Urologic emergencies

The Management of Penile Fracture: a Review of the Literature with Special Consideration for Patients Undergoing Collagenase Clostridium Histolyticum Injection Therapy

PURPOSE OF REVIEW

To review the current literature on acute management of traumatic penile fracture, with a specific discussion of those injuries following collagenase clostridium histolyticum (CCH) injections for the treatment of Peyronie's disease.

RECENT FINDINGS

The immediate repair of traumatic penile fracture injury is associated with significantly better prognosis for long-term sexual health. Corporal disruption following CCH administration has several distinct features, and the trend is to manage these patients conservatively in the absence of urethral injury. Traumatic penile fracture repair continues to have excellent results when performed immediately following injury. The post-CCH treatment setting portends increased difficulty during surgical management and can be successfully managed in most cases by conservative measures.

Direct patient-to-physician teledermatology: Not a flash in the pan(demic)

Dermatology is a clinical and visual discipline, which makes it the quintessential medical specialty for spot diagnosis and telemedicine. The COVID-19 pandemic has led to an unprecedented worldwide renaissance of teledermatology (TD). It has helped deliver high-quality medical care, while protecting the medical personnel and vulnerable patients from potential infection. Examining a patient from a distance through digital photography has many drawbacks, including lack of physical touch, difficulties in performing full body examinations, and several legal and ethical issues. We summarize have summarized the more common pitfalls and highlight the key aspects of direct patient-to-physician TD. Basic practical advice includes the use of TD for obtaining patient history, examining patient-captured photographs for inflammatory skin disease, and skin cancer screening.

Penile Fracture during masturbation - a case report

Penile fracture is a well-recognized but uncommon urological emergency. It is a tear in the tunica albuginea with rupture of corpus cavernosum. It may be associated with injury to corpus spongiosum and urethra. Diagnosis is usually clinical and Urethral injury should be suspected in penile fracture, especially in those cases with urethral bleeding and bilateral cavernosal rupture. Penile fracture is most commonly caused by injury during sexual intercourse. It has also been described with masturbation, rolling over or falling onto the erect penis, and other scenarios. A cracking or popping sound followed by pain, rapid detumescence, discoloration and swelling of penile shaft and urethral bleeding are common presenting symptoms. Prompt surgical intervention with closure of tunica albuginea is the treatment of choice with satisfactory cosmetic and functional results. We report a case of fracture penis in a 25-year-old male who came to emergency department of our hospital.

Penile gangrene: an unusual complication of malignant priapism in a patient with renal cell carcinoma

A 68-year-old man presented with priapism and penile gangrene. The patient had no history of penis trauma or medications for erectile dysfunction. Corpus cavernosa aspiration cytology were positive for malignant cells. Total penectomy was performed. Enhanced chest and abdominal computed tomography showed a left renal tumor with pulmonary and hepatic metastases. Ultrasound-guided renal biopsy showed clear cell renal cell carcinoma.

The top 100 cited articles on urological emergencies: A bibliometric analysis

OBJECTIVE

In this study, we bibliometrically evaluated the top 100 cited articles on urological emergencies published since 1975 with a multidisciplinary and interdisciplinary perspective.

MATERIAL AND METHODS

We obtained the data for this study from the Thomson Reuters Web of Science and PubMed. We determined 360 articles which were related directly or indirectly to urological emergencies between 1975 and 2017 and analyzed retrospectively the top 100 cited articles among these.

RESULTS

The mean citation impact factor of the top 100 cited articles was 25.8±50.1 (range: 4-467) between 1991 and 2014. We determined that classical articles were cited for 2588 times and the total number of self-citations was 23 (0.8%). Highest publication rate per year was in 2006 (n=9). Among the institutions which published ≥2 articles per year University of Texas led the way with 5 articles. The top 100 articles came from 27 countries and 58% of these are from the USA (n=29), the United Kingdom (n=23) and Germany (n=6). For the top 3 journals of the 33 of top 100 articles most frequently cited were published in journals with an impact factor ≥2 namely, Journal of Urology (n=15), British Journal of Urology International (n=13) and Urology (n=5) respectively. The most frequently cited main topics were penile emergencies with 22 articles and acute scrotal problems with 15 articles. Most of the classical articles on urological emergencies were based on clinical researches (n=95) and also we found that the average level of evidence for the top 100 cited articles was 4.16 (range: 1-5). Mostly preferred publishing language was English among this scientific papers (n=90).

