Optilume® drug-coated balloon dilation for the treatment of refractory post-TURP bladder neck contracture.

This case report presents the first use of Optilume® drug-coated balloon (DCB) technology for the management of post-transurethral resection of the prostate bladder neck contracture (BNC), a condition often resistant to traditional treatments. A 62-year-old male with recurrent BNC, unresponsive to multiple operative interventions, underwent treatment with the Optilume® DCB, resulting in significant symptom resolution without further invasive procedures. This novel application of DCB technology, delivering paclitaxel directly to the affected tissue, offers a promising alternative by targeting the underlying pathophysiology of BNC.

Thulium laser to intraurethral Gordian Knot: A novel technique.

Self-inserted urethral foreign bodies are an unusual albeit well documented phenomena and cause of hospital presentation. When conservative non-operative managements fail, operative management is imperative to prevent further complications including infection, stones, diverticula, and fistula formation. Minimally invasive alternatives should be considered when cystoscopic access to the foreign body is mechanically difficult. Through this case presentation, we showcase a novel technique to consider when dealing with intraurethral foreign bodies - the use of thulium laser with rigid ureteroscope. We believe this to be the first documented case of successful intraurethral foreign body fragmentation using thulium laser.

Evaluation of MV140 in preventing recurrent urinary tract infections: a multicentre double-blind randomized controlled trial protocol.

OBJECTIVES: To determine, firstly, whether MV140 reduces rates of recurrent urinary tract infections (rUTIs) in patients older than 65 years, measured as the number of urinary tract infections (UTIs) detected over 12 months following the completion of a 3-month treatment course and, additionally, to assess the number of re-admissions to the emergency department, the rate of antibiotic use for UTIs, the safety profile of MV140, and quality of life. MATERIALS AND METHODS: This is a multicentre, double-blind, randomized controlled trial with two arms. Patients will be randomized and allocated to receive either a 3-month course of MV140 or placebo (two sublingual sprays daily). Participants will have 3-monthly consultations with the investigator for 12 months to assess differences in rates of rUTIs between the two groups. Study candidates will be identified and recruited from inpatient and outpatient clinics across Sydney via referral to the investigation team. After obtaining consent, participants will undergo initial study consultations including urine microscopy and culture, uroflowmetry, and bladder scan to assess postvoid residual urine volume. Participants will be randomized and provided with a unique trial number. Electronic medical records will be reviewed to collect relevant information. Participants will be provided with a study diary to record relevant data. RESULTS: Follow-up consultations will be conducted every 3 months for a 12-month duration, during which the study diary will be reviewed. These follow-up consultations will primarily occur via telephone review, however, there will be flexibility for in-person reviews for participants who find telephone consultation prohibitively difficult. CONCLUSION: This is a multicentre, double-blinded, randomised control trial, the first in Australia to assess the safety and efficacy of MV140 Uromune vaccine in prevention of recurrent UTIs. Results have been promissing in the global literatures.

A narrative review: evaluation and surgical management of persistent and recurrent urinary incontinence after previous surgical treatment.

Background and Objective: Urinary incontinence after prostate treatment is associated with significant morbidity and impact on quality of life. Stress urinary incontinence can be treated by insertion of a urethral sling or artificial urinary sphincter. Persistent or recurrent urinary incontinence after such treatment can be frustrating and require specific evaluation and approach to management to optimize chance of successful outcomes and patient satisfaction whilst avoiding further patient morbidity. The aim of this review is to outline the evaluation and management of persistent and recurrent urinary incontinence in men after previous surgical treatment for stress urinary incontinence by way of narrative review. Methods: A literature review was performed using PubMed, MEDLINE, and Google Scholar between 2010 to 2023. The search strategy included the following MeSH terms: device, men, urinary incontinence, persistence, recurrence, and revision. A total of 140 English-language articles were identified and reviewed; 68 articles were considered relevant to the aims and the findings have been outlined in this narrative review. Key Content and Findings: There are many approaches currently practiced by surgeons in continence revision surgery. There is not clear consensus regarding optimum revision strategy for persistent and recurrent incontinence post urethral sling and artificial urinary sphincter insertion. Whilst small observational studies have reviewed different surgical approaches, there is a paucity of high volume comparative data from which to draw conclusions. However, there have been recent studies enabling a paradigm shift in the understanding of incontinence post artificial urinary sphincter insertion that may lead to improved revision strategies in future. Conclusions: There are various surgical modalities used to manage incontinence following urethral sling and artificial urinary sphincter insertion. There is currently no clear consensus on the optimal surgical technique for persistent or recurrent urinary incontinence after surgery. Further comparative studies would be beneficial to help guide surgeons as to which revision approaches would be suitable for select patients.

