Urologic prosthetics: an imaging review of short- and long-term complications

PURPOSE

Urologic prosthetics offer significant quality of life enhancements for patients with stress urinary incontinence and erectile dysfunction. Artificial urinary sphincter and penile prosthesis are the most commonly used prosthetics for these patients. Radiographic imaging offers important insight, guiding treatment when patients present with complications. Herein, we pictorialize normal radiographic findings and complications alike.

METHODS

We reviewed our IRB-approved prosthetics database, highlighting patients with prosthetic complications with available imaging. We collected imaging from patients without complications for baseline reference.

RESULTS

The radiographic appearance of orthotopic genitourinary prosthetics and a review of short- and long-term complications including hematoma, infection, malpositioning, leak and erosion are pictorialized.

CONCLUSION

Radiologic imaging serves as a vital complement to history and physical examination, aiding in the identification of complications and potentially streamlining surgical preparations. It is important for radiologists to familiarize themselves with standard prosthetic nomenclature, normal positioning and appearance, along with imaging findings of common complications.

Inflatable Penile Prosthesis Complication in the Emergency Department

Inflatable penile prostheses are a widely utilized treatment for erectile dysfunction. While MRI is the optimal imaging modality for patients with suspected implant complications, it is often unavailable in the acute setting. In light of these limitations, we present a case of urethral perforation by an implanted penile cylinder and its evaluation with contrast-enhanced computed tomography (CT) in an emergent setting.

Isolated nerve palsy following insertion of a three-piece inflatable penile prosthesis

Case report of a 57-year-old male who underwent insertion of an inflatable penile prosthesis due to erectile dysfunction, secondary to poorly controlled Type 2 diabetes and Peyronie’s disease. The surgical procedure was uneventful and there were no immediate post-operative complications. During a routine follow-up, the patient described problems with the deflation of the implant and severe lower back and leg pain. Diagnostic MRI scans revealed reservoir migration, impingement of the obturator nerve and oedema in the adductor muscle group. The reservoir was initially repositioned, and later on removed due to ongoing symptoms.

Application of Dynamic Enhanced Magnetic Resonance Imaging in the Diagnosis of Hematological Malignancies

The use of dynamic enhanced magnetic resonance imaging technology can effectively explore the diagnosis and clinical application of hematological malignancies. This paper selected 60 patients with hematological malignancies from 2015 to 2019; all of whom were diagnosed with hematological malignancies, including 40 men and 20 women, aged between 40 and 77 years. The main clinical manifestations of the patient are hematological malignancies, fever, and other symptoms. We used Siemens 3.0T to perform MRI and dynamic enhanced MRI examinations on 30 patients with hematological tumors. The PACS system was used to collect and organize clinical data. All patients were pathologically confirmed and clinically diagnosed with hematological malignancies. Based on the clinical data of the patients, retrospective analysis and summary were conducted and the clinical manifestations of hematological malignancies were discussed. The results showed that the diagnostic accuracy of 30 cases of dynamic enhanced MRI was 100%, while the diagnostic accuracy of ordinary MRI was lower than that of dynamic enhanced MRI, P < 0.05, and the difference was statistically significant. In addition, compared with dynamic enhanced MRI and MRI, P > 0.05, the difference was not statistically significant. Therefore, the application of dynamic enhanced MRI in the diagnosis of hematological malignancies is valuable.

MRI of Penile Prostheses: The Challenge of Diagnosing Postsurgical Complications

Penile implants are surgically inserted devices used for the treatment of erectile disfunction. Improvements in surgical techniques and in the manufacturing of these implants have reduced the risk of intra- and postoperative complications and increased the popularity and use of this therapeutic option. Routine imaging is not recommended before penile prosthesis surgery. Malleable penile prostheses use noninflatable shafts inserted into each corpus cavernosum, which appear hypointense on T1- and T2-weighted MR images. Inflatable penile prostheses (IPPs) may consist of two or three parts and are composed of two cylinders inserted into the corpora cavernosa that are filled with a saline solution to produce rigidity. These appear homogeneously T2 hyperintense and the silicone-based covering of the cylinders appears T2 hypointense, thereby clearly delineating the cylinders. In the case of three-piece IPPs, a reservoir containing the fluid may be placed in the pelvis. The most frequent complications are related to infection and mechanical failure, the latter being more common in IPPs because more components are involved. Less common complications include malpositioning. Detection and management of postoperative complications are challenging, and MRI plays a crucial role as it permits evaluation of the positioning and configuration of the prosthesis components, as well as assists in functional evaluation of IPPs when images are obtained of both the flaccid and inflated states. ^©RSNA, 2021.

Penile implant surgery-managing complications

Penile prosthesis surgery represents the end-stage treatment for erectile dysfunction. It is conventionally used only in cases of erectile dysfunction refractory to pharmacological treatments or vacuum constriction devices. Contemporary literature suggests that penile prothesis surgery is associated with a high satisfaction rate and a low complication profile. However, it must be appreciated that the complications of surgery can have devastating consequences on a patient’s quality of life and satisfaction and include infection, prosthesis malfunction, penile corporal perforation and penile length loss. Several factors – such as appropriate patient selection, methodical preoperative assessment and patient optimization, specific intraoperative protocols and postoperative recommendations – can reduce the risk of surgical complications. This narrative review discusses the diagnosis and management of both intraoperative and postoperative complications of penile prosthesis surgery.

Imaging review of penile pathologies encountered in the emergency department

While penile pathology is uncommon, prompt diagnosis and treatment of emergent and urgent penile pathology are necessary to prevent complications. This paper will review the imaging findings of the most common critical penile pathologies, including traumatic, vascular, infectious, foreign body-related, and urethral pathology, in addition to penile prosthesis complications. Each entity will be discussed in the context of presentation and treatment and complications of each pathology will be discussed.

