Faculty Bibliography

INTRODUCTION/BACKGROUND:Penile Prosthesis infection is a dreaded complication that can occur after primary inflatable penile implants. Redo prosthesis operations and salvage procedures have become increasingly popular after these inflections. These operations, however, have higher rates of re-infection as compared to primary implants. AIM/OBJECTIVE:We describe a patient who was referred for repeat redo penile prosthesis surgery in whom retained rear-tip extenders harboring purulent fluid was discovered during physical examination. RESULTS:The patient underwent exploration and two rear-tip extenders were removed. He later underwent redo prosthesis insertion and the device remains fully functional and infection free at follow-up. CONCLUSION/CONCLUSIONS:This case conveys the importance of a thorough physical examination and raises the index of suspicion for retained prosthesis fragments in patients with recurrent penile prosthesis infections.

Infection is a devastating complication of penile prosthesis surgery that occurs in approximately 2-5% of all primary inflatable penile primary implants in most series. Prevention of hematoma and swelling with closed-suction drains has been shown not to increase infection rate and yield an earlier recovery time. Despite the intuitive advantages of short-term closed-suction drainage in reducing the incidence of postoperative scrotal swelling and associated adverse effects, many urologists are reluctant to drain the scrotum because of a theoretical risk of introducing an infection. In conclusion, this study was undertaken to evaluate the incidence of infection in three-piece penile prosthesis surgery with scrotal closed-suction drainage. A retrospective review of 425 consecutive primary three-piece penile prosthesis implantations was performed at three institutions in New Jersey, Ohio, and Arkansas from 1998 to 2002. Following the prosthesis insertion, 10 French Round Blake (Johnson & Johnson) or, in a few cases, 10 French Jackson Pratt, closed-suction drains were placed in each patient for less than 24 h. All subjects received standard perioperative antibiotic coverage. Average age at implant was 62 y (range 24-92 y). Operative time (incision to skin closure) was less than 60 min in the vast majority of cases. There were a total of 14 (3.3%) infections and three hematomas (0.7%) during an average 18-month follow-up period. In conclusion, this investigation revealed that closed-suction drainage of the scrotum for approximately 12-24 h following three-piece inflatable penile prosthesis surgery does not result in increased infection rate and is associated with a very low incidence of postoperative hematoma formation, swelling, and ecchymosis.

We report a case involving a 55-year-old healthy man that presented with urinary retention and a lower abdominal mass. His evaluation revealed a large mucocele arising from the appendix that caused severe bilateral ureteral obstruction and renal failure. Appendiceal mucoceles are rare and insidious entities that can present with urologic manifestation. Despite their rarity, this case highlights the importance of including mucoceles in the differential diagnosis in cases involving ureteral obstruction caused by external compression.

Priapism is a relatively uncommon condition that may present as a medical emergency associated with significant pain and anxiety in the veno-occlusive or low-flow variant. Pharmacologic advances and, specifically, the availability of intracavemosal alpha-agonist therapy have dramatically improved the prospects of resolution for patients with low-flow priapism presenting within the first few hours of the acute episode. High-flow priapism is not considered an emergency and treatment measures are typically conservative aimed at preservation of potency. Urologists, radiologists, and other health care personnel caring for the patient with priapism must be familiar with various etiologic factors implicated in low-flow and high-flow priapism to formulate a logical step-care approach. Differentiation of the low-flow from the high-flow state is perhaps the most critical initial diagnostic challenge that determines the sequence of further interventions including surgical shunts in low-flow priapism refractory to medical therapy.