INTRODUCTION: Fournier's gangrene (FG) is a life-threatening necrotizing infection of the perineal, genital, or perianal regions, often requiring extensive surgical intervention and prolonged recovery. Despite advances in acute management, the long-term impact of FG on patients' self-esteem and quality of life (QoL) remains underexplored. METHODS: This retrospective study included 48 patients treated for FG at seven urological centres in Austria between 2017 and 2022. Several in-house data were collected and patients were contacted after a mean of 4.5 years to complete a questionnaire including the International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-5), Short Form (SF-12) QoL questionnaire, and the Rosenberg self-esteem scale (RSE). RESULTS: The study recruited 48 patients with a median age of 64 years
58.7% required intensive care unit stays due to infection (median duration, 6 days). The in-house mortality rate was 8.3%. Survivors (n = 44) had a median hospitalization of 16 days. They were contacted by mail, and 18 completed the questionnaire. There was a high prevalence of urinary symptoms and erectile dysfunction, wound pain, and impaired QoL. Severe erectile dysfunction (IIEF-5 score ≤7) was reported by 46.2%, and 38.9% reported Visual Analog Scale pain score ≥4. Impaired self-esteem (mean RSE score: 12.4) correlated with functional impairments, including urinary symptoms (IPSS ≥20 in 55.6%), erectile dysfunction, and wound-related pain. Physical and mental health were strongly associated with decreased self-esteem, with hypertension (61.1%) and alcohol abuse (16.7%) negatively impacting outcomes. CONCLUSION: FG negatively impacts patients' self-esteem and QoL, particularly in the presence of pre-existing risk factors. The findings highlight the importance of integrated rehabilitation approaches to mitigate long-term psychological and functional impairments.