Multimodality Functional Magnetic Resonance Imaging Assisted Treatment of Primary Insomnia and Anxiety and Depression

Based on multimodal functional magnetic resonance imaging technology, explore the changes of local brain function in the whole brain range of patients with primary insomnia at rest, and conduct correlation analysis to explore the relationship between this locality and function and clinical features. Provide further imaging evidence for the exploration of the neural mechanism of primary insomnia. Using multimodal functional magnetic resonance imaging, self-rating anxiety scale, self-rating depression scale to assess the status anxiety factor and trait anxiety of STAI in patients with primary insomnia (88 cases) and normal sleepers (82 cases). Factors and total scores, depressive mental disorders and total scores were statistically significantly different from the normal sleep group. The study found that patients with primary insomnia under the multimodal functional magnetic resonance imaging assisted treatment have abnormal local functional activities in multiple brain regions such as emotions and sensorimotor regions. We explored the brain of patients with primary insomnia from the perspective of functional differentiation. Changes in nerve activity are conducive to further understanding the characteristics of nerve activity in primary insomnia.

Revision Surgery for Inflatable Penile Prosthesis (IPP): A Single-Center Experience and Pictorial Representation

OBJECTIVE

To elucidate factors influencing Inflatable Penile Prosthesis (IPP) revision and describe outcomes associated with revision surgery.

METHODS

A single surgeon, retrospective review of all patients who underwent IPP revision between 2008-2016, was performed. Patient age, BMI, operative duration, blood loss, hospital duration, time from most recent penile implant to revision surgery, etiology of revision, and whether the patient had a prior failed revision surgery were all collected and analyzed.

RESULTS

A total of 57 patients, who had undergone IPP revision between the years 2008-2016, with at least 3 years of follow-up, were included in the investigation. Mean patient age and BMI were 68 and 29.2 kg/m², respectively. The mean time between the most recent implant operation to revision was 8.4 years. Four patients (7%) reported IPP revision failure within a 3-year follow-up period.

CONCLUSION

IPP revision demonstrates a relatively high success rate, in the short term, and should be offered to patients as a safe and effective option.

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.

Sonography of the penis/erectile dysfunction

Erectile dysfunction (ED) is defined as the persistent inability to achieve and/or maintain an erection for a satisfactory sexual activity. It is secondary to several organic, psychogenic, and combined causes, and represents a serious health dilemma affecting both men and their partners. The diagnostic approach to erectile dysfunction has significantly changed in the last years with the advent of phosphodiesterase-5 (PDE5) inhibitors, and with the recognition that surgical treatment of both arterial insufficiency and penile venous leak have poor long-term clinical outcomes. Although imaging modalities have diminished in importance, differentiating among causes of erectile dysfunction remains mandatory in good medical practice, and ultrasound (US) still remains the cornerstone of the diagnostic workup. US provides an objective, minimally invasive evaluation of penile hemodynamics. Moreover, it provides an excellent depiction of the penile anatomy and of its changes in pathological conditions such as in patients with Peyronie's disease, priapism, and posttraumatic erectile dysfunction.

Imaging of the adult male urethra, penile prostheses and artificial urinary sphincters

To discuss the imaging appearances of various pathologies affecting adult male urethra and to review the role of imaging in the assessment of artificial urinary sphincters and penile prostheses. Diagnosis of common male urethral diseases heavily depends on two conventional fluoroscopic techniques namely retrograde urethrography and voiding cystourethrography. These are useful in evaluating common urethral diseases like traumatic injury, infections, and strictures. Cross-sectional imaging can be useful in evaluating periurethral pathologies. Artificial urinary sphincters, slings, and periurethral bulking agents are used in the management of urinary incontinence and imaging can be utilized to detect complications in these devices. Cross-sectional imaging especially MRI plays a significant role in evaluating the different types of penile prostheses and their malfunctioning.

CT imaging of inflatable penile prosthesis complications: a pictorial essay

PURPOSE

Inflatable penile prostheses (IPPs) are widely used in the United States, for patients with erectile dysfunction refractory to other treatments. Complications subsequent to IPP insertion include infection, hematoma, fluid leak, component (cylinder/pump/reservoir) complications, and retained previous IPP components. Radiologists are often called upon to identify and characterize these complications utilizing CT prior to intervention. Our paper aims to provide a guide to familiarize radiologists with normal IPP component imaging and review the CT findings of commonly encountered complications.

METHODS

In this study, we retrospectively reviewed CT reports with descriptions of IPPs from 108 patients. We collected CT images of normal IPP components as well as reevaluated the CT findings of 33 patients with an IPP complication and correlated with immediately subsequent operative report.

RESULTS

The CT appearance of appropriately positioned normal IPP components in asymptomatic patients and each complication were described and compared to previous literature.

CONCLUSIONS

CT is a very useful modality to assess an IPP-related complication. It is inexpensive, fast, and immediately available in emergent situations, e.g., infection, hematoma, and component erosion. Additionally, CT is very sensitive and makes it easier to diagnose a system leak. It can identify most cylinder complications and pump malposition and can be extremely helpful to the surgeon in preoperative planning if revision is needed. After this review, the radiologist should be able to identify normal IPP components and their complications.

CT-guided minimally-invasive penile fracture repair

We present the case of a 28 year old patient with an incomplete tear of the tunica albuginea occurred after having sexual intercourse in the female superior position. The diagnostic assessment was performed first clinically, then with CT, owing to its high resolution, allowed to exactly detect the tear location leading to precise preoperative planning. After adequate diagnosis through imaging and proper planning, the patient was performed a selective minimally invasive surgical approach to repair the lesion. The patient had good erection with no angular deformity or plaque formation after a 3-month follow-up.