CONCLUSION

Although not considered as a completely unbiased and adequate criterion for scientific evaluations, analysis of the top 100 cited articles provides us with important current data on urological emergencies.

Priapism with penile gangrene: An unusual presentation of multiple myeloma

Penile gangrene is very rare sequel of ischemic priapism. Previous published reports have shown its occurrence in patients with sickle cell disease, urethral carcinoma, bladder carcinoma, thrombotic thrombocytopenic purpura, idiopathic, traumatic, etc. Ischemic priapism with penile gangrene as an initial presentation of multiple myeloma has not been reported. We present a 44-year-old patient of multiple myeloma presenting with ischemic priapism and penile gangrene requiring partial penectomy.

The role of ultrasonography in the diagnosis and management of penile trauma

PURPOSE

In this prospective study, we studied the role of ultrasonography (US) in the diagnosis and management of penile trauma.

METHODS

Between 2007 and 2014, 14 patients (mean age 39 years) with suspected penile fracture underwent US examinations. Almost all patients had a history of injury during sexual intercourse or manipulation of the penis. US examinations were performed in transversal and longitudinal planes starting at the level of the glans and moving down to the base of the penis. Color-Doppler was used to identify the vascular pattern or to see any abnormal vascularity.

RESULTS

The most common blunt injury to the penis that occurred in nine patients was penile fracture due to rupture of the corpus cavernosum. A tear occurred in only one of the corpora cavernosa. US showed an irregular hypoechoic or hyperechoic defect at the cavernosal rupture site. Four patients presented an injury to the subtunical venous plexus in the absence of complete tunical disruption. One patient had urethral rupture with inability to urinate and apparent urethrorrhagia. Ten patients underwent surgical operation, while four patients were observed and discharged after 2 days. Mean follow-up was 32 months (range 3-58). After 8 to 12 weeks, all of them were able to be sexually active as before. Angulations of penis persisted in one patient.

CONCLUSION

US may be the preferred imaging technique for evaluation of penile fracture before surgery. It is easy to perform, non-invasive, widely available, and inexpensive, although it requires an experienced team.

Fracture penis: a case more heard about than seen in general surgical practice

A 36-year-old man presented to the emergency department with a history of trauma to genitalia during intercourse. The patient reported the forceful collision between his penis and the bed and audible clicking sound with swollen penis thereafter. On examination, the genitalia was swollen with an 'S' shaped deformity. The skin over the swelling was apparently normal, with no local rise of temperature. A provisional diagnosis was made after clinical evaluation. Scrotum and testes examination revealed no abnormality. A subcoronal circumferential incision with de-gloving of penile skin was used to access the tunica. A rent in tunica albuginea and corpora cavernosa identified and the defect repaired with absorbable suture material after removal of clot and properly maintaining haemostasis. The patient's postoperative recovery was uneventful. The following case report demonstrates a typical case of fracture penis.

A rare but significant cause of priapism in the elderly: multiple myeloma

Priapism is a rare symptom with diverse etiological factors. Although most cases in adults are secondary to drug use and intracavernosal injections, blood dyscrasias and hypercoagulable states, vasculitis, penile metastases, neurological conditions, spider bites, carbon monoxide poisoning, and total parenteral nutrition may also result in priapism. We report a case of recurrent and refractory priapism in a 61-year-old man which was diagnosed as multiple myeloma after emergence of hypercalcemia and renal failure due to progression of the underlying pathology. The value of the initial diagnostic approach is emphasized.

Can bedside ultrasound assist in determining whether serum creatinine is elevated in cases of acute urinary retention?

BACKGROUND

There are no guidelines to determine which patients with acute urinary retention (AUR) require blood testing (i.e., serum creatinine) to assess for renal failure.

OBJECTIVE

To determine if hydronephrosis on bedside ultrasound correlates with an abnormal serum creatinine (Cr) level in cases of AUR.

METHODS

This was a prospective, observational study of subjects clinically diagnosed with AUR at two associated urban academic centers from October 2004 through August 2006. Emergency physicians completed a data form and performed a bedside ultrasound to determine the presence or absence of hydronephrosis. The data collected included suspected cause of AUR, amount of urinary output after Foley insertion, and blood test results. Follow-up was obtained by telephone and electronic medical record for 1 month. Standard statistics were employed.

