HbA1c over 8.5% is not predictive of increased infection rate following penile prosthesis implant surgery in diabetic patients with erectile dysfunction.

Diabetes mellitus is associated with increased risk of erectile dysfunction. Penile prosthesis implantation is an efficient therapeutic option for erectile dysfunction, but not without risk, as infection remains a prominent concern. This study investigates diabetes mellitus as a risk factor for penile prosthesis implantation infection and the relationship between haemoglobinA1c levels and infection rates. All diabetic patients with erectile dysfunction who underwent penile prosthesis implantation surgery between January 2012 and November 2019 at Hamad Medical Corporation, Qatar, were included in this retrospective observational study. A total of 599 diabetic patients with erectile dysfunction had penile prosthesis implantation. Mean age was 59.69 ± 31.19. Penile prosthesis implantation infection rate was 0.83% (5/599), while the mean haemoglobinA1c level was 7.58 ± 1.45 mmol/l (range: 4.1-12.6). A comparison between diabetic patients with penile prosthesis implantation infection and those without infection revealed no significant difference in the level of haemoglobinA1c between the two groups with mean haemoglobinA1c in patients with infected implants 7.14 and 7.59 for noninfected (p = 0.491). Limitations include retrospective single-centre design and low-infection rates reducing sample number. Penile prosthesis implantation infection rate in a large series of diabetic patients was low with no significant association between haemoglobinA1c level and penile prosthesis implantation infection observed.

Comprehensive Multimodality Imaging Review of Complications of Penile Prostheses.

OBJECTIVE: The objective of our article is to review the role of imaging in the diagnosis of various complications of a penile prosthesis (PP). CONCLUSION: Complications of a PP can be categorized into three groups: first, malpositioning, which includes buckling, floppy glans, erosion, migration, and crossover; second, mechanical failure, which includes fracture, aneurysm, and leakage; and, third, infection. Radiography, sonography, CT, and MRI are useful in the detection of these complications and complement each other, with MRI being the most useful imaging modality among them.

Introduction to Imaging of Penile Prostheses: A Primer for the Radiologist.

OBJECTIVE: The purpose of this article is to provide radiologists with an introduction to the imaging appearances of various types of penile prostheses and discuss imaging pitfalls. CONCLUSION: Two major types of penile prostheses currently are in use: malleable penile prostheses and inflatable penile prostheses. Sonography is useful in the assessment of the pelvic reservoir and scrotal pump. MRI helps in the complete evaluation of all the prosthetic components, making it a "one-stop shop" imaging technique.

Treatment of penile strangulation by the rotating saw and 4-needle aspiration method: two case reports.

INTRODUCTION: The aim of this article was to describe our experience in using rotating saw and also combination of the instrument with 4-needle aspiration. METHODS: A comprehensive review of the literature was performed using PubMed. "Penile strangulation, -constriction, -incarceration, -entrapment" were used as search terms, and a manual bibliographic review of cross referenced items was performed. RESULTS: Search results yielded nearly 70 cases of penile strangulation caused by a variety of objects. Various instruments have been described in the literature for their safe removal, each with its own pros and cons. CONCLUSIONS: Penile strangulation should be accepted as a self-induced priapism and managed as an emergency in order to preserve erectile function and to prevent penile necrosis. Surgical creativity and patience are necessary in order to have a successful outcome.

Axial penile rigidity influences patient and partner satisfaction after penile prosthesis implantation.

INTRODUCTION: Penile prosthesis implantation is one of the treatment choices that is kept for patients who were not satisfied with other treatments. Although penile prosthesis satisfaction rates are higher, there are some dissatisfied patients. The patients' reasons are mostly shortness and softness of implanted prosthesis. It was previously demonstrated that penile axial rigidity of more than 500 grams is enough for successful vaginal intromission. To our knowledge, there is no study comparing axial rigidity of penile prosthesis and satisfaction. OBJECTIVES: The aim of this study was to examine whether axial rigidity of penile prosthesis had impact on patient and partner satisfaction. MATERIALS AND METHODS: We enrolled one hundred patients who were implanted penile prosthesis before to evaluate their penile axial rigidity. We used Rigidometry (by using the digital inflection rigidometer) to assess the minimal axial pressure to bend the implanted penis. RESULTS: We demonstrated that mean axial pressure to bend the implanted penis was 984.8 ± 268.7 grams. Overall satisfaction score with the penile prosthesis implant was 4.55 and 4.49 (out of 5) in patients and partners, respectively. In total, seven men were unsatisfied with their implant and reported a mean satisfaction score of 0.6 ± 0.48 (out of 5). All prostheses types showed good and more than 500 grams axial rigidity. The patients with Ambicor type, which were buckled at about 710.5 grams, showed worse satisfaction rates in comparison to other prostheses in two patients. Digital inflection rigidometer results of other penile prosthesis types in unsatisfied patient were 842.0, 872.0, 887.0 and 920 g. in CX700, Titan, Genesis and Titan OTR, respectively. CONCLUSION: We demonstrated that dissatisfaction rate was highest in Ambicor prosthesis implanted patients. Additionally, patients with 3-piece penile prosthesis were more satisfied than 2-piece or malleable ones, interestingly, although some cases had lower axial rigidity results.

