others include heavy alcohol use, immunosuppression from HIV, chemotherapy or long-term steroids, severe malnutrition, and recent perineal infections, abscesses or procedures. It is far more common in men, but women and occasionally children are affected too.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Do SGLT2 inhibitors cause Fournier&#8217;s gangrene?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">This class of diabetes medicine \u2014 the drugs ending in -gliflozin \u2014 has been the subject of a regulatory safety warning about a rare association with Fournier&#8217;s gangrene. The risk is small and these drugs have important cardiovascular and kidney benefits, so nobody should stop one on the basis of an article. What matters is awareness: if genital or perineal pain, swelling or redness develops while taking one, seek urgent assessment rather than waiting, and tell the doctor which medicines you are on.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">What are the early warning signs of Fournier&#8217;s gangrene?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Pain in the genital or perianal area that spreads quickly and feels disproportionate to what is visible on the skin, dusky or darkening skin, foul odour, severe pain not controlled by ordinary painkillers, and signs of sepsis such as confusion, rapid heartbeat or low blood pressure. Symptoms worsening despite oral antibiotics is another warning. Any of these need emergency assessment.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">How is Fournier&#8217;s gangrene treated?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Three things working together: emergency surgical debridement, often in several stages, to remove infected tissue; broad-spectrum intravenous antibiotics narrowed once cultures identify the bacteria; and aggressive support of underlying problems such as diabetes and nutrition. Once the infection is controlled, reconstructive surgery closes the wound. Significant tissue may be lost in the process, which is part of why speed matters so much.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Can Fournier&#8217;s gangrene be cured?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Yes, with rapid recognition and aggressive treatment. With early surgery, modern antibiotics, intensive care and good control of underlying conditions, many patients recover fully. Mortality remains significant across published series, and the strongest determinant is how quickly the patient reaches an operating theatre \u2014 which is why the warning signs matter more than any other part of this article.<\/p>\n\n\n\n<script type=\"application\/ld+json\">\n{\n  \"@context\": \"https:\/\/schema.org\",\n  \"@graph\": [\n    {\n      \"@type\": \"MedicalWebPage\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2026\/05\/27\/fournier-gangrene-urologist-reflection\/#webpage\",\n      \"url\": \"https:\/\/drsoaraweeurology.com\/2026\/05\/27\/fournier-gangrene-urologist-reflection\/\",\n      \"name\": \"Fournier's Gangrene: A Urologist's Reflection on Saving Lives Through Surgery and Connection\",\n      \"description\": \"What Fournier's gangrene is, who is at risk including women and patients on SGLT2 inhibitors, the red-flag signs that require an emergency department, and how it is treated.\",\n      \"inLanguage\": \"en\",\n      \"datePublished\": \"2026-05-27\",\n      \"dateModified\": \"2026-08-15\",\n      \"isPartOf\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#website\" },\n      \"author\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"reviewedBy\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"publisher\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"about\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/2026\/05\/27\/fournier-gangrene-urologist-reflection\/#fournier\" },\n      \"audience\": { \"@type\": \"MedicalAudience\", \"audienceType\": \"Patient\" },\n      \"disambiguatingDescription\": \"Fournier's gangrene is a surgical emergency requiring an emergency department rather than a clinic appointment or a message. 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It is a form of necrotising fasciitis, meaning the infection rapidly destroys the deep tissue layer beneath the skin and can lead to sepsis and death if not treated urgently with surgery and antibiotics.\"\n          }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Who is most at risk for Fournier's gangrene?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"The most important risk factor is uncontrolled or undiagnosed diabetes mellitus. Others include heavy alcohol use, immunosuppression from HIV, chemotherapy or long-term steroids, severe malnutrition, and recent perineal infections, abscesses or procedures. 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With early surgery, modern antibiotics, intensive care and good control of underlying conditions, many patients recover fully. Mortality remains significant across published series, and the strongest determinant is how quickly the patient reaches an operating theatre.\"\n          }\n        }\n      ]\n    }\n  ]\n}\n<\/script>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Disclaimer:<\/strong> This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice. Patient details in this article have been generalised to protect privacy. No advice, diagnosis or prescription is given through personal messaging channels or social media \u2014 and a suspected necrotising infection is not something to ask about by message. If you suspect a serious infection, go to an emergency department immediately.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Fournier&#8217;s gangrene is one of the few conditions in urology where hours genuinely decide whether a patient lives. Dr. Soarawee Weerasopone reflects on speaking at the 26th Annual Scientific Meeting of the Cambodian Society of Surgery \u2014 on aggressive surgery, early recognition, and the human connection that carries patients through it.<\/p>","protected":false},"author":185281453,"featured_media":10233,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"advanced_seo_description":"Dr. Soarawee Weerasopone, urologist at Bangkok Hospital, explains Fournier's gangrene \u2014 a life-threatening urological emergency \u2014 including warning signs, risk factors, and why early diagnosis saves lives.","jetpack_seo_html_title":"Fournier's Gangrene: Warning Signs & Treatment | Dr. Soarawee, Urologist","jetpack_seo_noindex":false,"jetpack_seo_schema_type":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_wpcom_ai_launchpad_first_post":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"{title}\n\n{excerpt}\n\n{url}","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"_wpas_customize_per_network":false,"jetpack_post_was_ever_published":false},"categories":[1362],"tags":[],"class_list":["post-10222","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-infection"],"jetpack_publicize_connections":[],"jetpack_likes_enabled":false,"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/pgZdrK-2ES","jetpack_featured_media_url":"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Fourniers-Gangrene.jpg?fit=1200%2C630&ssl=1","_links":{"self":[{"href":"https:\/\/drsoaraweeurology.com\/ar\/wp-json\/wp\/v2\/posts\/10222","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoaraweeurology.com\/ar\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoaraweeurology.com\/ar\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/ar\/wp-json\/wp\/v2\/users\/185281453"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/ar\/wp-json\/wp\/v2\/comments?post=10222"}],"version-history":[{"count":16,"href":"https:\/\/drsoaraweeurology.com\/ar\/wp-json\/wp\/v2\/posts\/10222\/revisions"}],"predecessor-version":[{"id":11485,"href":"https:\/\/drsoaraweeurology.com\/ar\/wp-json\/wp\/v2\/posts\/10222\/revisions\/11485"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/ar\/wp-json\/wp\/v2\/media\/10233"}],"wp:attachment":[{"href":"https:\/\/drsoaraweeurology.com\/ar\/wp-json\/wp\/v2\/media?parent=10222"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/ar\/wp-json\/wp\/v2\/categories?post=10222"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/ar\/wp-json\/wp\/v2\/tags?post=10222"}],"curies":[{"name":"\u0648\u0648\u0631\u062f\u0628\u0631\u064a\u0633","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}