Complications associated with retained foreign bodies from infected penile implants: proposal for the use of an implant-specific checklist at the time of device removal.

INTRODUCTION: Infection of a penile prosthesis requires that all device hardware and associated foreign materials are removed, irrespective of whether a salvage procedure will be performed. Failure to remove all foreign bodies from the operative field may result in persistent infection, necessitating surgical intervention. AIM: To review our experience with complications arising from retained foreign bodies following removal of an infected penile prosthesis. We highlight the clinical features that should raise suspicion of retained device-associated materials, and also the role of imaging in evaluating these patients. Finally, a rational approach to prevent these occurrences is proposed with the implementation of an implant-specific checklist. METHODS: Medical records and imaging studies of patients presenting to our center with retained foreign bodies following removal of an infected penile prosthesis were reviewed. MAIN OUTCOME MEASURES: Clinical and radiologic details of each of these cases were abstracted, including patient demographics, presenting symptoms, characteristics of retained materials, bacterial cultures, treatment, and follow-up. RESULTS: Presenting symptoms included: (i) persistent and relapsing drainage from cutaneous fistulae; (ii) cellulitis overlying an infected reservoir; (iii) persistent penile pain; and (iv) an asymptomatic individual requesting elective placement of a second implant. Infected foreign materials retrieved included: two rear-tip extenders, a tubing connector, two infected reservoirs, and nonabsorbable mesh. Preoperative computerized tomography scan confirmed the presence and the location of all of these materials. Using this data, we propose using an implant-specific checklist to insure removal of all device-related foreign bodies when explanting an infected penile prosthesis. CONCLUSIONS: A number of adverse sequelae may result from inadvertently leaving behind device-related materials when an infected implant is removed. Ultimately it is the responsibility of the surgeon removing an infected implant to insure that all device components and associated materials are removed. We believe that implementing a two-step implant-specific checklist is a rational prevention strategy.

Improving risk stratification in patients with prostate cancer managed by active surveillance: a nomogram predicting the risk of biopsy progression.

OBJECTIVE: To develop a clinical tool that integrates different risk factors and provides individual predictions of the risk of biopsy progression in patients with prostate cancer managed by active surveillance. MATERIALS AND METHODS: Our analysis included 205 patients on active surveillance, each of whom had had at least two surveillance biopsies. We used the Cox proportional hazard regression model to analyse the association between different risk factors and progression-free survival over successive biopsies. This multivariate model was then used to develop a nomogram. Discrimination and calibration of the nomogram were internally validated using 200 bootstrap resamplings. RESULTS: The median follow-up of patients free of progression was 4.6 years. A total of 58 (28%) patients experienced progression. Factors significantly associated with progression were: overall number of positive cores in the diagnostic and first surveillance biopsies, race and prostate-specific antigen density. The bootstrapping concordance index of the nomogram including these variables was 81%. The nomogram tended to underestimate the probability of progression but it identified fairly accurately the distinct groups of patients at low, intermediate and high risk of progression. CONCLUSIONS: In the development cohort, the nomogram was able to separate patients with respect to their risk of biopsy progression. Since accurate risk stratification is essential to optimize patient care, this tool, if external validation confirms its performance, may prove useful for both the counselling and management of patients with low-volume, Gleason 6 prostate cancer.