Isolated pump erosion of an inflatable penile prosthesis through the scrotum in a diabetic patient.

Isolated pump erosion is a rare complication in patients with inflatable penile prosthesis. We describe a case of a diabetic patient who underwent inflatable penile prosthesis implantation with subsequent isolated pump erosion. Repeated attempts of conservative repair of the erosion failed. Finally, the inflatable penile prosthesis was replaced with a malleable one to avoid new pump erosion. In case of isolated pump erosion, replacement of the inflatable penile prosthesis with a malleable one looks to be a good alternative salvage treatment for the patient.

Feasibility and Outcomes of Temporary Bulbar Urethral Stent Placement After Internal Urethrotomy in the Largest Multicenter Series.

BACKGROUND: Recent years have seen the development of a new generation of temporary urethral stents as an adjuvant option after direct vision internal urethrotomy (DVIU). Despite some early promising results, large series addressing their safety and outcomes are still lacking. OBJECTIVE: To report complications and outcomes from the largest series of patients receiving a temporary bulbar urethral stent to date. DESIGN, SETTING, AND PARTICIPANTS: We performed a retrospective analysis of bulbar urethral stenting procedures after DVIU in seven centers. Patients either refused urethroplasty or were not fit for surgery. The stents were removed after at least 6 mo in place unless complications requiring earlier removal occurred. SURGICAL PROCEDURE: DVIU with a cold knife or laser is performed, followed by stent placement. At the end of the treatment period, the stent is removed under cystoscopy with gripping forceps. MEASUREMENTS: All patients underwent postoperative follow-up (FU) for assessment of complications while the stent was in place. After removal, the FU schedule consisted of office evaluation at 6 mo and 12 mo, and then annually. Failure was defined as any treatment for urethral stricture after stent removal. RESULTS AND LIMITATIONS: A total of 49% of the patients experienced complications. The most frequent were discomfort (23.8%), stress incontinence (17.5%), and stent dislocation (9.8%). Some 85% of the adverse events observed were Clavien-Dindo grade <3. The overall success rate at median FU of 38.2 mo was 76.9%. The success rate was significantly lower if the stent was removed before 6 mo (53.3% vs 79.7%; p = 0.026). CONCLUSIONS: Temporary urethral stents may be a safe choice with satisfactory results in patients not undergoing urethroplasty. A stent indwelling time shorter than 6 mo provides worse outcomes that are comparable to those with DVIU alone. PATIENT SUMMARY: We assessed complications and outcomes after placement of a temporary narrow tube in the urethra after surgery to widen a narrowing of the urethra. The treatment is safe and easily reproducible with satisfactory results. Further studies are needed to confirm our findings.

Reporting quality of abstracts of systematic reviews/meta-analyses: An appraisal of Arab Journal of Urology across 12 years: the PRISMA-Abstracts checklist.

