Inflatable penile prostheses: an update

MRI of common penile pathologies and penile prostheses

MRI can delineate finer details of penile anatomy and pathology due to inherent higher soft-tissue contrast and spatial resolution. It can characterize inflammation and identify abscesses, localize penile fractures, guide surgical planning in penile fibrosis and Peyronie's disease, and depict components of the penile prosthesis and its complications. MRI is a great investigative tool for penile neoplasms, including locally infiltrative neoplasms where clinical examination is limited, and local staging is crucial for surgical planning.

Infrequent Reservoir-Related Complications of Urologic Prosthetics: A Case Series and Literature Review

INTRODUCTION AND AIM

Complications related to inflatable penile prosthesis (IPP) and artificial urinary sphincter (AUS) reservoirs are rare, potentially life threatening, and poorly described in the literature. As more devices are implanted, the incidence of reservoir-related complications may increase, and it will be important to recognize the relevant signs and symptoms.

METHODS AND MAIN OUTCOME MEASURES

We present a case series of reservoir-related complications presenting to our institution for treatment. We also reviewed all accounts of reservoir-related complications within the urologic literature.

RESULTS

Three cases of reservoir-related complications are presented. Case 1 involves erosion of an intact AUS reservoir into the cecum of a patient with a history of myelomeningocele and bladder augmentation. Case 2 involves an IPP reservoir causing vascular compression, resulting in open exploration and repositioning of the reservoir. Case 3 involves intraperitoneal migration of a retained IPP reservoir to a subhepatic area, which was then removed laparoscopically. Literature review yielded descriptions of eight cases of intestinal complications, five cases of vascular complications, but zero reports of migration to a subhepatic area. Other notable complications include 20 reported cases of reservoir erosion into the bladder and inguinal herniation of the reservoir.

CONCLUSION

Complications involving urologic prosthesis reservoirs, although rare, can have serious implications for patients. A high index of suspicion and familiarity with treatment options is required in order to allow timely diagnosis and appropriate treatment. Patients with prior major abdominal surgeries seem to be more prone to intestinal complications of reservoirs and warrant special concern. Cui T, Terlecki R, and Mirzazadeh M. Infrequent reservoir-related complications of urologic prosthetics: A case series and literature review. Sex Med 2015;3:334-338.

Infections Associated with Inflatable Penile Prostheses

INTRODUCTION

The implantation of inflatable penile prosthesis (IPP) has become a successful method for the treatment of erectile dysfunction. Infections are rare but they can result in devastating complications following surgical implantation of the prosthesis.

AIM

To discuss pathogenesis, risk factors, and microbiology of IPP infections, summarize clinical manifestation and diagnostic methods, and discuss future directions of prevention and management.

METHODS

A PubMed search was performed of all articles published from 1960 to present relating to IPP infections.

MAIN OUTCOME MEASURE AND RESULTS

Skin flora organisms such as Staphylococcus epidermis are the most common source of infection. Several host and surgical risk factors for prosthesis infection have been demonstrated, including uncontrolled diabetes mellitus and previous surgical interventions. Biofilms play an important role in the pathogenesis of device-related infections. Pain, fever, drainage, and device extrusions are suggestive of IPP infection. Preventive methods include preoperative skin cleansing, systemic antibiotic prophylaxis, and the use of surface-modified prostheses. The most frequently utilized surgical management is a single-stage approach that comprises aggressive irrigation and debridement, removal of all components of the infected prosthesis, and placement of a new IPP in the same surgical setting.

CONCLUSION

Advances in systemic antimicrobial prophylaxis, skin cleansing and surface-modification of the devices, as well as a number of other potentially protective measures, have decreased the rates of infections. Currently, most infected IPP are surgically managed by adopting the salvage approach. Al Mohajer M and Darouiche RO. Infections associated with inflatable penile prostheses. Sex Med Rev 2014;2:134-140.

Ischemic Gangrene of the Glans following Penile Prosthesis Implantation

The development of ischemic gangrene of the penis following implantation of prosthesis is unusual, and very few cases are available in the literature. As a result, no established treatment protocol is available. We report our experience within a case of gangrene of the glans following implantation of a three-component prosthesis. We present a 53-year-old male, smoker with diabetes and hypercholesterolemia, who underwent surgery for the insertion of a penile prosthesis with 3 components to correct his erectile dysfunction and severe Peyronie's disease. The procedure was carried out without incidents. During the postoperative period, the patient began to complain from penile and perineal pain. He developed avascular necrosis of the glans. The necrosed area was excised. Four weeks later, he developed fever and perineal pain arriving to the emergency room with the prosthesis extruding through the glans. He had emergency surgery to remove the prosthesis plus surgical lavage and was prescribed broad-spectrum antibiotic therapy. Four weeks later, the penis was completely revascularized and reepithelialized. Ischemic gangrene following penile prosthesis implantation takes place in patients with poor peripheral vascularisation. Diabetes mellitus has been the common denominator to all of the reported cases.