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.

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.

Treatment satisfaction is a predictor of long-term compliance in patients with erectile dysfunction (ED). We assessed patient satisfaction with and efficacy of Viagra (sildenafil citrate) using the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) and 3 global efficacy questions. Twenty-nine men with ED who had completed a prior study of MUSE (alprostadil) versus Caverject (alprostadil) took a 50-mg dose of Viagra 1 h preceding intercourse. Efficacy and patient satisfaction with Viagra were high. Satisfaction as measured by EDITS was highly correlated to patients' final ED treatment choice. This correlation could make EDITS useful in identifying long-term patient satisfaction, and thus of considerable clinical benefit.