Objective: We appraised the reporting quality of abstracts of systematic reviews/meta-analyses (SR/MAs) published in one urology journal and explored associations between abstract characteristics and completeness of reporting. Methods: The Arab Journal of Urology (AJU) was searched for SR/MAs published between January 2011 and 31 May 2022. SR/MAs with structured abstract and quantitative synthesis were eligible. Two reviewers simultaneously together selected the SR/MAs by title, screened the abstracts, and included those based on inclusion/exclusion criteria. Data of a range of characteristics were extracted from each SR/MAs into a spreadsheet. To gauge completeness of reporting, the PRISMA-Abstract checklist (12 items) was used to appraise the extent to which abstracts adhered to the checklist. For each abstract, we computed item, section, and overall adherence. Chi-square and t-tests compared the adherence scores. Univariate and multivariate analyses identified the abstract characteristics associated with overall adherence. Results: In total, 66 SR/MAs published during the examined period; 62 were included. Partial reporting was not uncommon. In terms of adherence to the 12 PRISMA-A items were: two items exhibited 100% adherence (title, objectives); five items had 80% to <100% adherence (interpretation, included studies, synthesis of results, eligibility criteria, and information sources); two items displayed 40% to <80% adherence (description of the effect, strengths/limitations of evidence); and three items had adherence that fell between 0% and 1.6% (risk of bias, funding/conflict of interest, registration). Multivariable regression revealed two independent predictors of overall adherence: single-country authorship (i.e. no collaboration) was associated with higher overall adherence (P = 0.046); and abstracts from South America were associated with lower overall adherence (P = 0.04). Conclusion: This study is the first to appraise abstracts of SR/MAs in urology. For high-quality abstracts, improvements are needed in the quality of reporting. Adoption/better adherence to PRISMA-A checklist by editors/authors could improve the reporting quality and completeness of SR/MAs abstracts.

Complications of penile augmentation by use of nonmedical industrial silicone.

INTRODUCTION: Penile augmentation has been reported in the literature by injecting various materials by nonmedical persons. AIM: This study aims to present our experience in management of penile augmentation complications associated with injection or implantation of industrial silicone by lay persons. MAIN OUTCOME MEASURES: Early surgical intervention can lead to faster recovery and better cosmetic and functional outcome. METHODS: Two patients had injection of industrial silicone paste, and the other two had industrial silicone ring implantation. All the patients except one were presented after 13 months of the procedure. Patients with industrial silicone ring presented with multiple sinuses of penile skin in one, and abscess discharge pus from the site of implanted ring in the other. Both patients with injected silicone paste presented with swelling and deformity of the penis that interfered with their intercourse. Silicone ring patients underwent skin incision and drainage of the infected materials and extraction of the implants with delayed skin closure. The two patients with silicone paste injection underwent two-stage penile reconstructions using scrotal flap. RESULTS: Patients with extracted rings had smooth recovery with acceptable cosmetic outcome. One of them was not initially satisfied with the length of his penis that was overcome by short-term use of vacuum device. One of the patients with silicone paste injection had wound infection that was successfully treated with local wound care. Both had satisfactory penile length and acceptable cosmetic outcome. All patients had normal erectile function postoperatively. CONCLUSION: Complications of using industrial silicone injection can be drastic, and awareness of the public can avoid using of this material for penile augmentation.

Use of Temporary Membrane-Covered Self-Expandable Metallic Stent - UVENTATM for Treatment of Recurrent Bulbar Urethral Stricture.

Introduction: Recurrent urethral stricture is a real challenge. Interestingly use of temporary double layered self-expanding nitinol urethral stent with polytetrafluoroethylene (PTFE) membrane coating (UventaTM, Taewoong Medical, South Korea) has been recently reported with promising short-term results in recurrent urethral stricture. However most of the reported studies are published as abstracts of either case reports or case series of miniscule numbers. The aim of our study is to evaluate the outcome of this temporary urethral stent in patients with recurrent urethral stricture after urethroplasty as well as after multiple visual internal urethrotomy. Materials and Methods: In this retrospective study, 22 patients had placement of double-layered self-expanding stent with PTFE membrane coating (Uventa, Taewoong Medical) for recurrent bulbar strictures. The present study included cases between 2017 and 2020. The stricture in each patient were evaluated with Uroflowmetry and ascending urethrography. The data of demographic and clinical characteristics included age, aetiology, location and length of stricture, along with maximum urinary flow rate (Qmax), number of previous interventions, and stent-related complications. Results: The overall clinical success was achieved in 13/22 (59.1%) of patients at a median follow-up of 17 months (range 2-44). The mean maximum urine flow rates were 7.07 ± 3.55mL/sec, 23.50 ± 10.41mL/sec, 21.41± 15.55 mL/sec, 14.88 ± 9.77 and 17.63 ± 12.28 mL/sec before, while stent in place, at 3 months, 6 months and 12 months after the procedure, respectively. Conclusion: In our study, the success rate of temporary urethral stent placement has remained at 59.1% at a median follow-up of 17 months. We conclude that further randomized controlled studies with long-term follow up are required to fully evaluate the outcome.

