An unusual success with simultaneous urethral repair and reimplantation of penile prosthesis in a patient with urethral stricture induced by rotated tubing

Three-Piece Inflatable Penile Prosthesis Implantation for the Treatment of Severe Erectile Dysfunction Following a Complex Pelvic Fracture: A Case Report

Pelvic fracture is one of the common causes of erectile dysfunction (ED). The pathophysiology of ED following pelvic injury is quite complicated and comprises vascular, neurogenic, corporal, as well as psychogenic causes. Penile prosthesis implantation is the third-line treatment of ED due to any reason including pelvic trauma that poorly responds to other standard treatments. In this study, we reported a case of a 33-year-old man with severe erectile dysfunction and urethral stricture following a complex pelvic fracture due to a traffic accident who was successfully implanted with a three-piece inflatable penile prosthesis at People's Hospital 115. At the sixth month of follow-up, this device has been working effectively, the patient had the ability to attain full erection for sexual intercourse. Both the patient and the partner are satisfied with their sexual lives. ED is a long-term consequence of pelvic fracture. The high proportion of young patients with a demand for erection rehabilitation and complex pathophysiology make the treatments even more challenging. Penile implant surgery is a potential treatment for refractory ED patients suffering from pelvic trauma.

Erectile and Ejaculatory Dysfunction After Urethroplasty

PURPOSE OF THE REVIEW

The goal of this paper was to evaluate the impact on erectile and ejaculatory function after anterior and posterior urethroplasty.

RECENT FINDINGS

With a rise in the use of urethroplasty, its impact on sexual function has come into question. For anterior urethroplasties, some degree of erectile dysfunction is common, but this tends to be transient, with most patients having a resolution of any de novo dysfunction by 12 months. Patients with posterior urethral strictures have a very high rate of erectile dysfunction prior to surgery and may show improvement after urethroplasty. Ejaculatory function tends to improve in patients due to alleviation of obstruction while some patients notice degradation in force of ejaculation. While urethroplasty has a minimal permanent effect on sexual function for most patients, there are some patients who notice improvement and others worsening. Patients should be counseled on these risks prior to urethroplasty.

Erectile dysfunction in urethral stricture and pelvic fracture urethral injury patients: diagnosis, treatment, and outcomes

Urethral stricture disease, pelvic fracture urethral injury (PFUI), and their various treatment options are associated with erectile dysfunction (ED). The etiology of urethral stricture disease is multifactorial and includes trauma, inflammatory, and iatrogenic causes. Posterior urethral injuries are commonly associated with pelvic fractures. There is a spectrum in the severity of both conditions and this directly impacts the treatment options offered by the surgeon. Many published studies focus on the treatment outcomes and the relatively high recurrence rates after surgical repair. This communication reviews the current knowledge of the association between ED and urethral stricture disease, as well as PFUI. The incidence, pathophysiology, and clinical ramifications of both conditions on sexual function are discussed. The treatment options for ED in those patients are reviewed and summarized.

An unexpected course after simultaneous urethral repair and reimplantation of penile prosthesis in a patient with a urethral stricture

We experienced the growth of urethral hair along the urethral stricture six years after simultaneous urethral repair and reimplantation of penile prosthesis (RPP) in a patient with a urethral stricture. We detected hair in the urethra with a stricture on the bulbous urethra. Further, we performed hair removal by using a pair of cystoscopic forceps and internal urethrotomy. Then, we performed RPP, and the patient voided well; the prosthesis worked very well and without any complications. One-stage urethroplasty with a pedicle island of the penile skin and RPP in a simultaneous stage may be an option for treating the long-segment urethral stricture in the penile prosthesis patient. However, we should pay attention to the urethral hair growth that can occur after urethral repair performed using a skin graft.

An unusual surgical success with a defective penile prosthesis

A defective penile prosthesis is disconcerting for the surgeon performing an implantation in a patient with erectile dysfunction. We became aware of the defective Titan penile prosthesis just after insertion of the left cylinder, which had an abnormal rotation (180 degrees) due to abnormal rotated tubing, which occurred at the manufacturing plant. We successfully performed the implantation by cutting and re-connecting the tubing between the cylinder and pump with a spare connector. When the surgeon encounters a defective penile prosthesis with abnormal rotation of the cylinder due to abnormal rotated tubing in the operative field, disconnection and re-connection of the tubing using an extra connector are alternative cost-effective maneuvers.