Patient satisfaction after dual implantation of inflatable penile and artificial urinary sphincter prostheses.

OBJECTIVES: Since description of the transverse scrotal approach for artificial urinary sphincter (AUS) placement, simultaneous implantation of an inflatable penile prosthesis (IPP) and AUS through a single incision has been shown to constitute safe, efficient, and cost-effective treatment for men plagued by both erectile dysfunction and urinary incontinence. We present patient satisfaction outcomes after simultaneous dual implantation (DI) of an IPP and AUS. METHODS: We compared outcomes of postprostatectomy patients who underwent DI to those receiving IPP or AUS alone from 2001 to 2006. Telephone interviews using a standard questionnaire were conducted to evaluate prosthetic functionality, ease of use, and patient satisfaction. RESULTS: A total of 95 men were evaluated (31 for IPP alone, 31 for AUS alone, and 33 for DI). Daily pad usage decreased from 4.6 to 0.8 pads per day with AUS alone and 6.1 to 1.3 pads per day with DI. Patients were similarly satisfied with IPP rigidity during inflation and flaccidity during inactivation in both IPP and DI groups (4.1 to 4.4 for rigidity and 3.9 for flaccidity [1 = "unhappy" and 5 = "happy"]). Ease of scrotal pump operation was similar in all groups, as was overall prosthetic satisfaction. Most patients stated that they would recommend the DI procedure to a friend or relative (87% to 94%) or have the procedure done again (77% to 94%). CONCLUSIONS: Dual implantation produces encouraging outcomes in patient satisfaction, ease of use and functionality that are similar to those found after placement of either IPP or AUS alone.

A case of prostatitis due to Burkholderia pseudomallei.

BACKGROUND: A 67-year-old male, with a history of stable lower urinary tract symptoms, diabetes mellitus, benign prostatic hyperplasia, gonococcal urethritis, and excessive alcohol consumption, presented to the emergency room with sepsis and acute bacterial prostatitis. He had recently returned from a visit to Indonesia, where he had been a first-hand witness to the 2004 tsunami. INVESTIGATIONS: Complete blood cell count, urine analysis, blood, urine, and prostatic abscess cultures, chest X-ray, contrasted CT of the abdomen and pelvis, and (18)F-fluorodeoxyglucose PET. DIAGNOSIS: Melioidosis. MANAGEMENT: Broad-spectrum empiric antibiotics were administered initially; therapy was then changed to intravenous imipenem plus cilastatin with slow initial clinical improvement. (18)F-fluorodeoxyglucose PET localized the prostate as the only nidus of infection. Ultrasound-guided fine needle aspiration of a small fluid collection of the prostate also grew Burkholderia pseudomallei. The patient improved clinically and was discharged to complete a 2-week course of intravenous imipenem plus cilastatin followed by a 3-month course of oral trimethoprim plus sulfamethoxazole. This medication was switched to co-amoxiclav and doxycycline to complete the 3-month course. The patient was well at his last follow-up, 3 months following hospital discharge.

Adult-type testicular granulosa cell tumor: case report and review of the literature.

We report the clinical, sonographic, and pathologic findings of an incidentally discovered testicular granulosa cell tumor of the adult type in a 32-year-old man. Serum tumor markers were within normal limits. The sonographic findings revealed a well-circumscribed, hypoechoic mass. Gross inspection confirmed a unilobular, well-circumscribed mass without necrosis. Microscopically, the mass was demarcated by a thin capsule, with tumor cells arranged in nests with low mitotic activity. These cells were diffusely immunoreactive for vimentin and focally for inhibin. The entrapped rete epithelium stained positive for pancytokeratin (Lu-5). We present our management of this rare malignancy.

Transobturator versus transabdominal mid urethral slings: a multi-institutional comparison of obstructive voiding complications.

PURPOSE: In the last year TO slings have become an increasingly popular alternative to TA slings for the surgical treatment of SUI. Proposed advantages of the transobturator approach include improved speed, safety and the reduction of obstructive complications. We assessed outcomes of TO and TA slings in a large series of women treated at several institutions to compare the rate of obstructive complications from these procedures. MATERIALS AND METHODS: We reviewed the charts of 504 consecutive women who had synthetic mid urethral sling procedures (154 TO or 350 TA) performed by 24 different urologists for SUI at 8 institutions from 2002 to 2004. Obstructive complications were defined as increased PVR (greater than 100 cc), or the need for CIC, prolonged Foley catheter drainage or urethrolysis. RESULTS: While TO and TA sling procedures appeared to be similarly efficacious in eliminating the need for incontinence pad use (TO 89%, TA 86%, p = 0.36), the transobturator approach was associated with fewer obstructive complications (TO 11.0%, TA 18.3%, p < 0.05). Urethrolysis was required in none of the 154 TO cases and 8 of 350 (2.3%) TA cases. Concomitant pelvic surgery did not significantly increase the likelihood of obstructive voiding complications in either group. CONCLUSIONS: Although TO and TA sling procedures had similar short-term results for decreasing pad use in patients with stress urinary incontinence, the transobturator approach is associated with fewer obstructive voiding complications.