Ergonomics and Surgeon Comfort During Flexible Ureteroscopy.

The technological advancements of flexible ureteroscopy (FURS) and its accessories have resulted in broadening its indications to include the management of complex renal stones, with long operative time. The surgeon's understanding about the ergonomics of the ureteroscopes and their cognizance of the operation theatre layout helps to improve their performance, including the surgical outcomes. This paper will describe the ergonomics that are involved in conducting FURS which in turn will aid in developing a more conducive surgical environment for the surgeon during the procedure, based on scientific literature review and expert opinions in high-volume centres. Proper surgeon position, well-arranged operation theatre layout, monitor and pedal position, anaesthesia type, and surgical team are important factors to decrease musculoskeletal strains for surgeons and increase work efficiency. Different types of flexible ureteroscope have different characters and knowing these special characters leads to better ergonomics during surgery. Robotic-assisted FURS have shown good safety and ergonomics in clinical application.

Presentation, diagnosis, management, and outcomes of prostatic abscess: comparison of three treatment modalities.

PURPOSE: The lack of available guidelines for the management of prostatic abscess (PA) results in inconsistencies in its management. The most commonly used management modalities were conservative treatment with parenteral antibiotics alone, transrectal ultrasound-guided (TRUS) needle aspiration, or transurethral deroofing (TUD).The current study is a retrospective study and examines prostatic abscess cases treated by either one or more of the different modalities. We assess and compare presentation, diagnosis, management, and outcomes of prostatic abscess and we compare the outcomes of the three management modalities. METHODS: We retrieved the records of all patients (n = 23) admitted to the Urology department at Al Wakra hospital with the computed tomography (CT) diagnosis of prostatic abscess from January 2013 to March 2018. Data collected included demographic, clinical, laboratory, and imaging findings, as well as management modality, duration of hospital stay, duration of follow up, outcome, and recurrence. RESULTS: A total of nine (39.1%) patients had conservative treatment only; eight (34.8%) had TUD, and six (26.1%) had TRUS needle aspiration. The mean age was 52.7 years. Lower urinary tract symptoms and fever were the most common presentations (95.7% and 82.6%, respectively). CT scan of the abdomen and pelvis with contrast was undertaken for all patients and it showed that multiple abscesses were observed in 14 (60.9%) cases.The overall mean hospital stay was 8.45 days (range 2-21 days). We observed no recurrences for patients treated conservatively or those who undertook TUD, but three patient (50%) recurrences were noted in TRUS aspiration patients. There was no mortality across the sample. CONCLUSION: Early diagnosis of prostatic abscess and prompt management may have decreased the morbidity and mortality. Conservative management can succeed in subcentimeter abscesses but TUD is the definite therapy for large and multiloculated abscess. TRUS aspiration does have a role in treatment, but it has higher recurrence and longer hospital stay.

Recurrent Testicular Torsion of a Fixed Testis.

Recurrent testicular torsion after previous orchiopexy is rare and needs high index of suspension to avoid misdiagnosis and delayed management. This case showed that this diagnosis can occur even when the testis is still fixed to the scrotal wall. A 31-year-old male who had previous testicular fixation for testicular torsion with a single stitch to the lower pole before 6 years presented with recurrent testicular torsion and missed diagnosis. This case confirm that recurrent testicular torsion after previous fixation should be included in the differential diagnosis of acute scrotum and emphasis on the testicular fixation with nonabsorbable suture in at least two points to prevent recurrent torsion.

Penile Fracture: Simultaneous Complete Urethral Rupture with Bilateral Corpora Cavernosa Rupture.

Penile fracture is not uncommon blunt trauma to the penis. Here, we present a rare case of penile fracture during sexual intercourse. The patient presented with penile swelling, bleeding per urethra, and inability to pass urine. Retrograde urethrogram showed significant extravasation of contrast from anterior penile urethra and no contrast passing to proximal urethra. Surgical exploration showed complete urethral rupture and bilateral cavernosal rupture. This case represents the value of urethrogram to evaluate the urethral injury and the association of complete urethral injury with bilateral ventral cavernosal injury.

Urethral Catheterization of Buried Penis in Obese Patients: a Novel Technique and Literature Review.