Penile pressure ulcers secondary to indwelling catheter and prone positioning for COVID-19 infection.

Prone ventilation is an effective and increasingly utilised tool in the management of Acute Respiratory Distress Syndrome (ARDS), a common sequela of COVID-19 infection. However, its use is associated with a significant risk of pressure ulcers. We report a unique case of prone positioning, catheter-related penile pressure ulcer. Clinical awareness, early recognition and regular repositioning is crucial in the prevention of this complication.

Corpora cavernosum abscess and corporoglanular fistula following penile shunts for ischemic priapism.

Ischemic priapism is a urologic emergency requiring urgent intervention to prevent tissue necrosis and preserve erectile function. Cases refractory to aspiration and intra-cavernosal sympathomimetic therapy requires timely surgical shunting. Corpus cavernosum abscess following penile shunts is an exceedingly rare complication, with as few as 2 previous reported cases. We report our experience and outcome in the case of a 50-year-old patient who developed a corpora cavernosum abscess and concurrent corporoglanular fistula, following penile shunt procedures for ischemic priapism.

The perils of penile enhancement: case report of a fulminant penile infection.

BACKGROUND: Penile enhancement with injectable agents is a rising trend and yet has received little scientific attention despite the potential for serious complications. These include cosmetic, functional and systemic complications that may require complex penile reconstructive surgery. We report a case of delayed severe infection following penile filler insertion leading to multi-organ failure and intensive care support. CASE PRESENTATION: A 31-year-old man presented with fevers and progressive pain and swelling of the penile shaft, 3 days after unprotected sexual intercourse. The patient received subcutaneous hyaluronic filler injections at a cosmetic clinic for penile enlargement two months prior to presentation. Relevant social history include polysubstance abuse and multiple sexual partners. Physical examination revealed gross penile oedema and erythema, with a ventral curvature of the penile shaft and a superficial abrasion on the distal ventral penile shaft. Within 24 h the patient developed septic shock with anuria, hypotension and fevers to 40 °C, requiring transfer to the Intensive Care Unit (ICU) for vasopressor and inotropic support. Intraoperative penile exploration revealed multiple pus stained fillers which were drained and grew Streptococcus Pyogenes on cultures. There was no abscess or evidence of necrotising fasciitis intraoperatively. The patient improved with intravenous antibiotics and was stepped down from the ICU after four days and discharged on day eight. One month post admission there was significant superficial skin loss to both ventral and lateral aspect of the penis, with healthy granulation tissue at the base. The patient opted for conservative management with regular dressings. He reported normal sexual and urinary function three months post admission. CONCLUSION: This is the first published case of sepsis from a penile infection in the context of hyaluronic acid penile fillers. In an era of escalating demand for penile cosmetic procedures, there is an increasing need for early recognition and appropriate management of penile filler infections. We report an unusual case of a localised penile infection rapidly progressing to sepsis with multi-organ failure requiring intensive care support. The case demonstrates early surgical intervention with targeted antimicrobials can result in successful eradication of infection, with satisfactory cosmetic and functional outcomes for patients.