RESULTS

Among 96 enrolled subjects with AUR, 43 had a serum Cr level obtained on the initial visit, and 10 (23%; 95% confidence interval [CI] 11-36) of these had an elevated Cr (10% [95% CI 4-16] of the study cohort). The test characteristics of hydronephrosis on bedside ultrasound to detect elevation in Cr were a sensitivity, specificity, positive predictive value, and negative predictive value of 70%, 67%, 39%, and 88%, respectively.

CONCLUSION

In cases of AUR, the prevalence of elevated creatinine is high, and hydronephrosis based on bedside ultrasonography does not correlate with elevation in creatinine.

Priapism as a complication after total hip arthroplasty: a case report and review of the literature

Priapism is defined as a prolonged engorgement or erection of the penis or clitoris that is unrelated to sexual arousal. Recent studies have determined the incidence of priapism to be between 1.5 and 2.9 per 100,000 person years. The incidence of priapism following elective orthopedic surgery is rare. Defining the etiology of a case of postoperative priapism following orthopedic surgery can be difficult, and many times cannot be determined. This case represents the first report of priapism following an elective total hip arthroplasty (THA) performed under spinal anesthesia, and focuses on a review of the literature and potential etiologies of this rare complication. A 44-year-old man with a history of right hip osteoarthritis underwent elective minimally invasive cementless right THA under spinal anesthesia (1 mg of Intrathecal Morphine and 100 mg of intravenous Fentanyl) without initial complication. A preoperative Foley catheter was placed without incident and the patient was placed into the left lateral decubitus position. Surgical time was recorded at 60 minutes. Nine hours after the Foley catheter was removed, the patient developed a persistent painless erection. Successful emergent treatment included a penile Winter shunt, to irrigate blood from the corpora. A computed tomography scan of the pelvis ruled out pelvic deep vein thrombosis as an etiology. This case represents the first report of priapism after an elective THA. The incidence of priapism as a complication is well described and has been associated with numerous medical conditions discussed in this article.

A case of penile fracture with complete urethral disruption during sexual intercourse: a case report

Penile fracture is a rare condition. Primarily it is a rupture of the corpus cavernosum that occurs when the penis is erect. The rupture can also affect the corpus spongiosum and the urethra.

We report a case of a 37 year old man who presented with acute penile pain, penile swelling and the inability to pass urine after a blunt trauma during sexual intercourse. In emergency surgery we found bilateral partial rupture of the corpus cavernosum with complete urethral and corpus spongiosum disruption. In the one year follow up the patient presented with normal erectile and voiding function.

Emergency surgical repair in penile fracture can preserve erectile and voiding function.

Priapism in the Oncology Setting

CASE STUDY

N.L. is a 20-year-old Caucasian man with no significant medical history. He presented to the hospital with a two-day history of feeling ill with intermittent nausea, vomiting, blurred vision, and headache. He also noted slurred speech and left-upper-quadrant fullness for almost a month.

[Management of trauma to the male external genitalia]

Male genital injury, although rarely life-threatening, demands prompt, appropriate management to prevent long-term sexual and psychological damage. However, because of the rarity and disparity of severe genital injuries, there is still no universal therapeutic strategy. Urethral injury, although rare, may be associated with substantial long-term morbidity such as fistulas and strictures. Injuries to the scrotum and its contents may cause impaired fertility, chronic pain, hypogonadism, and altered self-image. Penile injury may lead to pain, curvature, and erectile dysfunction. This article concentrates on reviewing the major etiologies and mechanisms of urethral and genital injuries in men and summarizes principles and strategies of treatment based on the guidelines of the European Association of Urology.

Sonographic evaluation of penile trauma

OBJECTIVE

The purpose of this presentation is to illustrate the normal sonographic anatomy of the penis and various imaging manifestations of penile trauma.

METHODS

Penile trauma cases were collected and reviewed retrospectively from our archive.

RESULTS

The normal sonographic anatomy of the penis and various pathologic conditions of patients with penile trauma are discussed.

CONCLUSIONS

Sonography (especially with color Doppler sonography) is a useful imaging method for evaluating penile anatomy and various pathologic features in patients with penile trauma.