BACKGROUND: Urethral catheterization is a common procedure in daily medical practice and most medical staff are trained for the procedure. Buried penis in morbid obese patients with scrotal edema makes urethral catheterization challenging and sometimes fails. Different methods have been published to overcome the urethral catheterization difficulties in buried penis of obese patients. METHODS: A 51-year-old morbidly obese male patient presented with urine retention. On inspection of his external genitalia, there was no penile shaft seen and the penis was buried within the cavity between pubic fat and severely edematous scrotum. To overcome the urethral catheterization difficulties, we used a laryngoscope which helps in visualization of the glans and external urethral meatus. The figures demonstrate the technique used. RESULTS: Successful urethral catheterization under direct visualization was achieved. CONCLUSIONS: The technique is well tolerated by patients and increases the overall likelihood of successful urethral catheterization.

Treatment of Renal Fungal Ball with Fluconazole Instillation Through a Nephrostomy Tube: Case Report and Literature Review.

BACKGROUND Urinary tract candida infection can be due either to hematogenous dissemination of the organism or a retrograde infection. In debilitated or immunosuppressed septic patients, who have upper urinary tract obstruction with renal filling defect, fungal infection should be considered. We report on a patient with sepsis and renal fungal ball who was treated with percutaneous nephrostomy and intravenous antifungal agent, but the patient did not respond so instillation of fluconazole through nephrostomy was given. CASE REPORT A 60-year-old male patient with a known case of diabetes mellitus with refractory urine retention underwent transurethral resection of the prostate. Postoperatively, the patient developed recurrent high-grade fever with left loin pain, and elevated septic parameters; urine and blood culture were positive for Candida albicans. Computed tomography urography showed left hydronephrosis with filling defect in the left renal pelvis with suspected renal fungal ball. Left percutaneous nephrostomy was performed and intravenous fluconazole started but the fever did not subside, therefore, the treatment was changed to anidulafungin. The patient improved but urine from both the bladder and the nephrostomy remained positive for candida. Instillation of fluconazole at 300 mg in 500 mL normal saline was applied through the nephrostomy tube over 12 hours at 40 mL/hour for 7 days. CONCLUSIONS Renal fungal ball is rare but can be serious, especially in immunocompromised patients. Management options for renal fungal ball include intravenous antifungal agents and percutaneous nephrostomy with antifungal instillation of antifungal agents. The objective of this case report was to document treatment success with the use of fluconazole instillation through a nephrostomy tube.

What Is the Role of α-Blockers for Medical Expulsive Therapy? Results From a Meta-analysis of 60 Randomized Trials and Over 9500 Patients.

Use of α-blockers for medical expulsive therapy (MET) has been the subject of huge debate in urology. Moreover, there have been a number of randomized controlled trials with differing results. We conducted a systematic review and meta-analysis of randomized controlled trials investigating the efficacy of α-blockers for MET. This review confirms there is a role for α-blockers in MET for ureteric stones specifically in stones >5 mm and distal ureteric stones, which is associated with improved stone expulsion. However, there is a slight increase in risk of nonsignificant side effects.

Glans Necrosis Following Penile Prosthesis Implantation: Prevention and Treatment Suggestions.

OBJECTIVE: To examine possible etiology and treatment outcomes in 21 patients with glans necrosis following penile prosthesis implantation. METHODS: Glans necrosis typically presented with a dusky glans on the first postoperative day following prosthesis implantation. RESULTS: The blood supply to the glans penis consists of the dorsal arteries and the terminal branches of the spongiosal arteries. Using the cohort in our study, we compiled preoperative comorbidities and adjunctive surgical maneuvers that might compromise glans vascularity, leading to glans necrosis. Preoperative risk factors were arteriosclerotic cardiovascular disease (90%), diabetes mellitus (81%), smoking (81%), previous prosthesis explantation (57%), and previous radiation therapy (48%). The most prevalent intraoperative and postoperative factor was subcoronal incision for reasons as simple as coincident circumcision or as complex as for penile degloving (86%). Other factors detected were penile wrapping with an occlusive elastic bandage (62%), use of a sliding technique for penile lengthening (33%), and coincident distal urethral injury repair (29%). Seventeen patients (81%) managed expectantly with preservation of implanted prosthesis sustained significant glandular loss. Four patients managed with immediate prosthesis removal healed without sequelae. CONCLUSION: Patients with preoperative risk factors undergoing penile prosthesis implantation should avoid high-risk adjunctive surgical maneuvers. Upon development of signs of glans necrosis postoperatively, in the setting of these high-risk factors, immediate implant removal may prevent subsequent glans necrosis.