Fracture of the penis: a radiological or clinical diagnosis? A case series and literature review.

INTRODUCTION: Fracture of the penis is rare and needs a surgeon's attention for appropriate management. The exact role of diagnostic investigations has not been established. We studied the role of these investigations and the results of surgery. CASE SERIES: Seventeen patients with median age of 36 years (range, 27-72 years) presented to us between 2002 and 2007 with suspected fracture of the penis. The mode of injury was sexual intercourse (15 patients), masturbation (1 patient), and rolling over in bed (1 patient). The median time from injury to presentation was 10 hours (range, 1-144 hours). Clinical evaluation included patient history and examination for all patients, ultrasonography in 6 patients, retrograde urethrography in 6 patients, and magnetic resonance imaging in 1 patient. Fifteen patients underwent immediate surgical exploration, 1 patient was kept under observation, and 1 patient refused surgical exploration. DISCUSSION: Patient history and clinical examination were highly sensitive and accurate in predicting a cavernosal tear, and retrograde urethrography was highly sensitive and accurate in detecting urethral injury. Ultrasonography was highly specific but not sensitive for detecting a cavernosal tear. Radiological investigations did not influence patient management in any of the cases. On surgical exploration, 15 patients had cavernosal tears and 4 also had urethral injuries; all injuries were repaired successfully. One patient had a negative surgical exploration and was diagnosed as having a superficial dorsal vein rupture. One patient had a history suggestive of penile fracture but had a normal clinical examination and was kept under observation. At follow up in a mean of 7.5 months, no patient had erectile dysfunction or penile deformity. CONCLUSION: Further evaluation beyond taking a patient history and performing a clinical examination is not necessary in most cases for managing patients with suspected penile fracture. Retrograde urethrography may be omitted before surgical exploration, even in cases with suspected urethral injury. Early surgical repair is associated with a good outcome with minimal complications.

Acute pyelonephritis with renal vein and inferior vena cava thrombosis in a case of hyperhomocysteinemia.

Acute pyelonephritis is not considered a common cause of renal vein (RVT) and inferior vena caval thrombosis (IVCT). Apart from malignancy, RVT is not an uncommon condition amongst patients with nephrotic syndrome, most commonly seen in patients with membranous glomerulonephritis. However, RVT occurring in association to acute pyelonephritis is rare. Clinically, it is difficult to distinguish between acute pyelonephritis and RVT because both present with fever, flank pain, and hematuria. We report a case of acute pyelonephritis with RVT and IVCT with underlying hyperhomocysteinemia. The patient was treated with systemic anticoagulation, antibiotics, and B complex therapy. At 3 months follow-up, there was complete resolution of thrombus but the left kidney was nonfunctioning.

Tamsulosin facilitates earlier clearance of stone fragments and reduces pain after shockwave lithotripsy for renal calculi: results from an open-label randomized study.

OBJECTIVES: To evaluate the role of tamsulosin in the clearance of fragments after extracorporeal shock wave lithotripsy (ESWL) to treat renal calculi. METHODS: In this open-label prospective randomized study conducted at our institute from 2006 to 2007, 139 patients with normal renal function and a single radiopaque renal calculus, 5-20 mm, undergoing ESWL were enrolled. All patients underwent ESWL every 3 weeks until success or for

Non-interventional management of obstructive acute renal-failure in hormone-naïve prostate cancer.

Advanced carcinoma prostate (CaP) commonly presents as bilateral ureteric obstruction. The management often requires androgen ablation along with temporary urinary diversion (percutaneous nephrostomy or ureteric catheterization) which is not infrequently associated with complications. Two patients of hormone-naïve CaP presented to our emergency department with oliguric renal failure due to bilateral ureteric obstruction and were treated with dialysis, ketoconazole (for androgen ablation) and corticosteroids; urinary diversion was not feasible in either at the time of presentation. Brisk diuresis occurred within 48 hours obviating the need of urinary diversion. Follow-up of these cases is presented and justification of this approach is discussed.